Communication in conversation in stroke patients

Abstract

In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe verbal pragmatic difficulties. Frontal stroke also resulted in evident verbal and non-verbal disorders.

Language processing in right hemisphere stroke patients: Response speed and quality

“…From this perspective it is possible that a brain injury will exacerbate the language changes that can occur in normal ageing, and it is therefore fundamental not to lose a sense of what is considered as normal performance so that any deficits can be correctly determined. Recently Rousseaux, Daveluy, and Kalowski (2010) found reduced participation in communicate and pragmatic difficulties in right cortico-sub-cortical patients compared with a control group of similar age, gender and educational level.…”

A neuropsychological perspective on the link between language and praxis in modern humans

“…For some authors, gestural and verbal expressions are both impaired, owing to a common deficit in communication [125,126]. Other studies claim that gestural expression is less impaired than language, or even that it is more developed than in healthy individuals, perhaps as a result of compensation [46,127]. The neural bases of expressive gestures in healthy individuals have attracted much attention in recent years [128].…”

“…naturalistic multi-step actions [137]) or language (e.g. pragmatic communication [46]) seem to be supported by both hemispheres, or even to be lateralized to the right hemisphere (e.g. matching of finger postures [138] or prosodic processing [44]).…”

“…Prosody refers to the voice modulation that accompanies different emotional content or intention, and is classically attributed to the right hemisphere [44,45]. Finally, the pragmatic aspect of language refers to the complex combinations of symbols used to transmit complex ideas and includes many other cognitive functions, supported by both hemispheres [46].…”

The relationship between co-speech gesture production and macrolinguistic discourse abilities in people with focal brain injury

“…Blonder et al, 1995; Göksun et al, 2015; Göksun, Lehet, Malykhina, & Chatterjee, 2013; Hadar, Burstein, Krauss, & Soroker, 1998; Hogrefe et al, 2016; Rousseaux, Daveluy, & Kozlowski, 2010). These studies have not settled uncertainties about relative importance of each hemisphere in co-speech gesture production.…”