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Background: Proverb is representative metaphoric language used in a daily life. It has been suggested that the metaphor comprehension ability is controlled by right hemisphere in which a range of meanings of a word are activated. Therefore the right-hemisphere-damaged (RHD) patients have difficulty in appreciating the connotative relations between words. The goal of this study was to identify the ability of proverb comprehension in the RHD patients focused on the effects of familiarity and context. Methods: We investigated proverb comprehension ability of 12 RHD subjects and 12 normal control (NC) subjects using explanation task and multiple choice task. Twenty proverbs were selected and allocated into 4 conditions: familiar proverbsisolation, familiar proverbs-context, unfamiliar proverbs-isolation, and unfamiliar proverbs-context. Results: The ability of proverb comprehension in NC group was generally higher than RHD group. In explanation task, both groups comprehended familiar proverbs better than unfamiliar proverbs. With the context, comprehension ability for the unfamiliar proverb significantly improved compared to one without the context in NC group, which is not observed in the RHD group. In choice task, there was no familiarity effect in the RHD group and context effect was not significant in both groups. Conclusions: Familiarity effects on proverb comprehension were observed in both RHD and NC group in explanation task. However, the familiarity effects were not found in RHD on multiple choice tasks. It may be due to frontal lobe dysfunction such as reduced suppression function or reduced attention ability. On the other hand, when the subjects failed to figure out the meaning of unfamiliar proverbs, NC group used context effectively to interpret unfamiliar proverb, which was not observed in RHD group. The impairment of inference and integration ability of RHD group may affects utilizing contexts for comprehending unfamiliar proverbs.

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