Metaphor Training Program

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DESCRIPTION (provided by applicant): This project addresses an important gap in the clinical literature: the dearth of tools for remediation of the communication deficits associated with brain damage caused by stroke in the right cerebral hemisphere and by traumatic brain injury. While not typically aphasic as measured by standard aphasia test batteries, many patients with these types of injury exhibit a range of communication impairments with non literal language that impact their lives in negative ways. The tasks comprising the training program are motivated by a theoretical analysis of the neuropsychology of metaphor comprehension deficits and related topics. One notion is that damage to right posterior regions limits a patient's ability to process connotative associations between words. A second notion is that damage to right frontal and bilateral prefrontal regions can affect working memory and a patient's ability to review information and to select a most relevant alternative from a set. The training is based on a simple mode of representing semantic relations in words and narratives, Thinking Maps, that has been used extensively with children. Thinking Maps explicitly list the semantic features or associations shared between words that provide potential bases for metaphors. Thinking Maps make available the ingredients of metaphor in concrete form for practice and review. The protocol, which is based on single subject experimental design, is designed to evaluate and remediate: 1) difficulty generating appropriate associations to words; 2) difficulty evaluating connotative shared meaning; and 3) difficulty selecting from among alternative interpretations. Each patient is expected to progress through the program spending more time on some tasks and less time on others as a function of that patient's specific profile of cognitive impairment. The protocol will examine what specifically changes during training and the impact of the intensity of training on the duration and generalizability of gains. In addition, the protocol will assess the fading of treatment gains over time and will explore approaches to slowing or preventing that decline!