Right Hemisphere Disorder MASTERDECK

Define a Right Hemisphere Disorder

Impairments in cognition, communication, and general behavior that are a consequence of lesions in the right hemisphere of the brain

Communication deficits (RH) vs. language deficits (LH)

What are common etiologies of a RHD?

Stroke

Trauma

Brain tumor

Degenerative disease

Characteristics problems of RHD

Cognitive communication

Anosognosia — lack of awareness of own deficits

Left-sided neglect

Orientation

Attention

Organization

Memory

Reasoning

Problem-solving

Social judgement

Pragmatic language

Communicative deficits of someone with RHD

Impaired communicative effectiveness

Prosodic deficits

Impaired (disorganized) discourse and narrative skills

Confabulation and excessive speech

Difficulty understanding implied, alternate, or abstract meanings

Pragmatic deficits

Affective deficits of RHD

Understanding emotions expressed by other people

Describing emotions expressed on printed faces

Recognizing emotions expressed in isolated verbal productions

Understanding emotional tone of voice

Apathy and indifference

Difficulty expressing their own emotions through verbal and nonverbal means

What formal assessment would you use to assess someone with a RHD?

Rehabilitation Institute Chicago Evaluation of Communication Problems in Right Hemisphere Dysfunction (RICE-3)

• Determine extent of patient’s RH deficit

• 1 — Pragmatic communication, which can look at intonation, facial expression, eye contact, conversational turn-taking, topic maintenance, and more

• 2 — writing assessment, can analyze sentence organization, creation, and visuospatial letter spacing

• 3 — metaphorical language

• Additionally if patient is feeling fatigued, don’t necessarily have to do the assessment all in one sitting and can come back and administer a different subtest when they’re alert again

Treatment for RHD in the following:

• Deficit awareness

• Impaired attention

• Impulsive behavior

• Discourse

• Prosodic impairments

• Impaired reasoning

• Impaired inference

• Visual neglect

• Deficit awareness

  • Clinician provides immediate feedback on errors to increase awareness of problems

• Impaired attention

  • Drawing attention to treatment stimuli, giving specific directions, reinforcing attention to treatment stimuli, stopping the person for abrupt topic shifts or rambling

• Impulsive behavior

  • Giving nonverbal signal to wait a few seconds before giving impulsive response to questions (wait a few seconds and then tell me)

• Discourse

  • Story retelling and story generation

• Prosodic impairments

  • Variations in pitch, loudness, stress, syllable durations, and rate of speech is modeled for imitation

• Impaired reasoning

  • Use activities that require reasoning (planning a vacation) and prompt and reinforce correct and logically sequenced

• Impaired inference

  • Use of pictures that require inference

• Visual neglect

  • Visual scanning techniques (providing plenty of positive reinforcement for attending to objects on the left side)

Write a LTG and a STG for someone with RHD.