Imagine a person who has suffered a stroke and now has trouble talking with others. Chances are, you’re imagining someone who struggles to think of the right words or put them in the right order.

Such problems usually result from a stroke on the left side of the brain, called the left hemisphere. A right-hemisphere stroke may not affect speech as dramatically. But it can still make it difficult to carry on an ordinary conversation.

Breaking the Social Rules

“A right-hemisphere stroke usually doesn’t affect the ability to find words and form sentences,” says Nina Simmons-Mackie, Ph.D. As a professor of communication sciences and disorders at Southeastern Louisiana University, Dr. Simmons-Mackie specializes in stroke. She explains, “Instead, this type of stroke may affect pragmatics”—the ability to understand and follow the unwritten rules of social communication.

A right-hemisphere stroke may also impair thinking skills, such as attention, memory, and reasoning. Such impairments decrease speed and accuracy when using and understanding language. Often, stroke survivors don’t realize they have these problems. But family and friends are all too aware of the challenges.

People who’ve had a right-hemisphere stroke may struggle with these issues:

• Focusing too much on irrelevant details when describing something

• Being unable to read other people’s facial expressions and body language

• Not taking turns in conversation

• Being confused by nonliteral language, such as metaphors and sarcasm

• Having trouble staying on topic

Relearning How to Chat

Fortunately, speech-language therapy can help. Here are some of the strategies used to treat a person who’s had a right-hemisphere stroke:

• Information prioritizing. These activities help the stroke survivor relearn that some facts are more important than others. For example, the person may look at a picture and work with a speech-language pathologist (SLP) to pick out the most relevant details.

• Conversational cues. These activities help the stroke survivor relearn how to recognize nonverbal cues in conversation. For example, the person may watch a video clip of a conversation and work with the SLP on noticing cues that someone wants a turn to talk. The SLP may offer prompts, such as, “Do you notice how he’s leaning forward?”

• Communication partners. Family and friends can learn to do their part as well. For example, when talking with someone who has had a right-hemisphere stroke, it may help to avoid metaphors and sarcasm. It may also help to use questions and reminders to keep the conversation on track.

Reconnecting with Others

Treatment can make a big difference in overall stroke recovery, according to data from the American Speech-Language-Hearing Association. These data show that nearly three-quarters of right-hemisphere stroke patients who receive SLP services improve in problem solving and memory. Eighty percent increase their attention span.

And then there’s communication. “After a right-hemisphere stroke, some people become almost like talking computers. They don’t pick up on nuances of social give and take,” says Dr. Simmons-Mackie. Treatment helps such individuals connect with others again. It can make the difference between merely talking and truly communicating.