Making It Right? Some Thoughts about the Future of Treatment for Right Hemisphere Cognitive-Communication Disorders

Abstract

This article reflects on the future of intervention for language and communication disorders that follow unilateral damage to the right cerebral hemisphere. The author first introduces some of the challenges inherent in this task: a very small and preliminary evidence base and a limited number of investigators conducting treatment research for most of the consequences of these disorders, more general difficulties of translating evidence to practice, and limited graduate training in the area. The article then addresses some predictions and hopes for the future. The author foresees progress in defining the disorders and in clinicians' knowledge of the heterogeneity of the population, the multifaceted nature of complex impairments, and the expanding range of well-justified treatment options. The article next discusses the potential of noninvasive brain stimulation techniques, virtual reality-based approaches to intervention, and the promise of telerehabilitation. Finally, the author voices a concern that undeniably important new trends in health care, such as emphases on patient-reported outcomes and patient satisfaction measures, could penalize the subset of the client population that lacks awareness of or minimizes their deficits, and calls for vigilant clinician advocates in such cases.

Keywords

Right hemisphere disorders - cognitive-communication disorders - treatment - speech-language treatment

• References

• 1 Tompkins CA, Gibbs Scott A. Treatment of right hemisphere disorders. In Papathanasiou I, Coppens P, eds. Aphasia and related neurogenic communication disorders (2nd ed.). Sudbury, MA: Jones & Bartlett; 2017: 399-420
• 2 National Institute for Health and Clinical Excellence. How to change practice: understand, identify and overcome barriers to change. December, 2007. Available at: https://www.nice.org.uk/Media/Default/About/what-we-do/Into-practice/Support-for-service-improvement-and-audit/How-to-change-practice-barriers-to-change.pdf . Accessed February 13, 2016
• 3 Myers PS, Mackisack EL. Right hemisphere syndrome. In LaPointe LL, ed. Aphasia and Related Neurogenic Language Disorders. New York, NY: Thieme; 1980: 177-195
• 4 Joanette Y, Ansaldo AI. Clinical note: acquired pragmatic impairments and aphasia. Brain Lang 1999; 68 (3) 529-534
• 5 Myers PS. Toward a definition of RHD Syndrome. Aphasiology 2001; 15: 913-918
• 6 Tompkins CA, Lei C-M, Zezinka A. Nature and implications of right hemisphere language disorders. In Hillis A, ed. Handbook of Adult Language Disorders: Integrating Cognitive Neuropsychology, Neurology, and Rehabilitation. 2nd ed. New York, NY: Psychology Press; 2015: 491-517
• 7 Tompkins CA. Rehabilitation for cognitive-communication disorders in right hemisphere brain damage. Arch Phys Med Rehabil 2012; 93 (1, Suppl): S61-S69
• 8 Kortte KB, Hillis AE. Recent trends in rehabilitation interventions for visual neglect and anosognosia for hemiplegia following right hemisphere stroke. Future Neurol 2011; 6 (1) 33-43
• 9 Sohlberg MM, Fickas S, Ehlhardt L, Todis B. The longitudinal effects of accessible email for individuals with severe cognitive impairments. Aphasiology 2005; 19: 651-681
• 10 Hopper T, Bourgeois M, Pimentel J , et al. An evidence-based systematic review on cognitive interventions for individuals with dementia. Am J Speech Lang Pathol 2013; 22 (1) 126-145
• 11 Blake ML, Tompkins CA, Scharp VL, Meigh KM, Wambaugh J. Contextual Constraint Treatment for coarse coding deficit in adults with right hemisphere brain damage: generalisation to narrative discourse comprehension. Neuropsychol Rehabil 2015; 25 (1) 15-52
• 12 Tompkins CA, Blake MT, Scharp VL, Meigh KM, Wambaugh JL. Implicit treatment of underlying comprehension processes improves narrative comprehension in right hemisphere brain damage [abstract]. Paper presented at: Clinical Aphasiology Conference: Clinical Aphasiology Conference 2013: 43rd: May 28–June 2, 2013; Tucson, AZ
• 13 Max Planck Institute for Human Development and Stanford Center on Longevity. A consensus on the brain training industry from the scientific community. 2014. Available at: http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community/ . Accessed February 15, 2016
• 14 Brunker M. Lumosity to pay $2M to settle FTC charges over “brain training” ads. 2016. Available at: http://www.nbcnews.com/business/consumer/lumosity-pay-2m-settle-ftc-charges-over-brain-training-ads-n490571 . Accessed February 15, 2016
• 15 Cazzoli D, Müri RM, Hess CW, Nyffeler T. Treatment of hemispatial neglect by means of rTMS—a review. Restor Neurol Neurosci 2010; 28 (4) 499-510
• 16 Hesse MD, Sparing R, Fink GR. Ameliorating spatial neglect with non-invasive brain stimulation: from pathophysiological concepts to novel treatment strategies. Neuropsychol Rehabil 2011; 21 (5) 676-702
• 17 Summers JJ, Kang N, Cauraugh JH. Does transcranial direct current stimulation enhance cognitive and motor functions in the ageing brain? A systematic review and meta-analysis. Ageing Res Rev 2016; 25: 42-54
• 18 Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 2000; 527 (Pt 3) 633-639
• 19 Katz N, Ring H, Naveh Y, Kizony R, Feintuch U, Weiss PL. Interactive virtual environment training for safe street crossing of right hemisphere stroke patients with unilateral spatial neglect. Disabil Rehabil 2005; 27 (20) 1235-1243
• 20 Navarro M-D, Lloréns R, Noé E, Ferri J, Alcañiz M. Validation of a low-cost virtual reality system for training street-crossing. A comparative study in healthy, neglected and non-neglected stroke individuals. Neuropsychol Rehabil 2013; 23 (4) 597-618
• 21 Lohse KR, Hilderman CGE, Cheung KL, Tatla S, Van der Loos HFM. Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy. PLoS ONE 2014; 9 (3) e93318
• 22 Johansson T, Wild C. Telerehabilitation in stroke care—a systematic review. J Telemed Telecare 2011; 17 (1) 1-6
• 23 Turolla A, Piron L, Gasparetto T , et al. Telerehabilitation for stroke patients: an overview of reviews. Proc. 9th Intl Conf. Disability, Virtual Reality & Associated Technologies Laval, France, 10–12 September. 2012:323–328
• 24 Theodoros DGJ. Telerehabilitation for service delivery in speech-language pathology. J Telemed Telecare 2008; 14 (5) 221-224
• 25 Threats TT. Use of the ICF for guiding patient-reported outcome measures. Sig 2 Perspectives on Neurophysiology Neurogenic Speech Lang Dis 2012; 22: 128-135
• 26 Irwin B. Patient-reported outcome measures in aphasia. Sig 2 Perspectives on Neurophysiology Neurogenic Speech Language Disorders 2012; 22: 160-166
• 27 Sherman RO. Patient satisfaction now factors into Medicare reimbursement. American Nurse Today 2012;7(10). Available at http://www.americannursetoday.com/patient-satisfaction-now-factors-into-medicare-reimbursement/ . Accessed February 15, 2016
• 28 Légaré F, Ratté S, Stacey D , et al. Interventions for improving the adoption of shared decision making by healthcare professionals (Review). Cochrane review, The Cochrane Library 2010. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006732.pub3/full . Accessed February 15, 2016
• 29 Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med 2013; 368 (1) 6-8
• 30 Robbins A. The problem with satisfied patients. The Atlantic 2015, April 17. Available at: http://www.theatlantic.com/health/archive/2015/04/the-problem-with-satisfied=-patients/390684/ . Accessed February 15, 2016
• 31 Murphy M. HCAHPS: The true impact of patient satisfaction. Med Scribe J 2016. Available at http://scribeamerica.com/blog/hcahps-true-impact-patient-satisfaction/ . Accessed February 15, 2016