Communication difficulties following right hemisphere stroke: applying evidence to clinical management

Following reports in the 1960s that language may be affected by right hemisphere (RH) lesions, many limitations to effective communication in the right hemisphere damaged (RHD) population have been described and evidenced. However, stereotypical portrayals and descriptions of carefully selected cases may be misleading as to the extent of communication deficits. In many of the parameters in which RHD patients are presented as typically impaired, e.g. discourse skills, a less severe picture may emerge where data from the non-brain damaged (NBD) population are considered, with age and education variables controlled. Subsequent to RHD, some people show deficit on some communication measures, but many of these communication behaviours are also present in some NBD adults. Thus diagnosis of deficit must be made with reference both to the healthy peer population and the individual’s pre-lesion behaviour. The authors’ right RH stroke research programme includes studies of incidence of communication deficit, comparisons of RHD and NBD groups in various spoken discourse and comprehension tasks, comparison of RHD groups of different ages, detailed analysis of topic within discourse in RHD and NBD groups, family members’ views of communication behaviour following RHD, and the natural course of communication change during the first year after RH stroke. The findings from several studies are summarised and used as the basis for management recommendations, which may guide future outcome research. There is an urgent need for the evaluation of communication management programmes, to determine whether therapists may with confidence offer an effective intervention service to those people whose communication skills are affected by RHD.