right hemisphere

arousal

level of wakefulness and the ability to respond to stimuli

sustained attention

ability to hold attention on a single stimulus

selective attention

ability to hold attention on a stimulus while ignoring the presence of a competing stimulus

alternating attention

ability to move or alternate one’s attention back and forth from one stimulus to another

divided attention

ability to attend to one stimulus while simultaneously attending to another stimulus. aka multitasking

right hemisphere functions

• perception of melody, pitch, prosody

• reading - sight words

• constructing perception of gestalt

• spatial arrangement

• working memory (0-30 sec)

• Sustained attention & vigilance

• Facial recognition

• Production and understanding of facial expression

• Emotion of expression - Prosody and facial expression

right hemisphere's role in communication

• emotion

• cognitive functions - memory, attention, perception, inferencing

• largely nonlinguistic (not nonverbal)

  • receptive and expressive

some things that can cause damage to the right hemisphere

• infection/illness

• stroke

• surgery

• TBI

• tumor

• degenerative

right hemisphere damage

• Language often intact. No aphasia.

• Deficits affecting cognition, perception, and the use of language.

a group of deficits from right hemisphere damage

• Communication deficits

• Visuoperceptual/Visuospatial disorders

• Attentional/memory deficits

• Neuropsychiatric disorders

• Others

communication deficits from right hemisphere damage

• Prosopagnosia

• Reception/expression of facial expression

• Prosodic deficits (aprosodia)

  • Sarcasm, emotional expression

• Inferencing deficits

  • (effect on the role of on abstract, figurative language, metaphor, idiom, hyperbole)?

• Discourse deficits

discorse deficit

• Discourse-exchange of info between speaker and listener.

  • Lack of normal attention  

  • Lack of perception of nonlinguistic cues

  • Lack of ability to make appropriate inferences about shared knowledge, about meaning of nonliteral language and nonlinguistic cues

• = Lack of sensitivity to shared knowledge, problems with turn-taking and topic maintenance

discorse deficits create

• Loses ability to use and comprehend prosody

  • Lead to pragmatic deficits in exp/recep language

• Deficits in ability to use and recognize facial affect

  • Result is… Facial expression and speech affect does not reflect changes in emotional state

• Inappropriate emotional reactions

  • Euphoria

  • Inappropriate laughing and giddiness

visuoperceptual/visiospatial

• Simultagnosia

• Constructional deficits (i.e. putting things together appropriately).  

  • Difficulties with puzzles

  • Inferencing deficits Humor, problem solving

  • Prosopagnosia

  • Dressing disturbances

  • Deficits in grasping gestalt

  -Heightened attention to detail

  - Can’t see the forest for the trees

  -Often leads to inappropriate conclusions

hemispatial neglect (left neglect)

R semi ceases to acknowledge sensation from L side of space (attentional field)

semi-body neglect

one is unable to attend to/acknowledge one side of body

asomatognosia

a person can attend to one’s body but are unable to recognize their own body or parts of their body as belonging to themselves

somatophrenia

the paranoid misperception paired with asomatognosia that your own body part belongs to someone else often family or friends

what follows cerebral damage

sustained/selective deficits plus usual memory difficulties

neuropsychiatric disorders

• agnosognosia

• depression

• visual hallucinations

• paranoid hallucinations

• capgras delusion

capgras delusion

• Patient believes that their close relative or loved one has been replaced by an: alien, robot, or simply a look alike who looks, acts, and sounds exactly like the original person but… just isn’t.

• May perceive the imposter to have malicious intentions or may confabulate a reason for their presence.

• Pt may accept the imposters as benign and live with them but know and behave with the knowledge that the family member is an imposter.

• Inanimate objects/pets as replicas

• Possibly a lesion disconnects cognitive recognition from the emotional response that the patient is accustomed to that recognition eliciting.

the picture generally with right hemisphere disorders is

• Apathetic

• Disregarding of social rules

• May present with flat affect and monotone

• May be very concrete in interpretation of language

• Neglect,

• May not notice anything is wrong until you’ve spent some time with them.