Training Metaphor Interpretation in RHD Patients: Preliminary Results

Five stroke patients with right hemisphere brain damage (RHD) participated in a single subject experimental design intervention study to train metaphor comprehension. The theory motivating the program posits roles for coarse-grained semantic knowledge and working memory. Four patients showed clear improvement in metaphor interpretation associated with the start of training. Results indicate the potential of an evidence-based approach for treating deficits associated with RHD. The paper will describe the training program and discuss individual performances on metaphor, line orientation, working memory and other background measures

Perception of Nonverbal Cues After Right Brain Damage

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Improved Language in a Chronic Nonfluent Aphasia Patient After Treatment With CPAP and TMS

Objective: To present pretreatment and post-treatment language data for a nonfluent aphasia patient who received 2 treatment modalities: (1) continuous positive airway pressure (CPAP) for his sleep apnea, starting 1-year poststroke; and (2) repetitive transcranial magnetic brain stimulation (TMS), starting 2 years poststroke. Background: Language data were acquired beyond the spontaneous recovery period of 3 to 6 months poststroke onset. CPAP restores adequate oxygen flow throughout all stages of sleep, and may improve cognition. A series of slow, 1 Hz repetitive TMS treatments to suppress a posterior portion of right pars triangularis has been shown to improve phrase length and naming in chronic nonfluent aphasia. Method: The Boston Diagnostic Aphasia Examination and Boston Naming Test were administered pre-CPAP, and after 2 to 5 months of CPAP. These same tests were administered pre-TMS, and at 3 and 6 months post-TMS, and again 2.4 years later. Results: Post-CPAP testing showed increased Phrase Length, Auditory Comprehension, and naming Animals and Tools/Implements (Boston Diagnostic Aphasia Examination). Testing at 3 and 6 months post-TMS showed significant increase in Phrase Length, Auditory Comprehension, and Boston Naming Test compared with pre-TMS. These gains were retained at 2.4 years post-TMS. CPAP use continued throughout.Conclusions: Physiologic treatment interventions may promote language recovery in chronic aphasia

Treatment of Metaphor Interpretation Deficits Subsequent to Traumatic Brain Injury

Objective: To improve oral interpretation of metaphors by patients with traumatic brain injury (TBI).Design: Both single subject experimental design and group analysis.Setting: Patients’ homes.Participants: Eight adult patients with moderate to severe traumatic brain injury sustained 3 to 20 years before testing.Intervention: The Metaphor Training Program consisted typically of 10 baseline sessions, 3 to 9 1-hour sessions of structured intervention, and 10 posttraining baseline sessions. Training used extensive practice with simple graphic displays to illustrate semantic associations.Main Outcome Measures: Quality of orally produced metaphor interpretation and accuracy of line orientation judgments served as dependent measures obtained during baseline, training, posttraining, and at a 3- to 4-month follow-up. Untrained line orientation judgments provided a control measure.Results: Group data showed significant improvement in metaphor interpretation but not in line orientation. Six of 8 patients individually demonstrated significant improvement in metaphor interpretation. Gains persisted for 3 of the 6 patients at the 3- to 4-month follow-up.Conclusion: The Metaphor Training Program can improve cognitive-communication performance for individuals with moderate to severe traumatic brain injury. Results support the potential for treating patients’ residual cognitive-linguistic deficits

Assessing quality of metaphor interpretation by right hemisphere damaged patients

Patients with right hemisphere damage (RHD) can display various cognitive-linguistic deficits including disrupted comprehension of figurative language such as metaphor (Myers, 1999 and Tompkins, 1995). Most studies documenting figurative language comprehension difficulties have used multiple choice tasks (Van Lancker & Kempler, 1987). Multiple choice formats are generally easier than open-ended verbal explanation formats and, therefore, may be less sensitive and, accordingly, less adequate for documenting clinically relevant changes in the quality of comprehension over time. However, scoring a patient’s extended verbal responses can be subjective. Also, there is uncertainty whether the resulting scores provide only ordinal information or approach interval level measurement, which makes statistical analysis easier. Although scales have been developed for scoring proverb interpretation (Gorham, 1956 and Nippold et al., 1997), we are not aware of a scoring system for representing the quality of metaphor interpretations

A metaphor comprehension intervention for patients with right hemisphere brain damage: A pilot study

This intervention program addresses an important need in the clinical literature: tools for remediation of communication deficits associated with right hemisphere brain damage (RHD). Our program is motivated by the literature documenting non aphasic communication deficits, including deficits in metaphor comprehension, subsequent to RHD (Joanette et al., 1990, Myers, 1999 and Tompkins, 1995). The intervention is based on two themes. One is that RHD, particularly in posterior regions, limits a patient’s ability to process “coarse grained” semantic information such as, for example, weak or connotative associations between words (Beeman, 1998). A second notion is that lesion in frontal regions (in either hemisphere) can affect working memory and thereby curtail a patient’s ability to review information and to select the most relevant alternative from a set (e.g., Tompkins, Bloise, Timko, & Baumgaertner, 1994). For example, the concepts “family” and “cradle” each give rise to several associations, as illustrated in the figure below. The metaphor “a family is a cradle” works if a listener can generate a broad range of associations to each concept and, then, can identify appropriate shared associations, such as safety and comfort

Treating metaphor interpretation deficits subsequent to right hemisphere brain damage: Preliminary results

Aims: This investigation sought to determine whether a structured intervention focused on improving use of semantic associations could improve patients' ability to provide oral interpretations of metaphors following right hemisphere damage (RHD).Methods & Procedures: Principles of single participant experimental design provided the basis for the study. Five patients received either 10 or 20 baseline assessments of oral metaphor interpretation and, as a control, assessments of line orientation skill. They then received approximately 10 one-hour sessions of structured intervention to improve oral metaphor interpretation followed by post-training assessments and a 3-month follow up.Outcomes & Results: Patients' performances revealed evidence of good response to training as shown by patients' ability to reach criterion on all intervention tasks and by their significant improvement on oral metaphor interpretation. There was relatively little improvement on the line orientation task.Conclusions: The results of this study support the clinical usefulness of this new approach to treating communication deficits associated with RHD due to stroke, even years post-onset. There are, however, questions that remain unanswered. For example, additional data will be needed to gauge how a patient's severity of impairment relates to the potential for improvement, to chart the durability and scope of improvement associated with the training, and to determine the type of visuospatial ability needed for using this type of pictorial material

Selective Training of Theory of Mind in Traumatic Brain Injury: A Series of Single Subject Training Studies

Primary Objective:To examine the potential for treating deficits in Theory of Mind (ToM), i.e., using a person’s beliefs to understand and predict behaviour, and to test the hypothesis that improvements in ToM can be distinguished from performance in other domains such as judging line orientation and executive function.Materials and Methodology:In Study 1, two individuals with TBI participated in a protocol targeting ToM, which was assessed using a cartoon interpretation task. Participants also performed on a short form of the Benton Judgment of Line Orientation Task as a control. In Study 2, a third person with TBI participated in Attention Process Training (APT-1) followed by the ToM protocol. Executive function was assessed using the Paced Auditory Serial Addition Task (PASAT).Results:In Study 1, ToM performance but not judgments of line orientation responded to the ToM training. In Study 2, executive function, but not ToM, showed strong improvement with APT-1. In contrast, ToM but not executive function showed significant improvement with ToM training.Conclusion:ToM is a good candidate for intervention. For three persons with TBI, ToM performance showed selective improvement associated with ToM treatment, which suggests a practical as well as theoretical value for distinguishing ToM from executive function

Play in Children with Prenatal Cocaine Exposure: Development and Implications for Assessment

Play assessment of children with prenatal cocaine exposure is discussed in terms of the developmental play level and behaviors manifest during spontaneous play and the clinical implications for assessing such children. Studies have found a number of subtle differences in the play skills of children with prenatal cocaine exposure compared to children with no cocaine exposure, however, sensitive outcome measures are needed to capture these subtle developmental differences. Suggestions for assessing play, an early developmental skill, using multidimensional play analyses that incorporate developmental play levels and associated play behaviors, such as initiation and perseveration are discussed