Strokes occur in the United States at a rate of one every 40 seconds. Many of those who survive these brain injuries must contend with problems that range from motor function to cognitive, vision, hearing, and communication impairments.
The most diagnosed communication deficit after a stroke is aphasia, which is caused by damage to areas in the brain’s left hemisphere. Understanding and forming words can be difficult or impossible for people with aphasia. But communication is more than just the words we say — it’s also how and when we say them.
The communication skills of understanding, managing, and using language for different contexts, tone, and affect are governed in the right hemisphere of the brain, and these pragmatic communication skills can be impaired when a stroke causes apragmatism.
Jamila Minga, Ph.D., Assistant Professor of Head and Neck Surgery & Communication Sciences, is researching the communication problems that can follow right-hemisphere strokes. She also provides speech-language therapy services to adults with those disorders. Her mission is to help survivors of right-hemisphere stroke return to their jobs, families, and communities with their best possible outcomes.
RHD: Overlooked and Underdiagnosed
People who suffer from right-hemisphere strokes often appear to their acute-care providers to be communicating well, because they have no aphasia — they can understand speech and they can talk fluently. But after these patients leave the hospital, a different story sometimes unfolds.
People who suffer right-hemisphere brain damage (RHD) may develop linguistic apragmatism, meaning that they may find it difficult to understand the tone and context in other people’s speech. They may have trouble saying things that are appropriate for the communication partner and topic of discussion at the appropriate time. They may also have deficits in using non-verbal communication, such as tone of voice, gestures, and facial expressions.
These issues create significant barriers to effective communication; as a result, people with linguistic apragmatism may experience conflict and loss in close relationships, lose their job, or suffer from isolation and loneliness.
Despite these significant challenges in social exchanges, stroke survivors with RHD often don’t receive adequate treatment for communication difficulties. Dr. Minga says that most communication-focused speech-language therapy resources are aimed at addressing impairments that develop after a left hemisphere stroke, such as aphasia.
Increasing Understanding
Dr. Minga’s lab seeks to address this gap in understanding, diagnosis, and treatment of linguistic apragmatism. She’s working on a project to link RHD patients’ communication characteristics with brain imaging, to understand how and when damage to particular areas of the right hemisphere may affect communication.
RHD patients in Dr. Minga’s study are given a battery of linguistic tasks to identify the features of language production that are impaired. Neuroimaging is then used to map the communication behaviors to lesion areas within the right hemisphere.
The data from this investigation are being added to the RHDBank, a national shared database that Dr. Minga co-developed. This database includes a comprehensive demographic profile, cognitive assessment data, and multimedia interactions of patients with RHD that serve as a resource for Dr. Minga and other researchers who want to study language use in people with RHD.
How culture affects communication is an important aspect of this research, says Minga. This is largely because the pragmatic communication deficits that affect patients with RHD are culturally situated. For example, in one study she found that Black women with RHD are less likely to ask questions in clinical settings than their white counterparts.
Identifying patterns of communication deficits is an essential step toward developing effective tools for diagnosing, understanding, and treating communication deficits in people with RHD. Minga believes that her ongoing research will help to discover ways to measure communication deficits after RHD while raising awareness among clinicians of RHD communication deficits in patients of all cultures.
Fostering Awareness and outreach
Dr. Minga is also focused on raising awareness about RHD and its impact on survivors and their loved ones. She recently collaborated with Michael Pearce, a media specialist at North Carolina Central University, to develop a short documentary that explores the experiences of survivors and their loved ones, shedding light on the realities of living with RHD.
The documentary was selected for three film festivals to date: The Long Leaf Film Festival, North Carolina Film Festival, and the Raleigh Film and Arts Festival. She hopes to make her documentary more broadly available through PBS and film festivals.
Through research, clinical work in speech and language therapy, and outreach, Dr. Minga is raising awareness about linguistic apragmatism among researchers, clinicians, stroke survivors, and their loved ones and caregivers. Dr. Minga believes that this full-spectrum approach will help push forward the development of new diagnostic and treatment approaches. And in turn, this work will improve the quality of life of survivors, their loved ones, their caregivers, and our communities.