On making a sandwich: Procedural discourse in adults with right-hemisphere damage

In a clinical language evaluation, procedural discourse is often afforded less emphasis than either narrative or expository discourse. Yet, the generation of procedural discourse is a highly complex task that demands the integration of a range of cognitive-linguistic skills. The aim of this paper will be to investigate those skills with a view to demonstrating the potential diagnostic significance of procedural discourse in a clinical language evaluation. The context for these remarks will be the study of seven adults with right-hemisphere damage who were studied at two clinical facilities in the United States. These adults were recorded as they attempted to explain to an examiner how they would make a peanut butter and jelly (jam) sandwich. An analysis of the discourse produced by these adults reveals a complex and highly variable profile of skills and deficits. It will be argued that this profile is a consequence of cognitive and linguistic heterogeneity in the RHD population, with language impairment manifesting itself in different ways across a range of clients.