Apragmatism and Communication
Communication Disorders associated with RHD can affect prosody (melody of speech or tone of voice), pragmatics (social interaction), and theory of mind (understanding others’ point of view).
Pragmatics
Pragmatics involves lots of different ways we communicate with each other: the words and sentences we choose, the topics we talk about in different situations, the prosody or tone of voice, gestures, facial expressions, body language, and the social ‘rules’ used to have appropriate conversations or interactions. Until recently, there has not been a good label for these pragmatics deficits associated with right hemisphere brain damage. In 2021, a group of speech-language pathology researchers formed the International Right Hemisphere Collaborative and adopted the label apragmatism to describe these deficits. Apragmatism is the label for difficulties in conveying or comprehending the meaning or intent of a message and can include any or all of the different modes of communication (words, prosody, and/or body language).
Prosody
Prosody refers to the melody of speech - changes in rate, pitch, loudness, emphasis, and pausing that conveys emotion and helps convey what a speaker really means. Facial expression and body language are often coupled with prosody to communicate our intended meaning. Some people with RHD have aprosodia (a-pro-so’-de-a) in which they have difficulty controlling their own prosody or understanding a speaker’s prosody - or both. In the first situation, their speech may sound flat and monotone and it can be difficult to judge their mood/emotion or what they’re trying to communicate (humor, sarcasm, etc). In the second, they may appear insensitive to others because they do not pick up on emotion through tone of voice, and they may not get jokes or sarcasm.
Theory of Mind
Theory of mind is the ability to understand that other people have thoughts, ideas, perspectives, emotions, and feelings that are different from your own. RHD can sometimes affect theory of mind, such that the person doesn’t seem to be able to take another person’s perspective or point of view in the same way they used to. They may not seem to be as “connected” to others as they once were. They may not understand humor or sarcasm, or appear rude, indifferent, uninterested or insensitive to another person’s mood, feelings, needs or ideas. It is important to remember that it is not that they no longer care about others or that they are trying to be selfish or inconsiderate. Rather, the damage to the right side of their brain has caused them to be less able to relate to or understand a situation from another’s point of view