How is right hemisphere communication disorder disabling? Evidence from response mobilizing actions in conversation

Abstract

Aim

Assessment and intervention strategies for communication disorders caused by right hemisphere stroke are at an early stage of development. There is also little evidence on how right hemisphere communication disorder is disabling for everyday life. This study explores how a woman with conversational problems following right hemisphere stroke participated in everyday conversation with family members.

Method

One hour of triadic conversation was recorded and analyzed using the descriptive qualitative methodology of conversation analysis. It focused on attempts by the woman with right hemisphere stroke to direct conversation with “response mobilizing” communicative acts, i.e., communicative acts that set out clear expectations about who should speak, and how they should respond.

Results

Seventy-eight communicative acts produced by the woman with right hemisphere communication disorder were divided into five groupings based on how her conversation partners addressed them. Around half of her response mobilizing communicative acts received unsupportive responses from her conversation partners, including minimal acknowledgements, explicit rejections, and ignoring responses.

Conclusion

The findings of this study provide novel insight into the ways that right hemisphere communication disorder affects routine communication, and the nature of the disability it causes. This information will support the future development of evidence-based speech pathology assessment and intervention for right hemisphere stroke.

IMPLICATIONS FOR REHABILITATION

• Right hemisphere stroke can have complex implications for communication, but little is known about how they manifest in daily life.

• Familiar communication partners may deal with troublesome communicative acts in conversation by preventing them from developing, which may be useful information for speech pathology assessment.

• Speech pathologists should consider sampling everyday conversation because it can provide insight into the ways that communication disorders caused by right hemisphere stroke restrict participation in daily life.

Keywords:

• Communication disabilities
• neurogenic communication disorders
• speech pathology
• Social participation
• cerebrovascular stroke

Acknowledgements

The authors wish to thank the participants for their time and generosity.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Hewetson et al. use the term “cognitive-communication disorder” to indicate changes to communicative functioning caused by right hemisphere stroke. The most apt label for this population has been a source of (unresolved) debate [15]. Cognitive-communication disorder is likely the most commonly used label in clinical practice. It has also been applied to a variety of qualitatively different populations within the range of speech pathology practice; particularly, traumatic brain injury, right hemisphere damage, and dementia. We prefer the label “right hemisphere communication disorder” because it is population specific, descriptive, and somewhat more transparent.

2 Approximately 4 minutes of the recording were not transcribed. These untranscribed segments included around 1 minute of interaction with the researcher at the beginning and ending of the recording, and around 3 minutes in which Daisy received a phone call.

3 Random selection was completed using the random number function in Microsoft Excel. A list of response mobilizing action was assigned random numbers, and then sorted based on these numbers. This first four actions from each group were included in the reliability check.

4 Although we have termed them “unsupportive responses”, Daisy and Federico’s conduct in instances assigned to the No Response grouping is designedly unresponsive. That is, they provided no evidence of vocal or embodied orientation to Erin’s first position action, or explicitly and wholly rejected the action altogether. So, “unsupportive responses” is something of a misnomer. That said, not responding is also a type of controlled behaviour, and thus is a “responsive choice” of sorts. For this reason (and for reasons of parsimony) we have elected keep the No Response grouping under this heading. See Blythe [39] for further discussion on this point.

5 Tim is in hospitality, and he hosted Erin and Federico at an establishment he runs.

6 Immediately following Extract 2, Erin mentions the analogous experience of her other daughter (i.e., Daisy’s sister), which both Daisy and Federico collaborate in developing.

7 Erin’s first position actions at 11 and 26–27 were both included in the No Response grouping.

8 This is perhaps encouraged by the segmented nature of his turn, with the first part (i.e., I wouldn’t take it) potentially hearable as non-hypothetical answer.

9 In subsequent talk, Federico alludes to the fact they are being recorded when Daisy asks why he does not want to mention people. He is also discouraging of various other “racy” topics that arise over the course the conversation.

10 It should be noted that first position actions like this are an important source of evidence for developing a clearer account of the conversational symptoms of right hemisphere communication disorder (see Barnes et al. [22] and Barnes [42] on this point). A separate study addressing this topic with the present data is currently in progress. For now, however, using table 4, we can observe that the extreme epistemic stances encoded by questions and K- assertions (i.e., a strongly unknowing stance) and K + assertions (i.e., a strongly knowing stance) are fairly evenly distributed between the Typical/Delayed and Disaligning/No Response groupings.

11 Only one of Erin’s 78 first position actions was met with other-initiation of repair.

12 For instance, there is diversity in the “K + assertion” category, which includes both assessments and fact-oriented assertions, and some of which are initiating novel topics and courses of action. Again, interested readers are encouraged to explore the complete dataset at https://osf.io/bmrz6/.

Additional information

Funding

This research was funded by a Macquarie University Research Development Grant [5201700298].