Right Hemisphere Disorder Pt.2

A true ____ in a patient with RHD is rare

aphasia

Someone with RHD who has a true aphasia has a _____ ______

crossed aphasia

What should you do if a true linguistic problem is suspected in a client with RHD?

• Administer subtests from aphasia batteries that test language skills in isolation

• confrontation naming

What is the treatment for a client with language problems in isolation or in addition to RHD?

traditional approaches may be used

In RHD communication disorders/cognitive-linguistic disorders, mild _____/_____ language defcits may occur, but tend to not be ____ ______

expressive/receptive, clinically significant

More generalized language deficits may be the result ______ and ______ deficits in clients with RHD

attentional and extralinguistic

Although clients with RHD typically do not have aphasia, many of them do have…

communication disorders

With respect to comprehension, patients with RHD may…

• fail to recognize essential story themes

• demonstrate difficulty integrating info

• focus on unimportant details causing them to miss the main idea

• have difficulty using cues to understand implied meaning

• not understand humor or subtleties such as irony or sarcasm

• Fail to attend to communication partners’ facial expressions, prosodic cues, or the setting of the interaction

With respect to expression, patients with RHD may…

• be inefficient and uninformative during their discourse

  • hyperfluent and digressive vs. truncated and abrupt

  • opposing patterns of output occur with approx. the same frequency in patients with RHD

• Fail to use cues that convey emotion and intention through gesture and prosody

Digressive and inefficient output may be related to…

impaired appreciation of listener needs, meaning that they are unable to judge the effects of tangentiality on conversational partners

How are discourse deficits in RHD evaluated?

• informal assessment

• patient interview

  • purpose is to obtain a sample of the patient’s conversational speech

    • can provide insight into memory, orientation, insight, compliance w/ pragmatic rules, organization, accuracy, and efficiency

• Picture description

  • can be used to assess macrostructure and integration performance

Informal assessments w/ RHD clients are used because

many standardized assessments have concerns for reliability and validity, and may not be sensitive enough to capture deficits of those with mild RHD

There is a wide range of normal conversational and pragmatic behavior, so, it is critical to…

Determine what aspects are idiosyncratic to a patient’s pre-stroke personality and which ones may be the result of brain damage

How do you respond to questions as to why the patient is seeing an SLP if the patient is not aware or in denial of deficits, and the family are “just grateful they can still talk” ?

Say that all stroke patients are tested for communication deficits, and communication consists of more than speech and language.

Macrostructure refers to…

the overall theme, central message, or main point of narratives, pictured scenes, situations, or discourse.

Patients with RHD may have difficulty generating macrostructures in ______ and _______ of complex communication

comprehension, expression

Macrostructure deficits can lead to…

• missing the point of the conversation

• being unable to convey the gist of their own messages

Clients with RHD produce fewer…

core concepts

Generation of macrostructure depends on the capacity to draw ______ or ______ info

inferences, interpret

Generating inferences depends on at least 4 operations:

• attention to individual cues

• selection of relevant cues

• integration of relevant cues with one another

• association of cues with prior experience

Macrostructure deficits could be the result of

deficits in selecting and integrating/organizing important info

Interventions for macrostructure deficits target… (5)

• themes of pictured scenes, stories, or conversational interactions

• Inferences

• Integration information

• Formulation of revisions

• Managing alternative meanings

Activities for inferencing

• label items in a scene

• specify the relevant or significant items in a scene

• point to items that are related

• explain the relationships among items

Activities targeting themes of pictured scenes, stories, or conversational interactions

• generate titles, headlines, captions, summary statements, etc.

Activities targeting integration information

• organizing printed sentences into a story or pictures into a sequence

• group info into categories

Activities targeting formulation of revisions

two sentence stories that require the client to arrive at a different conclusion following presentation of a second sentence

Activities targeting managing alternative meanings

• Generating two meanings for homographs

• Grouping sets of words according to their meanings

Goals can be made harder for RHD clients by…

• manipulating the level of inferential complexity

• vary the number of details

• vary concrete to abstract

Patients with RHD may have problems _____ and ____ emotional content

Interpreting, expressing

Impaired appreciation and expression of prosodic features of speech is called

Aprosodia

Damage to the right hemisphere can result in reduced use of ____ variation and increased use of ______ to convey empathetic emotional stress

pitch, intensity

Evaluation of prosody in RHD clients can be done by

• Asking patient to identify the emotion conveyed in sentences of neutral content (comprehension of prosody)

• Asking the patient to produce or imitate prosodic contours that highlight mood or emphatic stress (production of prosody)

Treatment of prosody may not be a priority if the patient has 

other extralinguistic deficits

Prosodic impairment can occur with few or mild RHD symptoms and can interfere with

daily interactions

What are the two avenues for intervention with prosody deficits?

• cognitive treatment

  • describing the prosodic features used to convey specific emotions

  • matching prosody to facial expressions

• motoric treatment

  • involves imitating production of different emotions

Preliminary research of prosody treatments suggest

both avenues of intervention are effective