Apragmatism: The renewal of a label for communication disorders associated with right hemisphere brain damage

• Published in: International journal of language & communication disorders 2023-03, Vol.58 (2), p.651-666
• Main Authors: Minga, Jamila, Sheppard, Shannon M., Johnson, Melissa, Hewetson, Ronelle, Cornwell, Petrea, Blake, Margaret Lehman
• Format: Article
• Language: English
• Subjects: Adult; Brain; Brain damage; Brain Hemisphere Functions; Clinical Diagnosis; Cognitive impairment; cognitive–communication; Collaboration; Communication; Communication Disorders; Communication Disorders - diagnosis; Communication Disorders - etiology; Communication Disorders - rehabilitation; Concept Mapping; Definitions; discourse; Families & family life; Gestures; Humans; Labeling (of Persons); Language Disorders; linguistic/language disorders; Linguistics; Neurological Impairments; Paralinguistics; Patients; Pragmatics; Prosody; Rehabilitation; right hemisphere brain damage; Speech Language Pathology; Speech-language pathologists; Stroke; Stroke - complications
• ISSN: 1368-2822; 1460-6984; 1460-6984
• DOI: 10.1111/1460-6984.12807

Background Right hemisphere communication disorders are neither consistently labelled nor adequately defined. Labels associated with right hemisphere brain damage (RHD) are broad and fail to capture the essence of communication challenges needed for stroke‐related service provisions. Determination of rehabilitation needs and best‐practice guidelines for the education, management and functional improvement of communication disorders after RHD are all predicated on an apt diagnostic label and disorder characteristics. Aims In this paper apragmatism is proposed as a potential communication‐specific diagnostic label for the impairments in communication that occur after RHD. In particular, the researchers aimed: (1) to establish an operational definition of apragmatism; and (2) to describe the linguistic, paralinguistic and extralinguistic communication deficits under the umbrella term apragmatism. Methods & Procedures An international collaborative of researchers with expertise in RHD followed a multilevel approach to consider the utility of apragmatism as a diagnostic label. Adopting the relational approach to concept mapping, the researchers engaged in a series of group meetings to complete four levels of mapping: (1) identify and review, (2) define, (3) expert discussion and (4) label determination. Main Contribution Apragmatism was established as a suitable diagnostic label for the impairments in communication associated with RHD. The paper offers an operational definition and description of the linguistic, paralinguistic and extralinguistic features of apragmatism through evidence summaries and examples from people with RHD retrieved from the RHDBank. Conclusions & Implications The adoption of the term apragmatism offers an opportunity to capture the hallmark of RHD communication deficits. The use of the term is recommended when referencing the pragmatic language impairments in this population. Apragmatism, which may co‐occur with or be exacerbated by cognitive impairments, can interfere with the ability to interpret and convey intended meaning and impact the lives of right hemisphere stroke survivors and their families. What this paper adds What is already known on the subject RHD results in a heterogeneous group of deficits that range in cognitive–communicative complexity. Many of the deficits are subsumed under pragmatics. For example, adults with RHD may demonstrate tangential or verbose communication, insensitivity to others’ needs and feelings, pros