NEURO - Ch5 Right Hemisphere Disorders

Visual agnosia

An inability to appropriately perceive visual stimuli that results from damage to the central nervous system, not peripheral damage to the eyes or optic nerve.

Prosopagnosia

A neurologic deficit in the specific ability to cognitively process sensory information regarding the faces of others for the purposes of recognition.

Discourse

The exchange of communicative information between a speaker and a listener or the back-and-forth among individuals participating in conversation.

Simultagnosia

A neurologic disorder that produces the inability to visually perceive many details at once.

Achromatopsia

Color blindness. Also known as color agnosia.

Neglect

A general term used to describe a deficit in the ability to attend to sensory stimuli from one side of the body or the environment.

hemibody neglect

A deficit in the ability to attend to one side of the body. Also known as personal neglect.

hemispatial neglect

A deficit in the ability to attend to one side of the environment.

motor neglect

A condition of displaying diminished use of a neglected limb despite the limb being motorically intact.

extinction

A mild case of hemispatial neglect in which the affected individual can attend to stimuli within the neglected field of attention, but only with prompting.

asomatognosia

The condition in which an individual is unable to recognize or acknowledge a part of their own body (usually an extremity) as belonging to themselves.

somatophrenia

A deficit in the ability to perceive parts of one’s own body as belonging to oneself

capgras delusion

A neuropsychiatric deficit characterized by a belief that loved ones, significant others, or family members have been replaced by imposters.

fregoli delusion

A neuropsychiatric disorder in which the affected individual believes a familiar person is able to take on the guise of another person—at times, many other people—and can assume that other person’s exact appearance.

Normal right hemisphere functions include the following:

• Processing of nonlinguistic elements of communication such as prosody, facial expression, body language, and emotion

• Math/visuospatial skills such as perception of depth, distance, and shapes

• Localizing targets in space

• Identifying figure–ground relationships

• Processing melody of music

• Perception of macrostructure or gestalt

What is Right hemisphere disorder?

Right hemisphere disorders are a group of deficits or changes that occur following damage or pathology to a person’s right cerebral hemisphere.

What are Etiologies of right hemisphere disorders?

Etiologies of right hemisphere disorders include anything that damages the right hemisphere, including stroke, disease, trauma, seizures, infections, and toxicity. The type and severity of resulting deficits or disorders depend on the location and extent of damage. Degenerative diseases can also produce right hemisphere disorders, though usually in the presence of left hemisphere syndromes as well. This is because degenerative diseases usually affect both hemispheres simultaneously.

Communication deficits associated with right hemisphere damage include deficits in the following abilities:

• Facial recognition

• Comprehension of facial expression

• Production of facial expression

• Comprehension of meaning behind prosody

• Production of normal prosody

• Inferencing

• Discourse

Visuospatial deficits associated with right hemisphere damage include the following:

• Simultagnosia, which is the inability to visually perceive multiple details at one time

What is Cerebral achromatopsia?

Cerebral achromatopsia, which is color blindness resulting from trauma or damage to the cortex that causes the individual to see in shades of gray

Attention deficits associated with right hemisphere damage include the following:

• Neglect, which is the inability to attend to or recognize the body or environment contralateral to the lesioned hemisphere

• Hemibody neglect, which is the inability to attend to sensory information concerning one side of the body

• Hemispatial neglect, which is the inability to attend to sensory information from one side of the environment

• Asomatognosia, which is a condition in which an individual is unable to recognize or acknowledge a part of her own body (usually an extremity) as belonging to her

• Somatophrenia, a subtype of asomatognosia in which a person has the perception and belief that an extremity or side of his own body belongs to someone else

• Motor neglect, which is the diminished use of a neglected limb despite it being motorically intact

• Extinction, which is a mild form of hemispatial neglect in which a person is able to attend to objects within the field of neglect, but only with prompting

• Sustained and selective attention deficits, which can cause the affected individual to miss relevant information, become distracted by irrelevant stimuli, and further lose track of the topic of conversation

What must SLP’s understand in neuropsychiatric disorders?

Speech-language pathologists must understand and recognize neuropsychiatric disorders associated with right hemisphere damage because these can present alongside and interact with communication disorders.

Neuropsychiatric disorders that result from right hemisphere damage include the following:

• Anosognosia is the inability of the affected individual to recognize or realize that he has deficits. The affected individual usually blames failures in therapy on the speech-language pathologist or caregivers and explains away failures by refusing to acknowledge the deficits.

• Depression is common in any population following disease, stroke, surgery, or trauma. However, emotional changes in individuals with a right hemisphere disorder can go unnoticed or can be masked by other deficits.

• The Capgras delusion is the affected individual’s belief that loved ones, significant others, or family members have been replaced by imposters who look and sound like the original persons.

• The Fregoli delusion is the affected individual’s belief that a familiar person is able to take on the guise of another person, at times many other people, and assumes the other person’s exact appearance.

• Visual hallucinations are when an individual perceives something visually that does not truly exist or is not there. Visual hallucinations are caused by lesions or seizure activity in the posterior right hemisphere among the visual processing areas.

• Paranoid hallucinations are hallucinations that are perceived as threatening, ominous, or foreboding

Assessment of right hemisphere disorders usually includes the following techniques:

• A case history, which includes gathering information from medical charts, medical records, and interviews with the patient and family members

• Informal testing of cognitive deficits such as prosopagnosia, facial affect, prosody, inferencing, discourse, neglect, and attention deficits

• Formal testing for right hemisphere disorders, which usually assesses language abilities not tested in formal aphasia tests such as humor, metaphor, sarcasm, facial expression, and prosody

Treatment of right hemisphere disorders includes the following:

• Tasks that target expression and comprehension of facial expressions, prosody, discourse, pragmatics, neglect, attention, and anosognosia

• Environmental manipulations to reduce distractions might include closing the window blinds, turning off the television, instructing family members to speak clearly to the patient, one person speaking at a time, and speaking in short and easy-to-follow sentences while giving plenty of repetitions of important information and breaks for the patient to process what is being said

List and explain five functions of a normal right hemisphere

Which surgical procedure led to a sudden resurgence of interest in the study of the right hemisphere during the 1960s?

List three common etiologies of right hemisphere disorders.

Where in the brain might a lesion produce prosopagnosia, and how does prosopagnosia affect communication?

How do deficits in comprehension and production of facial expression affect communication?

How do deficits in comprehension and production of prosody affect communication?

How do deficits in inferencing and discourse affect communication and pragmatics?

How are hemibody neglect and hemispatial neglect different?

How might neglect affect a patient’s life and overall prognosis?

Name three neuropsychiatric disorders that can occur as a result of right hemisphere damage.

What are three usual components of assessment for right hemisphere disorders

How can a speech-language pathologist informally assess comprehension and production of prosody?

How can a speech-language pathologist informally assess neglect?

How can a speech-language pathologist informally assess the four levels of attention?

Name two formal assessments for right hemisphere disorder.

How can a speech-language pathologist treat neglect in therapy?

How can a speech-language pathologist treat anosognosia in therapy?

How can a speech-language pathologist treat discourse deficits in therapy?

Name two environmental manipulations a speech-language pathologist can use to reduce distractions.

Name two instructions a speech-language pathologist can give family members to facilitate communication with their loved one with a right hemisphere disorder.