How Do You Make a Peanut Butter and Jelly Sandwich?

Melissa Johnson

Written By: Melissa Johnson, Ph.D., CCC-SLP

How do you make a peanut butter and jelly sandwich? If you ask someone who had a left hemisphere stroke, they might say,

“First the bread.  Second (chuckles) um the /pinə/ (shakes head no) um /pinə/ butter.  Um uh but uh (shakes head no) um (chuckles) um (sighs) hard” (adapted from MacWhinney et al., 2011).

If you ask someone with right hemisphere brain damage (RHD) the same question, they might respond,

“I'd make it thick slices of bread. Um uh, get a nice uh fat butter knife so you can spread real well.  Eh um, my favorite peanut butter comes from um Whole Foods. It's uh no additives at all, just the peanuts.  And and I've got the whole, I've got a huge shelf full of that peanut butter.  ‘Cause um I used to go back to Rhode Island, which was where the nearest Whole Foods that I knew of.  And I would buy, uh I would stock up on stuff that they have.  And this is when I was living, like last time I did that I was living in Cooperstown.  I would go back to visit my friends in Rhode Island so I could go shopping at Whole Foods.  Now I don't have to do that because now there's one here I think…” (adapted from Minga et al., 2021).

Most people would agree that neither of these samples constitutes “typical” procedural discourse.  The person with aphasia is clearly struggling with word retrieval difficulty and agrammatism.  As for the person with RHD, we can describe the discourse as tangential, egocentric, and excessive in content.  But, while the discourse of people with RHD is sometimes excessive, there may also be a paucity of content (Blake, 2006).  Further complicating the picture is that some of the discourse characteristics found in RHD can also be seen in healthy adults (Blake, 2006).  Impaired discourse after RHD, which may be off-putting to friends or co-workers, is one possible cause of the negative social outcomes, such as difficulty maintaining vocational or avocational pursuits, and disrupted social relationships, that some people with RHD experience (Tompkins, 2012).

An important step in understanding how the discourse impairments of people with RHD play into such negative sequelae is identifying what makes the discourse different.  In 2016, the RHDBank, an extension of TalkBank, was developed for this purpose.  A variety of discourse genres are used to elicit samples that are transcribed in a standardized manner from multiple sites, allowing for comparisons across participants or across disorder types (Minga et al., 2021; note that qualified researchers and clinicians can freely access all of the resources on RHDBank or other TalkBank extensions by emailing Brian MacWhinney ([email protected]) with contact information and affiliation). 

The exact prevalence of communication impairments in individuals with RHD is unclear, but estimates are at least as high as 50% (Côté et al., 2007).  This statistic alone makes the case that the field of speech-language pathology has a vital role to play in helping these individuals to maximize their communicative function and, by extension, their quality of life.  To that end, Peggy Blake and I developed a website to provide information about the deficit profile after right hemisphere stroke.  Beyond that, however, the available resources for RHD are quite limited.  There are few widely used standardized assessments or evidence-based treatment approaches to guide clinicians’ work.  There are significantly fewer researchers with a primary interest in RHD than there are those working in aphasia research (Minga et al., 2021).  Nonetheless, it must be emphasized  to our students, to physicians, to funders, to clinicians, and to our patients and their families  that both the left and right hemispheres are critical for effective communication.

In an effort to celebrate and share with my ANCDS colleagues some of the incremental steps being taken in the right hemisphere world, I would like to highlight a couple of efforts I have had the privilege to participate in during this most unusual of years.  First, speech-language pathologist, Katherine Pietsch of California and I have had the pleasure of hosting the first (we think) bi-coastal RHD support group!  We have met twice over zoom with roughly an equal number of east and west coast participants with RHD and their care partners.  It has been a joy to see how quickly and authentically they have begun to connect with each other.  While some participants may not have full awareness of all of their deficits due to a higher prevalence of anosognosia in this population than in those with left hemisphere stroke (Jehkonen et al., 2006), this has not prevented them from engaging with each other in this format.  So far, discussions have centered on visual perceptual impairments and their impact on daily functioning (e.g., inability to drive).  In response, we invited an OT colleague to the second meeting.  We have not yet dug into the, perhaps, less easily grasped communication challenges of some of the participants.  But, there’s time for that!  For now, seeing them reap the benefits of connection that many people with aphasia have had access to through aphasia support groups, is enough.

And, finally, I would like to publicly express my appreciation for my colleagues across the United States and in Australia  Peggy Blake, Petrea Cornwell, Davida Fromm, Ronelle Hewetson, and Jamila Minga  for the fruitful and energizing conversations and writing efforts we have undertaken in the past year to increase the understanding of people with RHD.  More to come on that down the road, but, for now, suffice it to say, that collaborating with these esteemed colleagues has been a professional privilege and a joy!  I look forward with hope and excitement to the future of research and clinical innovation to benefit those with RHD, and all those with neurogenic conditions.

Côté, H., Payer, M., Giroux, F., & Joanette, Y. (2007). Towards a description of clinical communication impairment profiles following right-hemisphere damage. Aphasiology, 21(6–8), 739–749.

Jehkonen, M., Laihosalo, M., & Kettunen, J. (2006). Anosognosia after stroke: assessment, occurrence, subtypes and impact on functional outcome reviewed. Acta Neurologica Scandinavica, 114(5), 293–306.

MacWhinney, B., Fromm, D., Forbes, M. & Holland, A. (2011). AphasiaBank: Methods for studying discourse. Aphasiology, 25,1286-1307.

Minga, J., Johnson, M., Blake, M. L., Fromm, D., & MacWhinney, B. (2021). Making sense of right hemisphere discourse using RHDBank. Topics in Language Disorders, 41(1), 99-122.

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