right hemisphere

causes of RHD

stroke, TBI, tumors, surgery/, infections, seizures, neurodegenerative conditions

which is the most common cause of RHD?

stroke

anosognosia

lack of awareness of personal deficits

what is the impact of anosognosia?

poor self-monitoring of errors

reduced initiation of compensatory strategies

confidently inaccurate information

safety risks (poor insight into impairment severity)

unilateral left neglect

ignored left-side stimuli (body, visual field, environment)

what is the impact of unilateral left neglect?

misses visual social cues on left side

misses written material on left side

omits left-side details in stories, picture descriptions

may fail to engage with conversation partners on left side

what modalities are affected in neglected side?

visual, auditory, somatosensory, kinetic

how is visual affected in neglected side?

omits left-side test, images, scenes

how is auditory affected in neglected side?

may not attend to speakers on left side

how is somatosensory affected in neglected side?

may not feel touch on left side

how is kinetic affected in neglected side?

decreased movement or gestures on left side

neglect dyslexia

fails to read or recognize text on left

impact on communication from neglect dyslexia

poor reading comprehension

omission of key details while reading aloud

functional reading challenges (signs, forms, instructions)

apragmatism

pragmatic impairments

how is the linguistics impacted from apragmatism?

difficulty understanding jokes, sarcasm, figurative language

struggles with inferences and gist of conversation

may be tangential or verbose, or have reduced verbal output

how is the paralinguistics impacted from apragmatism?

aprosodia - difficulty using or interpreting intonation, pitch, rhythm

how is the extralinguistics impacted from apragmatism?

reduced facial expressions, body language, and gesture use

cognitive communication deficits

impaired awareness of deficits

attention deficits (including neglect)

memory difficulties

executive dysfunction (working memory, inhibition, problem-solving, reasoning and sequencing)

coherence problems involving discourse-level communication impairments

difficulty staying on topic

omits important details

may include irrelevant or tangential information

struggles with sequencing

cohesion problems involving discourse-level communication impairments

inconsistent use of pronouns and referents

ambiguity in referring to people or events

listener confusion due to inconsistent labeling

conversational and social deficits

poor conversational initiation

difficulty maintaining topics

poor conversational repair

egocentrism or excessive self-focus

reduced empathy and interpretation of emotions

additional deficits in RHD

pseudobulbar affect (emotional lability)

dysarthria

dysphagia

hemiparesis or hemiplagia (typically left sided)

RHD symptoms are often _____ but ______

subtle ; functionally significant

what is impacted in the patient’s life if they aren’t identified early?

work, relationships and independence

attention training for RHD

visual scanning

dual-task training

visual scanning consists of

cancellation tasks

functional scanning

anchoring

scanning drills from left to right

cancellation task

crossing off targets across a page

functional scanning

finding items placed on the left side

anchoring

bold lines on left margins to cue scanning

dual task training consists of

combining cognitive and motor tasks (walking while counting, etc.)

simulate real-world multitasking (conversation while performing simple tasks, etc.)

neglect interventions consist of

leftward scanning training

highlighting technique

environmental strategies

leftward scanning training

structured exercises scanning towards the left

visual anchors and cues to guide eye movements

highlighting techniques

use colored lines or markers on left margin

verbal reminders to attend to left

environmental strategies

place important objects on left side

position conversational partners on left

aprosodia treatment (prosody)

expressive aprosodia

receptive aprosodia

compensatory strategies

expressive aprosodia

imitative approach: repeating modeled sentences

cog-linguistic approach: teaching emotional intonation rules

contrastive stress drills

receptive aprosodia

identify emotions in audio/video clips

role-playing to recognize emotional tone

comparing multiple speech samples

compensatory strategies

use nonverbal cues (facial expression, body language)

encourage explicit verbal expression of emotions

memory treatment approaches

external aids

internal strategies

restorative techniques

external aids for memory

alarms, calendars, labeled items, etc

internal strategies for memory

mnemonics, rehearsal, visualization, semantic elaboration

restorative techniques

spaced retrieval, working memory drills, computer assisted training

EF and awareness treatment

planning and predicting task perofrmance

self-monitoring and self-evaluation (challenging for this group)

strategy generation with therapist support

safety education (risk awareness)

family/caregiver involvement for feedback and support

Myth: Right hemisphere strokes are "minor.”

Fact: RHD affects cognition, communication, and social function,
often subtle but disabling.

Myth: Aphasia is worse than RHD

Fact: Both affect communication differently; RHD impacts
relationships, work, and safety.

Myth: Right hemisphere strokes don’t affect language

Fact: RHD often affects pragmatic language, discourse, inference,
and prosody

Myth: Only physical therapy is needed after RHD.

Fact: SLPs are critical for assessing and treating cognitive-communication
impairments

Myth: Neglect means “ignoring” the left side

Fact: The brain fails to attend to the left; it's not a conscious choice

Myth: People with RHD are rude/self-centered.

Fact: Damage to theory of mind networks impairs awareness of others'
emotions and perspectives