Pragmatic and executive functions in traumatic brain injury and right brain damage: An exploratory comparative study

Zimmermann, Nicolle; Gindri, Gigiane; Oliveira, Camila Rosa de; Fonseca, Rochele Paz

doi:10.1590/S1980-57642011DN05040013

Abstract

Objective:

To describe the frequency of pragmatic and executive deficits in right brain damaged (RBD) and in traumatic brain injury (TBI) patients, and to verify possible dissociations between pragmatic and executive functions in these two groups.

Methods:

The sample comprised 7 cases of TBI and 7 cases of RBD. All participants were assessed by means of tasks from the Montreal Communication Evaluation Battery and executive functions tests including the Trail Making Test, Hayling Test, Wisconsin Card Sorting Test, semantic and phonemic verbal fluency tasks, and working memory tasks from the Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN. Z-score was calculated and a descriptive analysis of frequency of deficits (Z< -1.5) was carried out.

Results:

RBD patients presented with deficits predominantly on conversational and narrative discursive tasks, while TBI patients showed a wider spread pattern of pragmatic deficits. Regarding EF, RBD deficits included predominantly working memory and verbal initiation impairment. On the other hand, TBI individuals again exhibited a general profile of executive dysfunction, affecting mainly working memory, initiation, inhibition, planning and switching. Pragmatic and executive deficits were generally associated upon comparisons of RBD patients and TBI cases, except for two simple dissociations: two post-TBI cases showed executive deficits in the absence of pragmatic deficits.

Discussion:

Pragmatic and executive deficits can be very frequent following TBI or vascular RBD. There seems to be an association between these abilities, indicating that although they can co-occur, a cause-consequence relationship cannot be the only hypothesis.

Key words:
brain injuries; stroke; executive function; communication disorders.

Resumo

Objetivo:

Descrever a frequência de déficits pragmáticos e executivos em pacientes com lesão de hemisfério direito (LHD) e com traumatismo cranioencefálico (TCE), e verificar se existem dissociações entre pragmática e funções executivas nesses dois grupos.

Métodos:

A amostra foi composta de 7 casos de TCE e 7 casos de LHD. Todos os participantes foram avaliados por tarefas da Bateria Montreal de Avaliação da Comunicação e com testes de funções executivas como o Trail Making Test, Teste Hayling, Wisconsin Card Sorting Test, tarefas de fluência verbal semântica, fonêmica e livre, tarefas de memória de trabalho do Instrumento de Avaliação Neuropsicológica Breve NEUPSILIN. O escore Z foi calculado e a freqüência de déficits (Z< -1.5) foi descrita.

Resultados:

Os pacientes com LHD apresentaram déficits principalmente no discurso conversacional e narrativo, por enquanto que os pacientes com TCE demonstraram um padrão mais difuso de déficits pragmáticos. Quanto as FE, os déficits dos pacientes com LHD foram de memória de trabalho e iniciativa verbal, principalmente. Por outro lado, os pacientes com TCE apresentaram novamente um padrão mais geral de disfunção executiva, com prejuízos principalmente de memória de trabalho, iniciativa, inibição, planejamento e switching. Em geral, os déficits pragmáticos e executivos foram associados comparando os pacientes com LHD e com TCE, exceto por duas dissociações simples: dois casos de TCE demonstraram déficits executivos com ausência de déficits pragmáticos.

Discussão:

Os déficits pragmáticos e executivos podem ser muito frequentes após um TCE ou uma LHD. Parece haver uma associação entre essas habilidades, ressaltando-se que apesar de elas poderem co-ocorrer, uma relação de causa-consequência não parece ser a única hipótese.

Palavras-chave:
traumatismo cranioencefálico; acidente vascular cerebral; funções executivas; comunicação.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

Champagne M, Joanette Y. Lack of inhibition could contribute to non-literal language impairments in right-hemisphere-damaged individuals. Brain Lang 2004;91:172-174.
Munõz-Céspedes JM, Tobal JJM, Vindel AC. Evaluación de las alteraciones emocionales en personas con traumatismo craneoencefálico. Psicothema 2000;12:99-106.
Zaidel E, Kasher A, Soroker N, Batori G. Effects of right and left hemisphere damage on performance of the "right hemisphere communication battery". Brain Lang 2002;80:510-535.
Ylvisaker M, Holland, A. Coaching, self-coaching, and rehabilitation of head injury. In: Johns D, Editor. Clinical Management of Neurogenic Communication Disorders. (2nd ed.). Little Brown & Co; 1985;243-257.
Ferré P, Ska B, Lajoie C, Bleau A, Joanette Y. Clinical focus on prosodic, discursive and pragmatic treatment for right hemisphere damaged adults: what's right? Rehab Res Pract 2011;1:1-10.
Dardier V, Bernicot J, Delanöe A, et al. Severe traumatic brain injury, frontal lesions, and social aspects of language use: A study of French-speaking adults. J Comm Disord 2011;44:359-378.
Youse KM, Coelho CA. Working memory and discourse production abilities following closed-head injury. Brain Inj 2005;19:1001-1009.
Sabbagh MA. Communicative intentions and language: evidence from right-hemisphere damage and autism. Brain Lang 1999;70:29-69.
Angeleri R, Bosco FM, Zettin M, Sacco K, Colle L, Bara BG. Communicative impairment in traumatic brain injury: A complete pragmatic assessment. Brain Lang 2008;107:229-245.
Miotto EC, Cinalli FZ, Serrao VT, Benute GG, Lucia MCS, Scaff M. Cognitive deficits in patients with mild to moderate traumatic brain injury. Arq Neuropsiquiatr 2010;68:862-868.
McDonald S. Exploring the cognitive basis of right-hemisphere pragmatic language disorders. Brain Lang 2000;75:82-107
Fonseca RP, Salles JF, Parente MAMP. Development and content validity of the brazilian brief neuropsychological assessment battery Neupsilin. Psych Neurosci 2008;1:55-62.
Fonseca RP, Salles JF, Parente MAMP. Instrumento de Avaliação Neuropsicológica Breve NEUPSILIN. Vetor Editora; 2009.
Hibbard MR, Uysal S, Sliwinski M, Gordon W. Undiagnosed health issues in individuals with TBI living in the community. J Head Trauma Rehab 1998;13:47-57.
Taylor LA, Kreutzer JS, Demm SR, Meade MA. ‚Traumatic brain injury and substance abuse: A review and analysis of the literature'. Neuropsych Rehab 2003;13:165-188.
Sacks AL, Fenske CL, Gordon WA, et al. Co-morbidity of substance abuse and traumatic brain injury. J Dual Diagn 2009;5:404-417.
Silver JM, Kramer R, Greenwald S, Weissman M. The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Inj 2001;15:935-945.
Fonseca RP, Parente MAMP, Côté H, Ska B, Joanette Y. Bateria Montreal de Avaliação da Comunicação - Bateria MAC; Rio Grande do Sul: Pró-Fono; 2009.
Joanette Y, Ska B, Cote H. Protocole Montréal d'Evaluation de la Communication MEC. Montreal, Ortho Editions; 2004.
Fonseca RP, Parente MAMP, Côté H, Joanette Y. Processo de adaptação da bateria Montreal de avaliação da comunicação: bateria MAC - ao português brasileiro. Psicol Reflex Crit 2007;20:259-267.
Reitan RM, Wolfson D. The Halstead-Reitan Neuropsychology Battery: Theory and Clinical Interpretation. Tucson AZ, Neuropsychology Press. - (1995): "Category test and trail making test as measures of frontal lobe functions". Clin Neuropsychol 1993;9:50-56.
Fonseca RP, Grassi-Oliveira R, Oliveira CR, Gindri G, Zimmermann N, Trentini C, Kristensen CH, Parente MAMP. Instruments of EF assessment: preliminary normative data and sociodemographic studies. Unpublished manuscript.
Burguess PW, Shallice T. The Hayling and Brixton Tests. Thames Valley Test Company; 1997.
Fonseca RP, Oliveira CR, Gindri G, Zimmermann N, Reppold CT, Parente MAMP. Teste Hayling: um instrumento de avaliação de componentes das funções executivas. In: Hutz C, Org. Avaliação Psicológica e Neuropsicológica de crianças e adolescentes. 2010;1:337-364.
Nelson HE. A modified card sorting test sensitive to frontal lobe defects. Cortex 1976;12:313-324.
Kavé G, Heled E, Vakil E, Agranov E. Which verbal fluency measure is most useful in demonstrating executive deficits after traumatic brain injury? J Clin Exp Neuropsychol 2010; 33:1-8.
Ferre P, Clermont MF, Lajoie C, et al. Identification de profils communicationnels parmi les individus cérébrolésés droits : Profils transculturels. Neuropsicol Latinoamer 2009;1:32-40.
Benton E, Bryan K. Right cerebral hemisphere damage: incidence of language problems. Int J Rehabil Res 1996;19:47-54.
Côté H, Payer M, Giroux F, Joanette Y. Towards a description of clinical communication impairment profiles following right-hemisphere damage. Aphasiol 2007;21:739-749.
Rogalski Y, Altmann LJP, Plummer-D'Amato P, Behrman AL, Marsiske M. Discourse coherence and cognition after stroke: A dual task study. J Communic Dis 2010;43:212-224.
Johns CL, Tooley KM, Traxler MJ. Discourse impairments following right hemisphere brain damage: a critical review. Lang Ling Comp 2008;1038-1062.
Rousseaux M, Daveluy W, Kozlowski O. Communication in conversation in stroke patients. J Neurol 2010;257:1099-1107.
Channon S, Watts M. Pragmatic language interpretation after closed head injury: Relationship to executive functioning. Cogn Neuropsychiatry 2003;8:243-260.
Ferstl EC, Walther K, Guthke T, von Cramon, DY. Assessment of story comprehension deficits after brain damage. J Clin Exp Neuropsychol 2005;27:367-384.
Yang FG, Fuller J, Khodaparast, N, Krawczyk DC. Figurative language processing after traumatic brain injury in adults: A preliminary study. Neuropsychol 2010;48:1923-1929.
Blake ML. Perspectives on treatment for communication deficits associated with right hemisphere brain damage. Am J Speech Lang Pathol 2007;16:331-342.
Martin I, McDonald S. Weak coherence, no theory of mind, or executive dysfunction? Solving the puzzle of pragmatic language disorders. Brain Lang 2003;85:451-466.
Samson D, Connoly C, Humphreys GW. When "happy" means "sad": Neuropsychol ogical evidence for the right prefrontal cortex contribution to executive semantic processing. Neuropsychologia 2007;45:896-904.
Gindri G, Zibetti MR, Fonseca RP. Funções executivas pós-lesão de hemisfério direito: estudo comparativo e freqüência de déficits. Rev Psico(PUCRS) 2009;39:282-291.
Champagne-Lavau M, Joanette Y. Pragmatics, theory of mind and EF after a right-hemisphere lesion: Different patterns of deﬁcits. J Neuroling 2009;22:413-426.
Wager TD, Smith EE. Neuroimaging studies of working memory: A meta-analysis. Cogn Affect Behav Neurosci 2003;3: 255-274.
Anderson TM, Knight RG. The long-term effects of traumatic brain injury on the coordinative function of the central executive. J Clin Exp Neuropsychol 2010;iFirst:1-9.
Henry JD, Crawford JR. A meta-analytic review of verbal fluency performance following traumatic brain injury. Neuropsychologia 2004;18:621-628.
Douglas JM. Relationship of executive functioning to pragmatic outcome following severe traumatic brain injury. J Speech Lang Hear Res 2010;53:365-382.
Moran C, Gillon G. Inference comprehension of adolescents with traumatic brain injury: A working memory hypothesis. Brain Inj 2005;19:743-751.
Muñoz-Cépedes JM, Melle N. Alteraciones de la pragmática de la comunicación después de un traumatismo craneoencefálico. Rev Neurol 2004;38:856-859.
Sacks AL, Fenske CL, Gordon WA et al. Co-morbidity of substance abuse and traumatic brain injury. Journal of Dual Diagnosis 2009;5:404-417.
Silver JM, Kramer R, Greenwald S, Weissman M. The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Injury 2001;5:935 945.
Barlow DH, Nock MK. Why can't we be more idiographic in our research? Perspectives on Psychological Science 2009;4: 19-21.
Barbarulo AM, Pappatà S, Puoti G et al. Rehabilitation of gesture imitation: A case study with fMRI. Neurocase 2008;14: 293-306.

Publication Dates

Publication in this collection
Oct-Dec 2011

History

Received
20 Sept 2011
Accepted
20 Nov 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Champagne M, Joanette Y. Lack of inhibition could contribute to non-literal language impairments in right-hemisphere-damaged individuals. Brain Lang 2004;91:172-174.

[2] Munõz-Céspedes JM, Tobal JJM, Vindel AC. Evaluación de las alteraciones emocionales en personas con traumatismo craneoencefálico. Psicothema 2000;12:99-106.

[3] Zaidel E, Kasher A, Soroker N, Batori G. Effects of right and left hemisphere damage on performance of the "right hemisphere communication battery". Brain Lang 2002;80:510-535.

[4] Ylvisaker M, Holland, A. Coaching, self-coaching, and rehabilitation of head injury. In: Johns D, Editor. Clinical Management of Neurogenic Communication Disorders. (2nd ed.). Little Brown & Co; 1985;243-257.

[5] Ferré P, Ska B, Lajoie C, Bleau A, Joanette Y. Clinical focus on prosodic, discursive and pragmatic treatment for right hemisphere damaged adults: what's right? Rehab Res Pract 2011;1:1-10.

[6] Dardier V, Bernicot J, Delanöe A, et al. Severe traumatic brain injury, frontal lesions, and social aspects of language use: A study of French-speaking adults. J Comm Disord 2011;44:359-378.

[7] Youse KM, Coelho CA. Working memory and discourse production abilities following closed-head injury. Brain Inj 2005;19:1001-1009.

[8] Sabbagh MA. Communicative intentions and language: evidence from right-hemisphere damage and autism. Brain Lang 1999;70:29-69.

[9] Angeleri R, Bosco FM, Zettin M, Sacco K, Colle L, Bara BG. Communicative impairment in traumatic brain injury: A complete pragmatic assessment. Brain Lang 2008;107:229-245.

[10] Miotto EC, Cinalli FZ, Serrao VT, Benute GG, Lucia MCS, Scaff M. Cognitive deficits in patients with mild to moderate traumatic brain injury. Arq Neuropsiquiatr 2010;68:862-868.

[11] McDonald S. Exploring the cognitive basis of right-hemisphere pragmatic language disorders. Brain Lang 2000;75:82-107

[12] Fonseca RP, Salles JF, Parente MAMP. Development and content validity of the brazilian brief neuropsychological assessment battery Neupsilin. Psych Neurosci 2008;1:55-62.

[13] Fonseca RP, Salles JF, Parente MAMP. Instrumento de Avaliação Neuropsicológica Breve NEUPSILIN. Vetor Editora; 2009.

[14] Hibbard MR, Uysal S, Sliwinski M, Gordon W. Undiagnosed health issues in individuals with TBI living in the community. J Head Trauma Rehab 1998;13:47-57.

[15] Taylor LA, Kreutzer JS, Demm SR, Meade MA. ‚Traumatic brain injury and substance abuse: A review and analysis of the literature'. Neuropsych Rehab 2003;13:165-188.

[16] Sacks AL, Fenske CL, Gordon WA, et al. Co-morbidity of substance abuse and traumatic brain injury. J Dual Diagn 2009;5:404-417.

[17] Silver JM, Kramer R, Greenwald S, Weissman M. The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Inj 2001;15:935-945.

[18] Fonseca RP, Parente MAMP, Côté H, Ska B, Joanette Y. Bateria Montreal de Avaliação da Comunicação - Bateria MAC; Rio Grande do Sul: Pró-Fono; 2009.

[19] Joanette Y, Ska B, Cote H. Protocole Montréal d'Evaluation de la Communication MEC. Montreal, Ortho Editions; 2004.

[20] Fonseca RP, Parente MAMP, Côté H, Joanette Y. Processo de adaptação da bateria Montreal de avaliação da comunicação: bateria MAC - ao português brasileiro. Psicol Reflex Crit 2007;20:259-267.

[21] Reitan RM, Wolfson D. The Halstead-Reitan Neuropsychology Battery: Theory and Clinical Interpretation. Tucson AZ, Neuropsychology Press. - (1995): "Category test and trail making test as measures of frontal lobe functions". Clin Neuropsychol 1993;9:50-56.

[22] Fonseca RP, Grassi-Oliveira R, Oliveira CR, Gindri G, Zimmermann N, Trentini C, Kristensen CH, Parente MAMP. Instruments of EF assessment: preliminary normative data and sociodemographic studies. Unpublished manuscript.

[23] Burguess PW, Shallice T. The Hayling and Brixton Tests. Thames Valley Test Company; 1997.

[24] Fonseca RP, Oliveira CR, Gindri G, Zimmermann N, Reppold CT, Parente MAMP. Teste Hayling: um instrumento de avaliação de componentes das funções executivas. In: Hutz C, Org. Avaliação Psicológica e Neuropsicológica de crianças e adolescentes. 2010;1:337-364.

[25] Nelson HE. A modified card sorting test sensitive to frontal lobe defects. Cortex 1976;12:313-324.

[26] Kavé G, Heled E, Vakil E, Agranov E. Which verbal fluency measure is most useful in demonstrating executive deficits after traumatic brain injury? J Clin Exp Neuropsychol 2010; 33:1-8.

[27] Ferre P, Clermont MF, Lajoie C, et al. Identification de profils communicationnels parmi les individus cérébrolésés droits : Profils transculturels. Neuropsicol Latinoamer 2009;1:32-40.

[28] Benton E, Bryan K. Right cerebral hemisphere damage: incidence of language problems. Int J Rehabil Res 1996;19:47-54.

[29] Côté H, Payer M, Giroux F, Joanette Y. Towards a description of clinical communication impairment profiles following right-hemisphere damage. Aphasiol 2007;21:739-749.

[30] Rogalski Y, Altmann LJP, Plummer-D'Amato P, Behrman AL, Marsiske M. Discourse coherence and cognition after stroke: A dual task study. J Communic Dis 2010;43:212-224.

[31] Johns CL, Tooley KM, Traxler MJ. Discourse impairments following right hemisphere brain damage: a critical review. Lang Ling Comp 2008;1038-1062.

[32] Rousseaux M, Daveluy W, Kozlowski O. Communication in conversation in stroke patients. J Neurol 2010;257:1099-1107.

[33] Channon S, Watts M. Pragmatic language interpretation after closed head injury: Relationship to executive functioning. Cogn Neuropsychiatry 2003;8:243-260.

[34] Ferstl EC, Walther K, Guthke T, von Cramon, DY. Assessment of story comprehension deficits after brain damage. J Clin Exp Neuropsychol 2005;27:367-384.

[35] Yang FG, Fuller J, Khodaparast, N, Krawczyk DC. Figurative language processing after traumatic brain injury in adults: A preliminary study. Neuropsychol 2010;48:1923-1929.

[36] Blake ML. Perspectives on treatment for communication deficits associated with right hemisphere brain damage. Am J Speech Lang Pathol 2007;16:331-342.

[37] Martin I, McDonald S. Weak coherence, no theory of mind, or executive dysfunction? Solving the puzzle of pragmatic language disorders. Brain Lang 2003;85:451-466.

[38] Samson D, Connoly C, Humphreys GW. When "happy" means "sad": Neuropsychol ogical evidence for the right prefrontal cortex contribution to executive semantic processing. Neuropsychologia 2007;45:896-904.

[39] Gindri G, Zibetti MR, Fonseca RP. Funções executivas pós-lesão de hemisfério direito: estudo comparativo e freqüência de déficits. Rev Psico(PUCRS) 2009;39:282-291.

[40] Champagne-Lavau M, Joanette Y. Pragmatics, theory of mind and EF after a right-hemisphere lesion: Different patterns of deﬁcits. J Neuroling 2009;22:413-426.

[41] Wager TD, Smith EE. Neuroimaging studies of working memory: A meta-analysis. Cogn Affect Behav Neurosci 2003;3: 255-274.

[42] Anderson TM, Knight RG. The long-term effects of traumatic brain injury on the coordinative function of the central executive. J Clin Exp Neuropsychol 2010;iFirst:1-9.

[43] Henry JD, Crawford JR. A meta-analytic review of verbal fluency performance following traumatic brain injury. Neuropsychologia 2004;18:621-628.

[44] Douglas JM. Relationship of executive functioning to pragmatic outcome following severe traumatic brain injury. J Speech Lang Hear Res 2010;53:365-382.

[45] Moran C, Gillon G. Inference comprehension of adolescents with traumatic brain injury: A working memory hypothesis. Brain Inj 2005;19:743-751.

[46] Muñoz-Cépedes JM, Melle N. Alteraciones de la pragmática de la comunicación después de un traumatismo craneoencefálico. Rev Neurol 2004;38:856-859.

[47] Sacks AL, Fenske CL, Gordon WA et al. Co-morbidity of substance abuse and traumatic brain injury. Journal of Dual Diagnosis 2009;5:404-417.

[48] Silver JM, Kramer R, Greenwald S, Weissman M. The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Injury 2001;5:935 945.

[49] Barlow DH, Nock MK. Why can't we be more idiographic in our research? Perspectives on Psychological Science 2009;4: 19-21.

[50] Barbarulo AM, Pappatà S, Puoti G et al. Rehabilitation of gesture imitation: A case study with fMRI. Neurocase 2008;14: 293-306.

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