Language 3 final exam- Right Hemisphere Syndrome

What historical events led to the study of right hemisphere function?

WWI and WWII — studies of soldiers with missile wounds revealed behavioral and cognitive changes tied to right hemisphere damage

What was the purpose of split-brain studies in the 1960s, and what did they reveal?

To treat epilepsy by cutting the corpus callosum; they revealed hemispheric specialization but also interdependence

How do modern models view left/right hemisphere function?

As connectionist and collaborative systems rather than strictly specialized

Which artery is most often associated with RHS after stroke?

The right middle cerebral artery (MCA).

How does RHS differ from left hemisphere damage (aphasia)?

RHS affects pragmatics, prosody, and cognition, not syntax or grammar; language form is usually intact but communication is inefficient

List stereotypic behavioral symptoms of RHS.

Self-centeredness, social inappropriateness, denial of deficits, verbosity, tangential speech, poor emotional inflection, distractibility

Which two domains are most commonly impaired?

Perception and attention

Describe neglect and its impact.

Failure to attend to the left side of space; may omit left-side items in reading, writing, or drawings and bump into objects on the left

What brain regions are associated with neglect?

Most often the right parietal lobe, sometimes the thalamus or basal ganglia

How common is neglect in right hemisphere brain injury?

Occurs in 1/3 to over 4/5 of right-hemisphere injuries, but <1/4 of left-hemisphere injuries

How does left neglect affect reading/writing?

Reads only the right side, omits left letters or words, handwriting slants up to the right

What is motor neglect?

Failure to use or move the left limbs despite no weakness or sensory loss

Examples of neglect in daily life?

Eating only from one side of the plate, shaving one side, crashing into objects on the left, ignoring left-side clothing pockets

Define anosognosia

Denial of illness—patients minimize or deny impairments, sometimes denying ownership of affected limbs

What is confabulation?

Unintentional fabrication of false memories to fill gaps or explain situations—"honest lying"

Define constructional impairment.

Inability to reproduce designs or patterns without perceptual/motor deficits; drawings are fragmented and disorganized

What is topographic impairment?

Difficulty orienting to environments, following routes, or reading maps; may "talk themselves through" navigation

Differentiate geographic disorientation.

Patient recognizes surroundings but misidentifies location (e.g., thinks hospital is their home)

What is reduplicative paramnesia?

Belief that duplicate people, places, or events exist due to disordered spatial perception and visual memory

What is prosopagnosia?

Face blindness—inability to recognize familiar faces; may extend to animals or objects

How does RHS affect emotion recognition and expression?

Difficulty perceiving and expressing emotional tone in faces and voices

Define attention types.

Arousal: readiness to respond

Vigilance: sustained alertness

Orienting: directing attention

Sustained: maintaining focus

Selective: ignoring distractions

Alternating: shifting focus

Divided: handling multiple tasks

Describe tonic vs phasic alertness.

Tonic: readiness over time (minutes–hours)

Phasic: quick responses to stimuli; RHS patients may miss cues without warning signals

What are common attention assessments?

Stroop Test, Symbol Digit Modalities, Test of Everyday Attention, Cancellation tasks, Line Bisection

How does attention affect communication?

Deficits cause poor topic maintenance, turn-taking, and comprehension in conversation.

Relationship between working memory and divided attention?

Both require holding and manipulating information; divided attention often uses working memory (e.g., digits backward tasks)

How is prosody affected in RHS?

Speech becomes flat and monotonous with reduced pitch/loudness variation and limited gesture

Describe connected speech in RHS.

Tangential, rambling, fragmented; may include irrelevant or confabulatory details

How is discourse comprehension affected?

Difficulty identifying relationships, judging appropriateness, understanding implied meanings, idioms, or humor

What is the suppression deficit hypothesis?

RHS patients activate multiple meanings but fail to suppress irrelevant ones, leading to misinterpretation

List pragmatic impairments.

Poor eye contact, off-topic remarks, interruptions, talking excessively, failing to repair misunderstandings

What are social consequences of pragmatic deficits?

Reduced relationship satisfaction, smaller social networks, job loss or demotion

Key standardized RHS assessments?

RHLB-2, MIRBI-2, RICE-R, Burns Brief Inventory

What are RHLB-2 subtests?

Metaphor picture, written metaphor, humor appreciation, inferred meaning, lexical semantics, emphatic stress, discourse analysis

What is MIRBI-2 used for?

Brief 35-item screening across 10 domains; efficient for detecting RHS

Which tools assess pragmatics?

RHLB-2, RICE-R, CADL-2, Communicative Effectiveness Index

How is neglect assessed?

Cancellation tests, line bisection, clock drawing, copying tasks, Apples test, and Indented Paragraph Test

What does a left:right ratio >1 mean?

Presence and severity of left neglect

Why is RHS therapy less standardized than aphasia therapy?

Effects are diffuse, not focal; limited norms and research

How to manage denial of deficits?

Use structured tasks, clear goals, involve family, focus on environment modification and caregiver training

Why focus on functional attention training?

Context-based tasks (e.g., conversation, daily routines) generalize better than decontextualized drills

Example sustained attention task?

Vigilance drill—monitoring a screen and signaling when a stimulus appears

Example selective attention task?

Completing cancellation while background noise plays (e.g., Coffitivity audio)

Example alternating attention task?

Switching between adding and subtracting numbers when prompted

Example divided attention task?

Performing a cancellation task while listening for a target sound

Strategies to manage impulsivity?

Use stop-sign gestures, clear start/stop cues, and structured pacing

Problem-solving training steps?

Identify → brainstorm → evaluate → choose → apply → review

How to treat prosody deficits?

Model emotional intonation; patient imitates, then practices independently

Describe scanning training for left neglect.

Use highlighters or left margin markers; fade cues as scanning improves

What are "edgeness/bookness" cues?

Tactile or visual boundary markers to train internal left scanning, aiding generalization

How is video feedback used in pragmatics?

Review recorded conversations to identify and modify inappropriate behaviors

Activities to target inference failure?

Interpreting idioms, choosing humor punchlines, identifying absurdities, reasoning tasks

Why involve caregivers?

They reinforce carryover, manage environment, and support compensatory strategies

Define executive function (EF).

The cognitive system for planning, organizing, problem-solving, monitoring, and adapting behavior

Common EF symptoms post-RHS?

Poor initiation, disorganization, impulsivity, perseveration, inefficient goal management

What is resource allocation theory?

The brain has limited cognitive resources; performance drops when demand exceeds capacity

Tests assessing EF?

FAVRES, BADS, Six Elements Test, Wisconsin Card Sorting, Tower Test, Tinkertoy Test

What is the FAVRES used for?

Evaluates verbal reasoning, complex comprehension, planning, and rationale through functional tasks

Emotional and psychological effects after RHS?

Self-doubt, concreteness, emotional lability, egocentrism, frustration intolerance

Define emotional lability.

Exaggerated or uncontrollable emotional reactions disproportionate to events

Define concreteness.

Failure to interpret abstract meaning, humor, or others' perspectives; overly literal thinking