WSU SLP 6480 week 10 right hemisphere disorders

normal right hemisphere function

processes certain nonlinguistic/emotional elements of communication (prosody, facial expressions, gestures, body language); math/visuospatial skills (perception of depth, distance, shapes); localizing targets in space; processing musical melody; perception of macrostructure/gestalt (parts of a whole)

right hemisphere disorders

a group of deficits or changes that occur following injury to the right cerebral hemisphere; typically NOT involved in linguistic deficits

impairments from RHD

social pragmatic communication abilities, cognitive functions that subserve language such as sustained/selective attention, that make effective linguistic communication possible

etiology of RHD

depends on location & extent of damage; any etiology that damages the right hemisphere, such as trauma, disease, seizures, infection/toxicity

when both hemispheres are damaged

it is common to have left hemisphere deficits like aphasia present simultaneously with right hemisphere deficits; often the case in TBI or multiple strokes

communication deficits associated with RHD

deficits in facial recognition, comprehension/production of facial expressions, comprehension/production of different prosody, discourse; these pragmatic deficits can be more subtle than the wholesale language deficits of those w aphasia, others perceive individuals w RHD as ‘odd’ and ‘difficult to deal with’; inferencing deficits

prosopagnosia

deficit specifically in the ability to recognize faces

visual agnosia

a general term used to describe an inability to perceive visual stimuli appropriately as a result of damage to the central nervous system and not damage to the eyes or optic nerve

prosody

the changes in pitch, stress, timbre, cadence, and tempo a person uses to infuse spoken words with emotional content

inferencing

the ability to take previous knowledge/experience and apply it to the interpretation of the meaning of details in a present situation; individuals with RHD have deficits with this

discourse

the exchange of communication information between a speaker and a listener

most common discourse deficits of those with RHD

lack of sensitivity to shared knowledge (responding appropriately), difficulties with turn taking in conversation, difficulties with topic maintenance, difficulties attending to conversation breakdowns and understanding the need to make conversational repairs

simultagnosia

the inability to visually perceive many details at once/simultaneously; individuals w this might perseverate on individual details of a picture or object and cannot see how these details fit into the whole; only exists in the visual processing domain

achromatopsia

color agnosia/color blindness, there are congenital and acquired forms

cerebral achromatopsia

acquired color blindness, rare and often results from trauma or damage to the cortex usually in the right cerebral hemisphere; individuals with this report seeing the world in shades of gray

neglect/unilateral neglect/hemineglect

refers to a person’s inability to attend to sensory stimuli from one side of the body or the environment; the side of the body or environment that is left unattended and unrecognized is contralateral to the damaged cerebral hemisphere, and because this condition is most often associated with right hemisphere lesions, the left side of the body is most commonly neglected

hemibody neglect

individuals with this cannot attend to sensory stimuli from one side of their own body and they exhibit a hyperfocus and awareness only of the nonneglected side of the body

the presence of neglect can be an important factor in determining

the overall possibility of recovery than the size of the lesion to the brain

sustained attention

the capacity to stay alert and to hold one’s attention on a single stimulus over time

selective attention

the ability to focus on one stimulus while ignoring another stimulus

without intact sustained and selective types of attention…

individuals with right hemisphere deficits miss relevant stimuli and further lose the thread of conversation; this leads individuals with RHD having difficulties communicating or acting appropriately in social situations 

primary levels of attention in hierarchal order

sustained attention

selective attention

alternating attention

divided attention

alternating attention

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

divided attention

the ability to attend to one stimulus while simultaneously attending to another stimulus (multitasking)

emotional changes & RHD

emotional changes in individuals with RHD can go unnoticed or can be masked by other deficits, it’s important for SLPs to recognize neuropsychiatric disorders associated with RHD because these can present alongside and interact with communication disorders

anosognosia

the inability of the affected individual to recognize or realize that he has deficits; explains away failures by refusing to acknowledge the deficits

depression

common in any population following disease, stroke, surgery, or trauma

visual hallucinations

when an individual perceives something visually that does not truly exist or is not there

paranoid hallucinations

hallucinations that are perceived as threatening, ominous, or foreboding

assessment of RHD

in-depth case history, informal testing of deficits associated w RHD, formal testing

case history

includes gathering information from medical charts, medical records, and interviews w the patient and family members

informal testing

includes testing of cognitive deficits such as prosopagnosia, facial affect, prosody, inferencing, discourse, neglect, & attention deficits

formal testing

assesses language abilities not tested in informal aphasia tests like humor, metaphor, sarcasm, facial expression, and prosody

RHD treatment

first responsibility of the SLP is to educate the family & caregivers regarding the nature of right hemisphere disorders; it is then appropriate to provide therapy to reduce or compensate for deficits, and then finally to encourage rehab at home when formal therapy is discontinued

treatment tasks of RHD

tasks that target expression and comprehension of facial expressions, prosody, discourse, pragmatics, neglect, attention, and anosognosia

environmental manipulations to reduce distractions during RHD treatment

closing the blinds, turning off the TV, instructing family members to speak clearly to the patient w one person speaking at a time, speaking in short and easy-to-follow sentences while giving plenty of repetitions of important info and breaks for the patient to process what’s being said