Communication and language functions are primarily centered in the left hemisphere of the brain. When injuries impact the left hemisphere, there are often overt communication challenges ranging from difficulty retrieving and producing words to form grammatical sentences or difficulty understanding spoken language. Less recognized and widely understood, however, are those communication challenges that can arise in the presence of right hemisphere damage (RHD). The right hemisphere is also involved in critical functions for effective communication, particularly in areas such as intonation, social pragmatics, and cognitive-communication skills. The right hemisphere also plays an important role in motor coordination, which can affect swallowing function if regions of the brain’s motor strip and supplementary motor strip have been impacted.  When the right hemisphere is injured—whether due to stroke, traumatic brain injury, or other neurological condition—it can lead to significant, yet sometimes overlooked, challenges in both speech, communication, and swallowing.

Understanding Right Hemisphere Brain Damage and Its Effects on Communication

The right hemisphere of the brain controls many aspects of non-verbal and expressive communication, cognitive functions, and motor coordination. 

Unlike left-hemisphere damage, which is often associated with aphasia (difficulty understanding and/or producing language), RHD primarily affects:

• Prosody – The rhythm, tone, and melody of speech, which convey emotions and intent.
• Cognitive-Communication Skills – Memory, attention, organization, and reasoning.
• Pragmatic Language – The ability to understand and use social cues in conversation.
• Visual-Spatial Awareness – The perception of space and awareness of one’s environment, which can influence both communication and eating behaviors.

So while many individuals living with RHD may speak clearly, fluently, and in grammatically correct and complex sentences, their communication challenges can make interactions and daily life difficult due to difficulty appropriately interpreting and responding to social communication cues. Dr. Jamila Minga, a leading expert in RHD at the Minga Right Hemisphere Communication Laboratory at Duke University, has extensively researched the impact of RHD on communication. Her work highlights that individuals with RHD often struggle to know what to say, when to say it, and how to say, which makes it hard to meaningfully connect with friends and family or effectively navigate professional settings and duties required to maintain a job.

Additionally, other researchers have explored the role of visual-spatial neglect, a symptom that is believed to occur more frequently in RHD than left-hemisphere injury wherein individuals fail to perceive information on one side of their visual field. This can lead to difficulties in reading, recognizing nonverbal cues, and reduced motor recovery—all of which have significant implications for cognitive communication and swallowing rehabilitation treatments and outcomes.

Recognition and greater public awareness of the unique and impactful communication challenges that those with RHD face is imperative to ensuring those that need support have access to quality speech and language services so individuals can work toward improved communication and safer swallowing.

Common Speech and Language Symptoms in Right Hemisphere Brain Damage

Individuals with RHD often retain their ability to form grammatically correct sentences and understand words, but their communication may be flat, disorganized, or socially inappropriate. Some of the most common speech and language challenges include:

• Monotone Speech (Aprosodia) – Difficulty expressing emotions through tone of voice.
• Difficulty Understanding Humor, Sarcasm, or Implied Meaning – Taking phrases literally and missing social cues.
• Disorganized or Impulsive Speech – Difficulty staying on topic and organizing thoughts.
• Reduced Awareness of Deficits – Struggling to recognize their communication patterns have changed or errors and challenges in cognitive, communication, or swallowing function.
• Individuals with RHD may have difficulty recognizing the listener’s perspective, which can impact social interactions.

Many researchers and clinicians highlight that individuals with RHD often have reduced awareness of their own communication difficulties (anosognosia), which can make rehabilitation challenging.

Swallowing Difficulties and Right Hemisphere Brain Damage

Because the right hemisphere also plays a role in motor coordination and attention, neurological injury to this area can cause swallowing difficulties (dysphagia). This can manifest as:

• Delayed Swallow Reflex – Increasing the risk of choking.
• Weak Oral Muscles – Leading to difficulty chewing or controlling food in the mouth.
• Silent Aspiration – Food or liquid entering the lungs without triggering a cough, increasing pneumonia risk.
• Reduced Sensory Awareness and Attention When Eating – Individuals with RHD may not notice food left in their mouth, increasing the risk of choking. They may eat too quickly or forget to chew properly, leading to swallowing difficulties.

Speech and Swallowing Treatments for Right Hemisphere Brain Damage

Rehabilitation for speech and swallowing difficulties after RHD focuses on improving communication skills, strengthening swallowing muscles, and developing compensatory strategies.

Speech Therapy Approaches for RHD

Speech therapy for right hemisphere brain damage aims to augment communicative success by improving social communication, expressivity and intonation in speech, attention, thought and language organization, and self-monitoring.

1. Prosody Training

Helps to restore natural intonation and emotional expressiveness through pitch variation exercises and choral reading techniques. This may look like:

• Pitch and intonation exercises (e.g., practicing exaggerating emotions like happiness or surprise).
• Contrastive stress drills (e.g., emphasizing different words: “I LOVE pizza” vs. “I love PIZZA”).
• Choral reading techniques where the patient practices speaking with a therapist to match intonation patterns.

2. Cognitive-Communication Strategies

Therapists support individuals to improve organization and topic maintenance in conversation by:

• Practicing structured storytelling (e.g., telling a short story in sequential order).
• Using visual supports, such as graphic organizers, storyboards or cue cards, to guide conversation.

3. Social Communication Training

Since pragmatic language skills are often affected,  therapy may include:

• Role-playing conversations to practice taking turns, staying on topic, and interpreting emotions.
• Video feedback, where patients watch recordings of their speech to improve self-awareness.
• Group therapy sessions to practice real-world interactions.

Swallowing Therapy Approaches for RHD

Swallowing therapy (dysphagia rehabilitation) focuses on improving muscle strength and coordination, increasing sensory awareness, and ensuring safe eating practices.

1. Swallowing Exercises to Strengthen Muscles

• Mendelsohn Maneuver: Helps strengthen the muscles that control the swallow reflex.
• Effortful Swallow: Encourages stronger muscle contractions to move food safely from the oro-pharynx region through the esophagus.
• Oral Motor Exercises: Strengthens the lips, tongue, and jaw for better control of food and liquid.

2. Swallowing Safety Strategies

• Chin tuck posture: Helps reduce aspiration risk when swallowing.
• Slow, mindful eating: Encourages attention to the task of eating, food in the mouth, and adequate chewing.
• Carepartner education: Helps loved ones recognize signs of swallowing difficulties and trains safe eating rituals, exercises, and compensatory techniques.

Final Thoughts: Supporting Speech and Swallowing Recovery

Right hemisphere brain damage presents unique challenges in communication and swallowing, but speech therapy and swallowing therapy can help individuals regain confidence and independence.

By working with a licensed speech-language pathologist (SLP) and practicing targeted therapy exercises, individuals with RHD can improve their ability to communicate, enjoy meals safely, and reconnect with their loved ones.

If you or a loved one is experiencing speech or swallowing difficulties after right hemisphere brain damage, early intervention is key—reach out to a speech therapist today for a personalized treatment plan.