right hemisphere disorders (E2)

etiologies of RHD

☆ CVA (cerebrovascular accident)

☆ tumors

☆ head trauma

☆ infection

communication impairments in RHD

☆ auditory comprehension

☆ verbal expression

☆ pragmatics

☆ awareness of impairments

☆ coherence

☆ organization

☆ verbosity

extralinguistic communication deficits

☆ anomalous content and organization of connected speech

→ excessive, confabulatory, and tangential speech

→ lack of cohesion

→ focusing on details rather than the gist

→ difficulty making references

☆ pragmatic language difficulty

→ eye contact

→ turn taking

→ impulsive answers to inquires

cognitive deficits

☆ left neglect

☆ anosognosia

☆ visuospatial processing deficits

☆ prosopagnosia

☆ attention deficits

☆ memory

left neglect

☆ failure to attend to stimuli from the contralateral side

☆ most common and most severe after right parietal lobe injury

anosognosia

☆ denial of illness

☆ lack of awareness of recognition of disease or disability

visuospatial processing deficits

☆ difficulty identifying objects, pictures, or drawings that are incomplete, distorted, or changed from their traditional prototypic form

☆ difficulty following familiar routes, reading maps, giving directions

prosopagnosia

☆ facial recognition deficits

☆ unable to recognize otherwise familiar persons by their facial features

attention deficits

☆ RHD plays important role in attention

☆ have some type of impaired attention, regardless of the presence of neglect

☆ less attentive and less alert

memory

☆ impaired memory

☆ recall of nonverbal visual material is particularly difficult

☆ impaired spatial orientation

goals of assessment

☆ to determine the presence, nature, and severity of deficits

☆ to determine treatment goals

☆ to monitor changes and maintenance of therapy gains

components of assessment

☆ review history (medical chart, talk to staff, etc)

☆ interview with patient (and family/caregiver)

☆ cognitive communicative evaluation

☆ formulate a diagnosis and treatment plan

test batteries used with RHD

☆ RIC evaluation of communication problems in RH dysfunction 3

☆ ross info processing assessment

☆ cognitive linguistic quick test

☆ RH lang battery 2nd ed

treatment of RHD tends to target

☆ a variety of cognitive, behavioral, and communicative impairments, combining both compensatory and impairment specific approaches 

treatment for left neglect

☆ impairment specific - practice visual scanning and search

☆ compensation - visual anchor

→ drawing a red line down the left margin of a printed page

treatment for attention

☆ compensatory strategies - compensate for reduced attention by eliminating distractions

☆ work to improve the impaired attention 

treatment for extralinguistic (higher level comm) deficits

☆ improve integration and organization skills

→ sequencing

→ grouping 

→ inferences

→ verbal reasoning and problem solving

sequencing

☆ organize pictures or sentences into a logical sentence

concrete grouping

☆ foods, tools, vehicles, etc

abstract concrete

☆ celebrations, disasters, suspicions

inferences

☆ identify items in a scene and explain the relation between them

treatment for extralinguistic deficits

☆ figurative language use

☆ producing and interpreting contrastive stress/intonation patterns and emotional prosody

LHD

☆ socially appropriate but impaired in production and comprehension of language (aphasia)

RHD

☆ socially inappropriate but with relatively intact production and comprehension of words and sentences