SLHS 539: 4/16 "Right Hemisphere Disorders"

Why isn’t Right Hemisphere Damage a large focus in SLP programs?

• Should it be? Why

• Because historically, non-dominant hemisphere strokes were not referred to SLP clinics

• Many of the symptoms/deficits that are co-morbid with RHD seem subtler than those that accompany LHD

• Primary disorders are related to nonverbal cognitive systems; so no display of word-finding and grammatical deficits associated with aphasia

• However, many of the “non-linguistic” deficits have direct impacts on linguistic abilities

  • A number of these deficits are linguistic in nature or at least paralinguistic

What are the problem areas related to right hemisphere damage? (6)

• Attentional: anosognosia (lack of recognition of a disease or impairment), proprioceptive deficits, left hemispatial neglect

• Visuospatial: topographic disorientation, constructional apraxia, prosopagnosia (face recognition deficits)

  • Auditory: amusia (inability to recognize familiar musical tones), phonagnosia (inability to recognize familiar voices)

• Social and Emotional: aprosodia (flat tone), “emotional agnosia,” (not being able to recognize other people’s emotions) pragmatics

• Theory of Mind: intention, inference, humor

• Discourse: integration, interpretation

Foreign Limb Syndrome

When an individual is hospitalized they may think that one of their limbs is not their own.

—> example of

Anosognosia

• Can symptoms overlap with left hemispatial neglect?

Lack of recognition of a disease or impairment.

Ex. A patient who can’t get out of bed on their own talks about going back to work the following week.

—> some symptoms overlap with left hemispatial neglect

Proprioception

The sense of the relative position of neighboring parts of the body.

—> A RHD individual might think someone else had touched their nose, or end up with their hand somewhere completely different.

• They might not recognize their own limbs (may be related to anosognosia)

Left Hemispatial Neglect

• What does this mean?

• Do they see the stimuli in the left visual field?

• Patients with symptom of RHD do not process stimuli in their left visual field.

• Not a visual problem (different than hemianopia), it is an attention problem.

• There is growing evidence indicating that they do see the stimuli i the left visual field, they are just not processed consciously.

T/F: Neglect is associated with a perceptual impairment.

False; not a perceptual impairment, it is an attention impairment.

What visuospatial deficits are associated with right hemisphere damage?

• Topographic Disorientation

• Constructional Apraxia

• Prosopagnosia

Topographic Disorientation

• Failure to orient to the immediate environment

• Experience “false memories” of two similar locations when only one exists in reality

Constructional Apraxia

An impairment of visuospatial motor functions (like a RH equivalent of apraxia of speech)

• Problematic for drawing

• May be related to a general global/local deficit

Prosopagnosia

• Difficulty in recognizing faces

• May confuse faces with everyday objects

• Some claim it is merely a subset where solely recognition of faces (and face-like shapes) is impaired —> debatable

What is the direct linguistic impact of these deficits?

• Reading problems (especially the left side) of words

• Writing and spelling problems, especially with letter shapes, writing sequentially

• Day to Day Conversations: Recognizing friends/family, being considered rational regarding problems, getting around, etc.

Auditory Agnosia

• Impaired ability to recognize sounds despite adequate hearing

  • May refer to deficient recognition of nonverbal or environmental sounds (auditory sound agnosia)

Amusia

aka “Music Agnosia” difficulty in recognizing familiar melodies without lyrics

Phonagnosia

Problem in recognizing people’s voices, or in deciding whether two voices are the same or different

Aprosodia

Difficulty with prosody of speech (flat tone)

Emotional Agnosia

Problems with properly identifying emotional cues (from other people)

• Hypoarousal/Hyporesponsiveness: shows less reaction than expected to emotional and disturbing pictures

• Experience difficulty with recognizing the emotional content of faces, words, and sentences.

Aprosodia

• Impaired emotional prosody (not linguistic)

• When tone of voice is linked to emotion, there is an impaired recognition of that emotion

• Productive Acropodia: flat affect/tone in speech

Phonagnosia is a disorder that can occur after right hemisphere damage. What is it characterized by?

A. Inability to hear people talking.

B. Inability to recognize musical melodies.

C. Inability to recognize people’s voices.

C. Inability to recognize people’s voices.

Hemispatial neglect can affect language abilities such as…

Reading

Speech production

Auditory speech comprehension

Reading A

Aprosodia caused by RHD is…

Specific to linguistic prosody

Specific to emotional prosody

Concern both

Emotional prosody

What are the levels of language processing?

• Lexical: word level

  • types of words/their relationships and allows for the access to the connotative meanings of words

• Sentence: RHD patients are rigid in terms of reinterpretation of an item (syntax)

• Discourse Processing: integrate info across sentences

• Theory of Mind

• Understanding Sarcasm

• Metaphor Comprehension

• Prosody: melodic line of speech that conveys info - has deficits identifying emotions involving prosody