08/01/2017

Helping Clients with Right Hemisphere Brain Damage with Post-Stroke Career Development

By Levette Dames and Jamila Minga

Communication is important to career development (Dumitru & Voinea, 2015). Career development is defined as a lifelong process of managing work experiences including thought processing and occupational goal setting that contribute to financial, physical, environmental, social, and sometimes spiritual development (Business Dictionary, 2015; Sampson, Peterson, Lenz, Reardon, & Saunders, 1996). Stroke, the leading cause of disability in the United States (CDC, 2008), can result in cognitive-communicative impairments that necessitate modifications in employment duties for successful return to work (Koch, 2005).

Right hemisphere strokes result in right hemisphere disorder (RHD). RHD is a constellation of deficits that can impair cognitive-communication abilities with respect to language comprehension (Beeman & Chiarello, 1998; Blake, Tompkins, Scharp, Meigh, & Wambaugh, 2015; Tompkins, Scharp, Meigh, & Wambaugh, 2012) and language production (Blake, Duffy, Myers, 2002; Kennedy, Strand, & Burton, Peterson, 1994; Minga, 2014 & 2016) depending on the areas of neurological breakdown. The functional impact of these deficits can be seen when survivors have difficulty with attending, organizing, and planning tasks; do not successfully use the social rules of language; lack the ability to understand the perspective of communication partners; and are unable to gauge what to say, when to say it, and how to say it, despite fluent and intelligible speech. These impairments can be subsumed under pragmatic aspects of communication (Tompkins, 1995) and may cause difficulty with post-stroke socialization, career acquisition, and career maintenance.

While cognitive-communication deficits in adults with RHD are well recognized, to our knowledge, there are no studies that focus on assisting adults with RHD in post-stroke career development while taking into consideration residual deficits. Post-stroke career development is needed to assist adults with RHD in acquiring and maintaining positive career thoughts for enhanced employment outcomes. Career practitioners (CPs) and speech-language pathologists (SLPs) can contribute to improving the lives of adults with RHD by combining their complementary specialties to assist these unique clients in becoming more self-sufficient. A first-step in this process is to promote an intellectual exchange of knowledge between CPs and SLPs in three areas: (1) common communication behaviors associated with RHD, (2) the influence of these behaviors on career development, and (3) the contribution of career counseling to improving post-stroke career development.

Speech-language pathologists and researchers with clinical experience in adult neurogenic communication disorders and RHD can provide CPs with a basic understanding of the hallmark deficits associated with RHD. Some avenues for the exchange of information include sharing recent evidence-based literature, observation of adults with RHD in various communicative contexts, while performing job duties, and during face-to-face discussions. Each avenue can serve as a basis for understanding how and in what ways the RHD deficits may be improved for successful employment. The particular influence that residual deficits have on career acquisition and maintenance, however, need to be specific to the person and their prior career.

In order to assist adults with RHD in post-stroke career development, CPs can use the cognitive information processing approach (CIP, Sampson et al., 1994). CIP has been researched with individuals diagnosed with breast cancer (Dames, 2013; Dames, Zalaquett & Exum, 2014), and end stage renal disease (ESRD; Dames, Muhmud & McDowedell, 2016). This can assist adults with RHD return to work by serving as a tool for CPs to start the conversation concerning occupational expectations while providing counseling on functional limitations of the disorder. Specifically, CPs can gain greater insight into dysfunctional career thoughts about returning to work by asking the clients to complete the Career Thoughts Inventory (CTI; Lenz, Sampson, Peterson, & Reardon, 2012).

A focus of the CIP approach is to improve dysfunctional career thoughts. Career thoughts are defined as the assumptions, plans, strategies, feelings and behaviors associated with career choice (Lenz, Sampson, Peterson, & Reardon, 2012) and are addressed in three domains:

1. Knowledge Domain:

Self-Knowledge: CPs should acquire knowledge of the deficits associated with RHD. Familiarity can provide a foundation for understanding the complexity of impact of the disorder on post-stroke career development. Adults with RHD should have or develop insight into how their communication has changed. A client who states for example, “There’s nothing wrong with my communication” may lack awareness of the impact of stroke on communication and return to work.

Occupational Knowledge: CPs should have or obtain career assessment tools and approaches that will help clients return to work given cognitive-communication concerns. Adults with RHD can work to understand how pre-stroke occupational knowledge can transcend into achieving or maintain an occupation that will be empathic of their needs as a RHD client. For example: “I get it, I had a stroke and no one wants to hire me.” A client may maintain the idea that they can’t return to work because of the stroke.

2. Decision Making Skills Domain:

CPs can use the second tier in the CIP pyramid entitled the decision making skills domains that includes Communication Analysis Synthesis Valuing Execution (CASVE) to help adults with RHD understand the influence of residual cognitive-communication capabilities and limitations with respect to career objectives. Adults with RHD may need to adapt new or improve on the old career skills in the decision making domain. “I can’t return to my old job so I guess I can’t work anymore.”

3. Executive Processing Domain:

Metacognitions: CPs can assist in diminishing negative career communication thought processing through self-talk and self-awareness. For example:

Self-talk: “I will never be able to communicate with my clients over the phone as I use to”

Self-Awareness: “I am ashamed when customers hear my slurred speech”

Collaborative services by CPs and certified SLPs can be an invaluable tool. We have outlined three areas that can serve as a foundation for merging two areas of expertise for the post-stroke career development of adults with RHD. Future studies assessing the utility of this collaboration with survivors of RHD are forthcoming.

References & Resources

Business Dictionary.com. WebFinance Inc. Retrieved from http://​www.​businessdictiona​ry.​com/​definition/​career-development.​html

Beeman, M., & Chiarello, C. (1998). Right hemisphere language comprehension: Perspectives from cognitive neuroscience. Mahwah, N.J: L. Erlbaum Associates.

Blake, M. T., Tompkins, C., Scharp, V., Meigh, K., & Wambaugh, J. (2014). Contextual Constraint Treatment for coarse coding deficit in adults with right hemisphere brain damage: Generalization to narrative discourse comprehension. Neuropsychological Rehabilitation, 25(1), 15-52. DOI:10.1080/09602011.2014.932290

Blake, M. L., Duffy, J. R., Myers, P. S., & Tompkins, C. A., (2002). Prevalence and patterns of right hemisphere cognitive/communication deficits: Retrospective data from an inpatient rehabilitation unit. Aphasiology, 16, 537-548. 

Dumitru, C., & Voinea, V. (2015). Correlations between career management, communication, and career development. Valahian Journal of Economic Studies, 6(2), 99-108.

Kennedy, Mary R.T., Strand, W.B., Edythe A., Burton,W., & Peterson, C. (1994). Analysis of first-encounter conversations of right-hemisphere-damaged adults. Clinical  Aphasiology, 22,67-80.

Koch, L., Egbert, N., Coeling, H., Ayers, D. (2005). Return to work after the onset of illness: Experiences of right hemisphere stroke survivors. Rehabilitation Counseling Bulletin, 48(4), 209-218.

Lenz, J. G., Sampson, J. P., Peterson, G. W., & Reardon, R. (2012, February). Applying cognitive information processing theory to career counseling and services. Presented to the Florida Career Development Association, Gainesville, Florida.

Minga, J. (2014). Question use following right hemisphere brain damage (Order No. 3673059). Available from ProQuest Dissertations & Theses Global. (1652500781). Retrieved from http://nclive.org/cgi-bin/nclsm?url=http://search.proquest.com/docview/1652500781?accountid=12713

Minga, J. (2016). Discourse production and right hemisphere disorder. Perspectives ASHA SIGs,1(2), 96-106. doi:10.1044/persp1.SIG2.96.

Sampson, J. P., Jr., Peterson, G. W., Lenz, J. G., Reardon, R. C., & Saunders, D. E. (1994). Career Thoughts Inventory: Professional manual [research edition]. Odessa, FL: Psychological Assessment Resources, Inc. 

Sampson, J., Jr., Peterson, G., Lenz, J., Reardon, R., & Saunders, D. (1996). Career Thoughts Inventory: Professional manual. Odessa, FL: Psychological Assessment Resources, Inc.

Tompkins, C.A (1995). Right hemisphere communication disorders: Theory and management. San Diego:Singular Publishing. 

Tompkins, C. A., Scharp, V. L., Meigh, K. M., Blake, M. L., & Wambaugh, J. (2012). Generalisation of a novel implicit treatment for coarse coding deficit in right hemisphere brain damage: A single-participant experiment. Aphasiology, 26(5), 689-708.

Jamila Minga PhD, CCC-SLP is an Assistant Professor at North Carolina Central University and an Appointed Member, Bioinformatics Genomics and Computational Chemistry Core (BGCCC), Biomedical Biotechnological Research Institute (BBRI). She graduated from the University of North Carolina at Chapel Hill with a B.A. in Linguistics and a M.S. in Speech and Hearing Sciences. She earned her doctorate in Communication Sciences and Disorders from the University of North Carolina at Greensboro. She is the Director of the Right Brain Stroke Research Clinic (RBSRC), founder of the Right Brain Stroke Research Registry (RBSRR), and co-developer of the RHDBank Discourse Protocol. Dr. Minga has over 12 years of clinical experience as a certified speech-language pathologist serving adults with neurogenic communication disorders. She is dedicated to advancing the literature concerning pragmatic communication deficits in adults with RHD. She can be reached at Jminga1@nccu.edu

Levette S. Dames, RN, PhD is an assistant professor at North Carolina Central University and a registered nurse for more than 20 years with a master’s degree in school counseling and a PhD in Curriculum and Instruction/Counselor Education that specialized in career counseling. She is also a licensed school counselor in North Carolina. She has worked in hospital settings, high schools, and in elementary schools. She has taught undergraduate and graduate courses. She developed and organized a Career Development course for student athletes at the University of South Florida and a human sexuality course at NCCU. She is a past-president of the Florida Career Development Association (2011-2012). She presently serves as the SACES International Counseling Interest Group co-chair, a faculty athletic senate member at NCCU, and the field site coordinator at NCCU. Her research focuses on career development for student athletes and persons diagnosed with a chronic illness especially breast cancer, end stage renal disease, high school students. She has also focused on group counseling research and social/emotional learning. She can be reached at lsdames@nccu.edu