The Metaphor Training Program (Lundgren et al., 2011; Brownell et al., 2013) is a structured intervention designed to remediate one type of cognitive-linguistic deficit in patients with RHD, processing a common form of nonliteral language.

One foundation of the protocol is graphically supported practice with the types of word associations that play a major role in many instances of metaphor according to our guiding theoretical analysis. The other foundation is selecting a good completion for a metaphor from the available associations.

Pre-Training Assessment

It is suggested that the initial assessment of cognitive and linguistic functioning include, among other tests, The Formulaic and Novel Language Comprehension Test (FANL-C, Kempler & Van Lancker, 1996); The Cognitive and Linguistic Quick Test (CLQT, Helm-Estabrooks, 2001); The Benton Line Orientation Task short form (Qualls, Bliwise, & Stringer, 2000); and a working memory span test (Tompkins et al., 1994). These tests were chosen in order to assess the patients’ knowledge of figurative language, cognitive-linguistic abilities, visuospatial performance, and working memory.

Baseline Phase—The following baseline probes should be administered in order to establish a baseline of performance using untrained oral metaphor interpretation probes, Benton line orientation, and a modified quality of life scale (SAQOL-39; Hilari et al, 2003) that includes measures of mood and energy. Training should be initiated immediately following baseline.

Training Phase

The training program is comprised of five tasks (Metaphor Training Program (PDF)) ordered to move a patient along a performance continuum from easier to more difficult as a way to keep patients engaged in the program. Also, some tasks build directly on other tasks. The easiest tasks require evaluation of connotative meaning of single words (Task I) or word associations (Task II). Tasks III and IV require more effort and call on a number of skills often at risk in brain-damaged patients: generation of word associations (Task III) and evaluation of patient-generated associations linking two nouns (Task IV). Finally, Task V requires selection of a metaphor ground from candidate shared associations.

Post-Training Assessment

The purpose of the post training assessment is to gauge generalization and maintenance of gains achieved during training, and, in addition, to provide a preliminary basis for interpreting any gains. Novel oral metaphor interpretation, line orientation, and quality of life were evaluated, as well as (among others) working memory span (Tompkins et al., 1994) and nonliteral language comprehension (FANL-C, Kempler & Van Lancker, 1996).

Lundgren, K., Brownell, H., Cayer-Meade, C., Milione, J., & Kearns, K. (2011). Treating Metaphor Interpretation Deficits Subsequent to Right Hemisphere Brain Damage: Preliminary Results. Aphasiology.iFirst, 1-19.  doi: 10.1080/02687038.2010.500809.

Brownell, H., Lundgren, K., Cayer-Meade, C., Milione, J., Katz, D., & Kearns, K. (2013). Treatment of Metaphor Interpretation Deficits Subsequent to Traumatic Brain Injury Damage: Results from a Preliminary Study.   Journal of Head Trauma Rehabilitation, 28(6), 446-52. doi: 10.1097/HTR.0b013e31825b5e85.