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Affective prosody and facial expression cues differentially augment spoken sentence and discourse comprehension for acute left and right hemisphere stroke survivors

Year: 2026

Type: article

Abstract: Comprehension for spoken sentences and discourse is differentially impacted by left- (LH) and right-hemisphere (RH) brain damage, such as that caused by stroke. Comprehension deficits can have disabling effects on one's ability to process information, participate in everyday life, and create and maintain relationships. This cross-sectional, observational study evaluated differences in sentence- and discourse-level comprehension between LH and RH stroke survivors across different prosodic conditions and examined relationships between comprehension and damage to key LH and RH regions. Participants included 43 LH and 46 RH acute stroke survivors and 39 controls. All participants completed an in-house clinical assessment that included short passages presented in three conditions: neutral prosody, affective prosody, and affective prosody plus facial expression cues. Stroke survivors also completed magnetic resonance imaging. Consistent with expectations, stroke participants achieved lower comprehension accuracy than controls across conditions. LH participants' accuracy in the 'affective prosody plus facial expressions' condition was greater than in the neutral prosody condition, and total LH lesion volume was associated with performance. RH participants' accuracy in the 'affective prosody' and 'affective prosody plus facial expressions' conditions was greater than in the neutral prosody condition. Overall, both groups' scores increased linearly from Condition 1 to 3. None of the prespecified LH or RH brain regions were significantly associated with performance. Findings suggest that some acute LH and RH stroke survivors with comprehension deficits can benefit from affective prosody and facial expression cues, but different or additional cues may be needed for greatest benefit.

Source: Neuropsychologia

DOI: 10.1016/j.neuropsychologia.2026.109606