Right Hemisphere Dysfunction Part 1

Right hemisphere CVAS (45%) occur only _____ ____ _____ than left hemisphere CVAs (55%).

• slightly less frequently

In right hemisphere CVAs, there are significant biases in (3)

• awareness/education

• stroke severity assessments

• medical treatment

General stroke scales are biased towards identification of ___ ____ ______.

• left hemisphere strokes

What is the most recognizable disorder associated with RH CVAs?

• unilateral neglect

What percentage of RH CVAs initially present with neglect?

• 25%

Data similarly suggests that patients with RH TIAs or CVAs may not present to a hospital until their stroke has extended to the point that the symptoms are severe. True ot False

True

In older adults, RHD symptoms are misinterpreted as

• effects of normal aging

There may be a reduction in the chance that an individual with a RH CVA may themselves recognize that something is wrong because of…

• reduced awareness of deficits

What can happen if patients cannot recognize that something is wrong?

• cannot get tPA drug

• longer hospital stays because of it

What is unilateral/hemispatial neglect?

• failure to respond or orient to stimuli on the side opposite the lesion

• denial of neglect is a common characteristic

• presents in visual (most common), tactile, auditory, or olfactory senses

Typical sites of lesion for neglect

Cortical: frontal, temporal, parietal

Subcortical: thalamus and basal ganglia

Professionals involved in the evaluation of neglect (4)

• physicians

• OTs

• neuropsychologists

  • SLPs

4 informal assessment tasks and describe them

• cancellation

  • simple: target stimuli are all the same

  • complex: easy to varied task difficulty (one on CLQT)

• line bisections: requires patients to bisect a horizontal line by drawing a vertical line through its center

• scanning: scanning a line of targets embedded in foils

  • assesses the influence of neglect on reading

• drawing: from memory or copying symmetrical objects

3 attentional deficits associated with RHD

• arousal and orienting

• vigilance and sustained attention

• selective attention

RH plays a special role in… What does this mean for intervention?

• arousal and orienting to external environment

Individuals with RHD have ______ _______ _______ in response to simple visual and auditory stimuli?

• slower reaction times

  • performance deteriorates over time

    • give longer wait time for processing

For selective attention, performance is dependent on 4 things

• arousal

• orienting

• vigilance

• sustained attenstion

3 assessments to evaluate attention deficits

• Burns Brief Inventory of Communication and Cognition – Right Hemisphere Inventory

• The Rehabilitation Institute Chicago Evaluation of Communication Problems in Right Hemiphere Dysfunction - 3 (RICE-3)

• Mini-Inventory of Right Brain Injury (MIRBI)

What do we know from our discussion regarding traditional vs functional approaches?

• consider embedding attention task and corresponding scaffolded supports into activities of daily living

More research is needed on the ______ and ________ of attention treatments

• efficacy and generalization

Direct attention training may be effective for ______ _____, but _________ to more functional tasks is limited.

• discrete skills

• generalization