The Right Hemisphere Language Battery 2nd Edition

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The Right Hemisphere Language Battery2nd Edition

• Karen L. Bryan
• Presented by Stephanie Carambia
• Josh Schneider

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Language Processing in the Right Hemisphere

• Lexical-Semantic Processing
• Complex Language Processing
• Metaphorical Language
• Humor
• Integration of Linguistic Information
• Discourse
• Prosody Stress
• Emotional Language
• Rationale for RHLB these categories are not
  included in left hemisphere aphasia batteries.
  There is need for an assessment that will
  identify the communication deficits in RHD.

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Right Hemisphere Damage (RHD)

• Damage to Right Temporal Region
• Affects memory performance on visually presented
  objects
• Note The subtests in the Right Hemisphere
  Language Battery are not dependent on memory
  skills.

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Adults with RHD

• Characteristics insensitive, pragmatic
  deficiencies, poor insight to limitations,
  literal in their interpretations of messages,
  poor attention skills
• Deficits visual perceptual deficits, unilateral
  neglect, face recognition deficits and
  anosognosia

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Language Deficits Associated with RHD

• Lexical-Semantic Processing
• Studies have shown that RHD individuals have
  difficulty understanding the meaning of
  individual words.
• RHLB RHD patients made significantly more errors
  by choosing the semantic item over the visual or
  phonological items.

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Language Deficits Associated with RHD contd

• Metaphorical Language
• RHD patients show a deficient ability to
  comprehend metaphors
• Believed to be due to a disruption in
  connotative (associated) meaning. They are
  literal in their interpretations.
• RHLB RHD patients made significantly more errors
  by choosing the literal meaning of the metaphor
  over the control items-not a visuospatial
  impairment. RHD patients had difficulty
  understanding true metaphorical meaning and were
  unable to judge if their response was plausible.

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Language Deficits Associated with RHD contd

• Humor
• Studies have shown that RHD patients have
  different responses to humor when compared to LHD
  and normal control groups.
• RHD patients were more likely to choose
  irrelevant endings to jokes.
• Believed to be connected to a deficit in inferred
  meaning.
• RHLB RHD patients made most errors by choosing
  the unrelated and straight forward neutral items.
  Shows insensitivity to the importance of element
  of surprise
• Note Humor is subjective strong influence of
  individual and culture
• May ask patient to tell a funny story,
  considering visuoperceptual abilities can show
  cartoons

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Language Deficits Associated with RHD contd

• Integration of Linguistic Information
• RHD patients are bad judges of plausibility
• Trouble with abstract sentences, logical
  reasoning, coherent stream of thought, tend to
  focus on insignificant details
• RHLB RHD patients had difficulty with all 3
  passages. Most of their errors were based on
  inference. They gave plausible responses that
  were not in accordance with the info in the
  passages.
• Consistent with past research suggesting
  difficulty with complex linguistic information

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Language Deficits associated with RHD contd

• Discourse
• Studies have shown RHD patients have impaired
  production of narrative discourse
• Problem integrating all the necessary components
  for successful speech
• Prosody, inferencing, attention, understanding of
  paralinguistic cues
• RHLB RHD patients had higher error ratings
  compared to controls

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Language Deficits Associated with RHD contd

• Prosody and Stress
• RHD patients have difficulty discriminating and
  identifying intonation that indicates changes in
  emotion
• Cant match emotion to facial expression
• RHLB RHD patients use of prosody impaired
  compared to controls. Difficulty with use of
  emphatic stress.

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Language Deficits Associated with RHD contd

• Emotional Language
• One Theory
• Left hemisphere responsible for positive emotion
• LHD tends to have a depressing affect
• Right hemisphere responsible for negative
  emotion
• RHD tends to have a elated affect (anosognosia)
• Problems with emotional language can be
  contributed to problems with inference.

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Subtests of the Right Hemisphere Language Battery

• Metaphor Picture Test
• Written Metaphor Test
• Comprehension of Inferred Meaning
• Appreciation of Humor
• Lexical Semantic Test
• Production of Emphatic Stress
• Discourse Analysis

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Metaphor Picture Test

• 11 sentences each including a common metaphor
• Psychological-physical metaphor
• An adjective used to described a physical aspect
  of an object is used to convey a psychological
  state
• Example The girl left the scene of the accident
  with a heavy heart.
• Cross-sensory metaphor
• An adjective used to describe one sensory
  modality is used to describe an object associated
  with a different sensory modality.
• Example He must have green fingers, his garden
  is lovely

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Metaphor Picture Test contd

• Four Pictures are presented on 1 plate
• Correct metaphorical meaning
• Literal meaning
• 2 Control pictures
• Each will describe one aspect of the sentence
• Position of the target picture is controlled
  others are randomized

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Written Metaphor Test

• Control for face recognition deficits
• 11 sentences each with including a common
  metaphor
• 3 sentences are printed out on each card
• True metaphorical meaning
• Metaphorical meaning that only targets one aspect
  of the metaphor
• 1 control sentence providing the literal meaning
  of the 2 terms of the metaphor

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Comprehension of Inferred Meaning

• Assess the ability of the patient to comprehend
  inferred meaning
• 3 short paragraphs (52-64 words) are printed out
  on separate cards
• Simple syntactic structures without embedding
• Each paragraphs describes a situation or event

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Appreciation of Humor

• 11 non offensive jokes with clear punch lines
• Each joke is printed out on a card with 4 choices
  for correct punch line
• Actual punch line
• Straight ending of neutral content
• Straight ending of emotional content
• Surprise ending that does not relate to the joke
• Use high frequency terms

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Lexical Semantic Test

• 21 high frequency target nouns selected from a
  range of semantic categories
• Presented in line drawings
• 6 line drawings are included on 1 stimulus card
• The targeted noun (car)
• A functional associate (driver)
• 2 semantically related objects (van, bus)
• A phonological control-rhyming word (bar)
• A visual control (shoe)
• Semantically related items may look similar,
  visual control will show perceptual error not
  linguistic

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Production of Emphatic Stress

• Assessing the use of stress to differentiate new
  information from given information
• 10 sentences Each has two clauses joined by
  either and or but are depicted in 2 line
  drawings
• In the 2nd clause, five sentences have main
  stress on the last word and the other 5 have main
  stress in another position

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Discourse Analysis

• Evaluates 2 way interaction
• Discourse Analysis Rating Scale based on Social
  Interaction Scale used to rate natural
  conversation
• 11 parameters Supportive routines, humor,
  questions and assertive routines, narrative,
  variety, formality, turn taking, meshing,
  discourse comprehension and prosodic ratings
• Ratings made based on spontaneously occurring
  conversation and a recording of the greeting
  between examiner and patient at beginning of
  session
• Picture Description tasks from the Western
  Aphasia Battery or Boston can be used to obtain
  further information on patients structural
  language ability

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Discourse AnalysisScoring

• Recommended jot down initial impression during
  session finalize ratings at end of session
• 0-4 rating scale
• 4 normal conversation
• 0 severely limited performance
• Consider interaction taking place formal
  interview vs. informal discussion
• Additional ratings for eye contact, use of
  gestures, organization of output and completeness
• Rate in relation to normal interaction not
  pathological
• Take into account what subject says and its
  effect on the listener
• Consider the nature of the language difficulties

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Individual Profile

• Brief details of patient
• t scores for each sub test
• Standard deviation
• Recommend using different colored pens
• One form can be used for a number of re-tests
• Easily see patients progress

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Background Research

• Groups of Subjects tested on the Right Hemisphere
  Language Battery
• 30 RHD vascular subjects
• 10 RHD nonvascular subjects
• 30 LHD vascular aphasic subjects
• 10 LHD nonvascular aphasic subjects
• 30 neurologically normal subjects

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Subjects

• Only right handed individuals were selected
• Between the ages of 20-80
• No history of hearing loss
• Only suffered one CVA or neurological episode
• Groups were matched for age, sex, and social
  background
• 18 males 12 females
• Control Group hospital patients with no
  neurological disorder history tested under same
  hospital conditions
• Experimental Subjects tested 1-6 weeks post
  onset retested at 14-20 weeks post onset. 79
  were retested

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Statistics

• RHD and LHD patients were compared to controls
  using ANOVA with multiple comparison Tukey HSD to
  determine significant differences
• RHD patients made significantly more errors than
  the control group on all of the subtests
• RHD patients made significantly more errors than
  LHD patients on all of the subtests with the
  exception of the lexical semantic test
• Paired t tests were used to evaluate differences
  between test and retest results
• RHD patients showed significant differences in
  the lexical semantic test and discourse analysis
• LHD patients showed significant differences in
  comprehension of inferred meaning, lexical
  semantic test, and production of emphatic stress
  test
• Battery believed to be reliable for RHD patients
  and reasonably reliable for LHD patients on some
  of the subtests

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How reliable is the RHLB really?

• Thomson et al. compared RHD patients to a control
  group on the RHLB
• RHD patients and the control group only differed
  significantly on the Discourse Analysis
• Poor performance from both groups in the Metaphor
  Picture, Inference and Humor tests.
• Control group thought the the Inference and
  Humor tests were the least straightforward
• Jokes werent funny
• Thought surprise punch lines more humorous
• Humor impossible to test due to cultural and
  individual preferences
• Illustrations in the Metaphor Picture and Lexical
  Semantic Test were misleading not difficult
• Inference test too long and too much
  information difficult to understand what the
  questions was referring to. Described as memory
  test.
• Discourse Analysis subjective judgment, less
  reliable
• RHD patients appeared with abnormal communication
  skills achieved normal results on the RHLB
• Brain tumor patients outperformed stroke
  patients RHLB validated for vascular patients

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Other Uses for the RHLB

• Gunter et al. used the test to compare NLD
  individuals (nonverbal learning disabilities
  syndrome) to Aspergers Syndrome
• Tested on metaphor-picturing matching, written
  metaphor choice, inferred meaning comprehension
  and humor appreciation.
• Only significant difference AS showed poor humor
  appreciation
• Researchers Hypothesis NLD is due to a
  dysfunction of the white matter in the right
  hemisphere. Aspergers Syndrome may also be
  associated with right hemisphere dysfunction

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Bibliography

• Brookshire, R.H. (2002). Introduction to
  Neurogenic Communication Disorders. (6th
  Edition). Elsevier Science London
• Bryan, K.L. (1995). The Right Hemisphere
  Language Battery, Second Edition. Whurr
  Publishers Ltd London
• Gunter, H.L., Ghaziuddin, M., Ellis, H.D.
  (2002). Asperger Syndrome Tests of Right
  Hemisphere Functioning and Interhemispheric
  Communication. Journal of Autism and
  Developmental Disorders, Volume 32, 4. pgs
  263-281.
• LaPointe, L.L. (Ed.) (2004). Aphasia and
  Related Neurogenic Language Disorders (3rd
  Edition). Thieme Medical Publishers New York
• Thomson, A, Taylor, R., Fraser, D. and Whittle,
  I.R. (1997) The utility of the Right Hemisphere
  Language Battery in Patients with Brain Tumors.
  European Journal of Disorders of Communication,
  32, pgs 325-332.