Pragmatic features in patients with right hemisphere damage: A neuroimaging study

Background: Pragmatic impairment is commonly observed in individuals who have sustained right hemisphere damage (RHD). A limited number of neuroimaging studies have explored the relationship between pragmatics and the role of the right hemisphere.Objectives: The aim of this study was to investigate the association between pragmatic impairment and the specific lesion site in patients with RHD.Methods: This cross-sectional study was conducted on 34 patients with RHD referred to Ghaem Hospital in Mashhad from September 2020 to December 2022. The lesion site was determined using a combination of CT scans and MRI imaging. The pragmatic skills of the participants were assessed using the Adult Pragmatics Profile (APP), a validated assessment tool that evaluates three domains: verbal, nonverbal, and paralinguistic skills. The relationship between the lesion site and the scores of three test subscales was investigated using a one-way analysis of variance.Results: The results showed no statistically significant difference in the scores of verbal variables (P=0.11) across the different lesion groups (cortical, subcortical, and other brain areas). Moreover, no significant difference was found regarding the nonverbal (P=0.88) and paralinguistic (P=0.12) variables. Patients with lesions in the motor cortical area exhibited the lowest average total score of 19.71 out of a possible 35 points. Further examination of the individual subscale scores indicated that the verbal component had the lowest average score (17.97) among these patients.Conclusion: RHD patients exhibited pragmatic impairments; however, there was no clear relationship between lesion site and pragmatic test score. Patients with lesions in the motor cortical area had a lower overall score. Addressing these pragmatic deficits is crucial to improving the patient's overall quality of life, as pragmatics plays a key role in communication.