Right Hemisphere Brain Disorder (RHBD or RHD)

What are etiologies that can cause HD?

-Ischemic Stroke
-Hemorrhagic Stroke
-Trauma
-Brain Tumor
-Degenerative Disease

What are characteristic problems of RHD?

•Cognitive communication
•Anosognosia
•Left-sided neglect
•Orientation
•Attention
•Organization
•Memory
•Reasoning
•Problem-solving
•Social judgment
•Pragmatic language

What is cognitive communication?

when memory, attention, and problem solving skills are affected a higher level

What is anos

-reduced awareness
-might be aware of some deficits

when someone has anosognosia, is it possible for the client to become more aware as time goes on?

yes

What is left-sided neglect?

-they are unable to notice items on the left side
-not a vision problem, its an attention problem

What are possible challenges with orientation?

answering questions like who, where, and when

What are the types of attention?

sustained, selective, alternating, divided

What might you see if organization with some one who has RDH?

difficulty not only in terms of discourse but also having a hard time planning their day to day life

What are executive functioning skills?

-reasoning
-problem-solving
-social judgment

What does pragmatic language include?

-comprehending pragmatic language
-conveying pragmatic language

What might you see if pragmatic language is affected?

-answering surface level questions
-difficulty with in depth questions
-topic maintenance is affected

What are specific cognitive-communication impairments noted in RHD?

•Monotone voice
•Disorganized speech
•Confabulation
•Verbose with limited information
•Insensitivity to others
•Fixated on own interests
•Limited social skills
•Difficulty grasping overall significance of events
•Understanding inferences
•Fixations on irrelevant details

What might someone with RHD have monotone voice?

-right hemisphere is responsible for emotions
-if there is damage there they might have flat affect
-which can affect the voice causing monotone

What is disorganized speech?

-rambling and tangential
-have a lot of works just not content words

What are confabulations?

-difficulty with memory
-might unintentionally make things up

What problems might someone with RHD have with understanding inferences?

•Integrating verbal information into an overall theme
•Ignoring unneeded information
•Making revisions to accompany new information

What do you first want to look at with someone with RHD?

-disorder
-memory
-attention

What are some affected deficits with RHD?

•Comprehending prosody
•Understanding emotional affect in others
•Facial expressions associated with emotions
•Appearing distant and remote
•Voice often monotone

Is there a lot of research on looking at sentences of discourse treatments reporting on prosodic, expressive, and receptive, and pragmatic outcomes?

no

Who do we need the active help of with cognitive-communication disorders for RHD, working with visual spatial neglect, attention deficits lack of facial expression, and poor body language, prosody, memory, and executive functions?

OTs

What are important areas of an SLP to have goals for clients with RHD?

-using context cues to infer and difficulties getting the big picture
-Discourse
-attention deficits
-body language/facial expression
-prosody
-memory
-executive functioning

What might be included in goals for using context clues to infer and difficulties getting the big picture?

-getting the gist of a story
-idioms
-sarcasm
-getting the speaker's intent are often missed

What do you often see in discourse for someone with RHD?

-disorganized
-tangential
-taken in an over-personalized manner

Some with RHD have very limited speech output and others may be excessively verbose. They may be thought of as 'quirky' or disorganized. Symptoms vary by _________

individual

We now know that __% to __% of those with RHD have communication impairments.

50% to 78%

The verbal deficits of RHD are _______________ and ____________

-extralinguistic
-paralinguistic

About __% with RHD have communication deficits but NOT with phonology, morphonology, syntax, and semantics

50%

What do people with RHD tend to have compromised?

-attention
-memory
-visuospatial
-executive functioning skills
-suppressing incoming stimuli

People with RHD tend to have adequate ___________ __________ ___________

superficial social communication

Deficits with RHD are most apparent in conversations with more _________ _________

complex communication

What are right hemisphere cognitive deficits?

-Attention and neglect
-Organization
-Executive functioning
-Orientation
-Judgment
-Pragmatics

What are right hemisphere language deficits?

-prosody
-pragmatic language

What are dementia cognitive deficits?

-attention
-orientation
-making associations

What are dementia language deficits?

-anomia
-language comprehension
-global deficits

What are dementia memory deficits?

-working memory
-memory span
-retention
-episodic memory

What can be helpful for those with left sided neglect?

scanning and cancellation tasks

What is something you can do to help with symmetry with left-sided neglect?

Train to use a flat grid board divided in quarters to focus on all quadrants.

If someone with left side neglect is shown that there is a left side, will they be able to see it then?

yes

What should you with someone who has RHD on attention and neglect issues?

work directly on them

What are some compensatory aids that increase left-side scanning?

•Verbal cues
•"Look to left" with highlighting,
•Lighthouse procedure,
•Cancellation tasks,
•Trail-making, letters, numbers, etc.

What is the lighthouse procedure?

-tell the client to imagen they are a light house
-you are going to scan every material that you have

What might you use to help with attention and neglect?

highlighters
stick notes

What are the areas of attention for treatment?

-sustained
-selective
-alternating
-divided

What is sustained attention?

focus on one thing

What is selective attention?

maintaining attention given distractions

What is alternating attention?

switching focus

What is divided attention?

doing two things at once

What should you take notes on around areas od attention treatment?

-arousal
-orienting
-vigilance

What is vigilance?

integrating multiple pieces of information to help you make a decision

What are visual perceptual deficits?

-Prosopagnosia
-simultagnosia
-visual agnosia
-visual discrimination deficits
-visual integration deficits
-visual imagery deficits
-spatial disorientation especially for two-dimensional images

What is prosopagnosia?

a term that refers to a person's inability to recognize faces of individuals including one's own face.

What is simultagnosia?

a term that refers to a person's inability to focus attention on the whole image. Rather, they only focus on one part at a time (nose on a face).

What is visual agnosia?

an inability to recognize objects (visual agnosia) or colors (achromatopsia).

What are visual discrimination deficits?

poor detail awareness

What are visual integration deficits?

difficulty seeing the whole picture

What are visual imagery deficits?

difficulty reading facial expression

What are spatial disorientation especially for?

two-dimensional images

What kind of difficulties will someone with RHD have with daily functions?

-finding his/hay around
-self grooming
-answering questions appropriately
-staying on topic
-Inhibiting interruptions
-being organized