This communication impairment arises from damage to the right side of the brain. The person may understand much spoken language and appear to have good speech, but there are some aspects of communication that may be difficult for the person with right hemisphere communication impairment. The person may superficially present as being a reasonable communicator but subtle or ‘hidden’ difficulties can disrupt the process of communication.
Not everyone who has right hemisphere brain injury will exhibit communication impairment. However, the person with right hemisphere communication impairment may present with a combination of any of the following difficulties:
- Thinking of the right word to say, sometimes using an incorrect word. Most errors involve using a word related in some way to the target word e.g. ‘dog’ for ‘cat’.
- Speaking too much with poor turn taking.
- Expressive language may lack coherent structure and it may be difficult to work out the specific conversational themes from the person’s speech.
- Non-verbal communication may lack the normal range of emotional expression (i.e. decreased vocal intonation, facial expression and body language).
- Interpreting other people’s vocal intonation and facial expressions – they may struggle to understand non-verbal aspects of communication.
- Understanding and following conversation.
- Understanding metaphor/‘sayings’ (e.g. phrases such as ‘he’s in a black mood’, ‘it’s a skeleton staff’, ‘I’m over the moon’, ‘he’s got butterflies in his stomach’). This type of sentence can be confusing and may sometimes be taken literally.
- Interpreting proverbs (e.g. people in glass houses shouldn’t throw stones).
- Understanding and appreciating word based humour.
- Misinterpretation of sarcasm.
- Understanding verbal inference. Polite ‘hints’ may not be understood e.g. ‘it’s a hot day, I’m thirsty’ will be interpreted by most people as a need for a drink, ‘I have a headache; your music is very loud’ will be interpreted as a request to turn music down. These ‘hints’ may be missed by the person with a right hemisphere communication disorder. In our polite society we use a lot of inference without even being aware of it.
- Recognising faces (prosopagnosia). This causes communication difficulties when the person cannot recognise who is approaching them, are unsure if they know them and whether they should greet them or not. This may make the person appear rude, unfriendly or reserved, which may not be the case.
- Decreased awareness of and insight into their communication difficulties.
- A range of cognitive impairments which may affect communication e.g. attention, memory, reasoning, judgement, impulsivity.
- Visual neglect, the person failing to recognise or respond to visual stimuli on their left side. This may affect reading and writing, but also awareness of people to the left.
How to Help the Person with Right Hemisphere Communication Impairment