Right Hemisphere Disorder

Aprosodia - deficit in ability to:

1) discriminate, identify or classify prosodic patterns that signal emotion/affect, grammar, or pragmatics (receptive) and/or2) manipulate prosodic patterns to convey emotion/affect, grammar, or pragmatics (expressive)• Aprosodia in RHD tends to be difficulty with affective / emotional prosody

A comment on flat affect

Difficulty with:

Organization of output

Providing the right amount of information• Providing relevant information (e.g., tangential information included)

Cognitive impairment

Attention• Memory

Executive function skills Anosognosia

Attention impairment in RHD

Reduced attentional resources and reduced ability to efficiently allocate attentional resources

Alternating and divided attention

Attention impairment - Left neglect

Occurs in ~25% of right-hemisphere strokes

Left neglect definition

Disorder of attention to left side• Can impact visual, auditory & tactile modalities• Visuospatial most common• Can impact movement of contralesionally limb

Viewer-centered / egocentric

decreased attention to left side of visual field

Object-centered / allocentric

decreased attention to left side of object no matter where it is in visual field Region of space affected

Personal neglect

person does not pay attention to left side of body

Peripersonal neglect

affects region of space within arm's reach

Extra-personal neglect

affects region of space beyond arm's reach

Neglect alexia

omission of reading letter or words to the left of midline

Neglect agraphia

beginning writing in middle of page

Functional impact of left neglect

Performing self-care on one side of the body only (shaving, brushing hair)

Not attending to visual and auditory stimuli on left side (including conversational partners)

Bumping into things while walking

Reading and writing difficulties

Memory impairment in RHD

Declarative memory

Visual memory

Autobiographical memory

Working memory

Executive function impairment in RHD

Impairments of problem-solving, reasoning, organization, planning

Impacts on language

Disorganized and tangential communication

Anosognosia

reduced awareness of deficits

Not denial of deficits (that would require awareness)

RHD assessment

speech, language, cognition

Speech

Speech production (dysarthria)

Prosody

Language

Pragmatic language skills

Reading and writing

Macrolinguistic features of discourse (comprehension & production)

Ability to summarize, identify topic, understand gist

Organization of output (verbal and written), ability to convey gist

Cognition

Attention (including left neglect)

Memory (especially visual memory)

Executive function skills

Awareness of deficits

Receptive aprosodia

no published studies

Expressive aprosodia

limited published studies

Motoric / motor speech approach

Modeling, imitation, production in unison

Contrastive stress drills

Cognitive-affective approach

review of prosodic patterns that express emotion (volume, pitch, rate)

Compensatory strategies

for affective aprosodia, state emotions explicitly

Nonliteral language comprehension

1 study

Metaphor interpretation - identifying features common to both concepts in the metaphor explicitly to determine the intended meaning (e.g., "my job is a prison")

Contextualization

no published studies

Identification of contextual cues

E.g., "bat" - "The athlete swung the bat." - What are the 2 meanings of "bat"? What cue do you have about the meaning for the sentence?"

Social communication

behaviors of the speaker and listener in a communication exchange

no studies specifically for RHD, but can adapt from TBI literature

Explicit training in social communication, social rules, and self-monitoring

Theory of Mind

perspective taking activities

Emotion perception/recognition

explicit training in interpreting facial expressions and emotional prosody

Visual scanning treatment (VST)

repeated practice starting at the - repeated practice starting at the right

Example stimuli - symbol cancellation, picture description, reading, finding

objects or pictures

Visual anchors - highlighting on left, line guide

Verbal cues

Speech and language impairment

Dysarthria

Aprosodia

Lexical-semantic impairment• Pragmatic language impairment

Social cognition

communication-related decision-making and problem-solving