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What's left to learn about right hemisphere damage and pragmatic impairment?

Background: The nature and causes of pragmatic impairments following right hemisphere damage (RHD) continue to pose a challenge to researchers and clinicians. It is widely accepted that impairment in pragmatic and para-linguistic aspects of language can result from unilateral damage to the right hemisphere (RH), but it still uncertain exactly what the RH's special contributions to these areas of language and communication is. Advancing our understanding of the RH's role in pragmatics and communication will require a theoretical framework for pragmatics that is suited to the clinical environment. Aims: I first sketch several theoretical approaches to pragmatics, and suggest that Perkins' (2007) emergentist approach to pragmatics is the best suited to describing and explaining communication difficulties in a clinical setting. I then consider some of the implications of adopting the emergentist approach for research on pragmatic impairment in RHD by describing three relatively unexplored areas of research in the domain of RHD and pragmatics: application of conversation analysis techniques, investigation of the contribution of perceptual impairments to pragmatic impairment, and the comparison of pragmatic impairment across clinical groups. Main Contribution: I propose that the emergentist approach to pragmatics provides a useful framework for investigating issues of pragmatic impairment in RHD and other clinical groups, and show how adopting this approach naturally leads to research in three relatively unexplored areas. Conclusions: I argue that pursuing these lines of investigation will help move forward research in RHD, pragmatic impairment, and the general role of the right hemisphere in pragmatics.