Right Hemisphere Stroke: Tangentiality and Theory of Mind

Right Hemisphere Stroke: Tangentiality and Theory of Mind

You may know that adult stroke patients with right hemisphere lesions often have problems with pragmatic communication. What you may not know is that SLPs and OTs never assessed or treated patients’ right hemisphere communication or cognitive skills before the 1980’s.

Up until that time, therapists were taught that the right hemisphere was involved in visual spatial skills but not higher levels of cognition or communication. Howard Gardner and his associates at Harvard University and several speech-language pathologists nationwide published research in the 1980’s, identifying cognitive-linguistic deficits associated with right hemisphere brain damage. Only after these findings did therapists begin testing and treating these deficits.

Right hemisphere and language

In the past decade, neuroscience research has clarified the deficits associated with right hemisphere brain damage and the role it plays in language and cognition. This has changed how therapists establish goals and determine cognitive processes behind these deficits.


For example, a common communication problem seen after a right hemisphere stroke is “tangentiality,” a tendency for a patient to verge off into tangents, far removed from the topic of conversation.

Working with tangentiality, a therapist might focus on “topic maintenance” as a conversational goal. Newer neuroscience research, however, suggests that the theory of mind – the ability to take the perspective of others – may be at fault.

Theory of mind deficit might also impact other aspects of communication. Thus, working with theory of mind might be a more efficient way to treat some of the communication problems seen in these patients. Join Dr. Martha Burns for updates on the newest neuroscience research for right hemisphere disorders and to learn how to determine effective treatment goals for patients with these disorders.