Right Hemisphere Disorders

What are typical functions of the right hemisphere?

• Non-linguistic communication (prosody, richer context)

• Math skills

• Visuospatial skills (depth, localization)

• Macrostructure or gestalt (

What are the elements of non-linguistic communication?

• emotional elements of communication

• psosody

• facial expression

• gestures

• richer context (of what's being said, differentiating between the literal vs. actual meaning)

What are the elements of visuospatial skills?

• perception of depth, distance, shapes

• identification of figure-ground relationships (focusing on an object so other things become the background)

• localization of targets in space (how close/far things are)

What does macrostructure or gestalt mean?

putting many small details together to see the larger picture

ex: we learn language in chunks, then when we can manipulate sound/language we can just so it individually (w/o chunks) to see the larger picture

What is shared between both hemispheres?

Recall, hemispheres don’t work in isolation; they work together to accomplish the goal

What change in understanding of the right hemisphere occurred in the 1960s?

Severing the corpus callosum allowed researchers to better understand hemisphere functioning

What is the role of the right hemisphere in communication?

• not involved in the linguistic aspect of communication

  • people with aphasia can still read body language, getures, facial expression

• damage can lead to social pragmatic communication deficits

RH disorders are not singular, they are a group of disorders, it plays a role in having the full communication picture

Individuals with RH damage present with communication deficits in the area of…

pragmatics

What cognitive functions are associated with the right hemisphere?

Sustained attention and selective attention

What are common causes OF right hemisphere disorders?

mainly Stroke

• disease (ex: polio, HIV)

• trauma (if on RH impact, then LH is affected, so affects the whole brain)

• seizure disorders

• infection

• toxicity

The extent of damage matters (small core & small pnumbra vs small core & big pnumbra)

• contingent on location

• severity of damage

What does NOT cause RHD?

Dementia

What disorders and deficits are associated with RH damage?

• Communication Deficits

• Visuoperceptual Deficits

• Attentional Deficits

• Neuropsychiatric disorders

What are examples of communication deficits associated with RH damage?

• facial recognition (prosopagnosia)

• Facial Expression Comprehension (comprehending facial expressions and using facial expressions)

• prosodic deficits

• inferencing deficits

• discourse deficits

What are examples of visuo-perceptual deficits associated with RH damage?

• simultagnosia

• cerebral achromatopsia

What are examples of attentional deficits associated with RH damage?

• neglect (hemispatial and hemibody)

• sustained and selective attention deficits

What are examples of neuropsychiatric disorders associated with RH damage?

• anosagnosia

• depression

• Capgras delusion

• Fregoli delusion

• visual/auditory hallucinations

• paranoid hallucinations

Communication difficulties manifest as deficits in…

pragmatics

Someone with communication deficits can be preceived as…

odd or difficult to communcate with since they take EVERYTHING literaly (doesn’t get sarcasm even if overly displayed by person)

Pragmatic deficits can be subtle compared to LH disorders since they’re more noticible

Visual Agnosia

deficit in the ability to perceive/recognize visual information (vision is intact)

a person cannot recognize visually presented objects, people, or places despite having functional eyesight and no major deficits in language, memory, or intellect

What is prosopagnosia? (facial recognition)

Individuals cannot recognize familiar faces (under visual agnosia)

ex: cannot recognize spouse or family member but can recognise keys and other objects

the ability to recognise faces isn’t just social its survival so when the RH is damaged someone loses the ability to process visual info about facial features and spatial relationships between them (how far apart eyes are)

How do individuals with prosopagnosia recognize people?

by voice, smell, clothing, or other distinctive features.

What difficulties do individuals with RH damage face in emotional recognition? (facial expression comprehension)

difficulties correctly identifying emotions on the faces of speakers (ex: if someones sad, mad)

this causes someone to be less informed on the state of a person and more literal interpretation of verbal information

since they can’t recognise facial expression they also can’t do them!

• Reduced facial expressions make social interaction challenging

• perceived as having a “flat face” since they can’t modify it

Why is facial expression comprehension important?

allows for verbal meaning to be reinforced or altered (knowing sarcasm with eye roll)

helps us sement whats being said or understand the underlying meaning

What are the two components of speech?

• Linguistic (language)

• prosodic (pitch, stress, timbre, cadence, tempo)

  • words are blended w/emotion, ex: “ITS NOT WHAT YOU SAID, ITS HOW YOU SAID IT”

What are the prosodic components?

pitch, stress, timbre, cadence, and tempo

What are prosodic deficits?

Difficulties processing prosodic components of speech

• Literal interpretation of verbal information

• Poor performance identifying the speaker’s emotion

  • Misinterpretation of sarcasm and figurative language (ex: raining cats and dogs Pt: “its not raining cats and dogs)

• Difficulties using prosody to express their own emotions

What is inferencing?

Ability to draw logical conclusions (based on expressions and facts)

• allows for appropriate perception of macrostructure components

What do inferencing deficits cause?

inability to read facial expressions (partially rooted in inferencing)

• unable to infer meaning from facial expressions

What is discourse?

The exchange of communicative information between speaker and listener

What do we need to be aware of for effective discourse?

• topic

• purpose of why we’re having a convo

• the presence and limitations of knowledge shared (ex: someone you see everyday vs not)

• the cultural background and the cultural appropriateness regaurding expression (ex: speaking to mom vs friend)

• ability to perceive breakdowns and make the needed repairs

What are common discourse deficits in individuals with RH damage?

• Lack of sensitivity to shared knowledge

• difficulties with turn-taking

• difficulties with topic maintenance

someone could be perceived as pedantic (arrogant) or stating the obvious

What is simultagnosia? (visouperceptiual deficits)

The inability to visually perceive multiple details at once, or simultaneously

• a person will perseverate on the details and not know how they fit in the whole (cannot put visual details together)

  • exists in the visual processing domain

ex: don’t know the details of mug but recognise the handle something that might be on a mug and correctly guess that the object is a mug

• if they feel the object they will perceive it as a whole because of the tactile input

What is cerebral achromatopsia? (visouperceptual deficit)

color blindness (can be congenital or acquired)

• A rare loss of color vision due to trauma or damage to the cortex, resulting in seeing only shades of gray.

What is neglect?

Inability to attend to sensory stimuli (on one side of their body or enviroment)

• the unattended side of the body or enviroment is ignored

• hyper focus in nonneglected side of body/space (ex: tilt to right)

unnatended areas of the Parietal, Temporal, Occipital lobes to leasioned hemisphere (check w/prof)

• most neglected side of body/sapce is left due to RH lesion

• right side neglect can occur of LH is impaired

What is hemibody neglect?

inability to attend to sensory stimuli on one side of their body

• often display hemiparesis (weekness on left side)

• motor neglect (diminished use of limb despite intact motor function)

What is the condition of diminished use of a limb despite intact motor function called?

hemibody neglect

What is hemispatial neglect?

inability to attend to sensory stimuli on one side of the environment

• one side of the environment is ignored ex: closing left eye so left field of vision gone

Which side of the body is most commonly neglected in hemispatial neglect?

The left side, due to right hemisphere lesions.

What is extinction in the context of hemispatial neglect?

individuals can attend to the neglected side with prompting. (mild cases)

Mild cases of hemispacial neglect is known as…

extinction

Mild cases of hemispacial neglect cause…

individuals to not be able to recognize the existence of the neglected world

• visual, auditory, and olfacotry info might be ignored

What is asomatognosia? (neglect aka attentional deficit)

The inability to perceive one's own body parts as belonging to oneself.

• can be paired w/somatophernia

What is somatophernia?

the delusion that the body part belongs to someone else (fabricating stories, disgust and aversion to their limbs)

What is sustained attention?

holding focus on a stimuli for an extended period of time

What is selective attention?

focusing on a stimuli while ignoring other surrounding stimuli (talking to a friend in a busy resturant)

Deficits in sustained and selcetive attention from RH leasions cause an individul to:selective

• miss relevant information (ex: during lectures)

• are distracted by irrelevant stimuli (crunching during lectures)

• lose track of what is being spoken of (hard to follow directions/conversing)

We need both types of attention to be able to attend, process, and understand language, important social cues and socila interactions

What is anosognosia? (neuropsychiatric disorders)

inability to recognize one's own deficits, often leading to denial of problems.

• can blame poor preformance on SLP, caregivers or refuse to acknowledge the possibilty of deficits which limit recovery EVEN though they know they had surgery/stoke

Depression

• common after disease, surgery, stroke, or trauma

• can go unnoticed/hidden by other deficits in those w/RHD (since they’re also monotone, less expressive)

• Difficulties with expression may not be indicative of their emotional state

What is the Capgras delusion?

The belief that loved ones have been replaced by an identical imposters (who look and sound like the original person)

• they cant recognise faces of loved ones and will cofabulate stories of why they’ve been replaced

• occurs in psychological disorders but also presents following an injury (damage usually in RH)

What is the Fregoli delusion?

The belief that a familiar person can take on the guise of another person.

• can mistake others as a familiar person or person in disguise (ex: can mistake a stranger walking down the street for their fomer boss who has disguised themselves) basically someone out to get them

What are visual hallucinations?

Perceptions of visual stimuli that do not exist, often due to lesions or seizure activity in posterior RH betwen visual processing areas

what are Paranoid hallucinations?

perceiving threatning visual stimuli that does not exist (someone following them)

Informal assessments of RHD include:

• prosopagnosia (show photos of family)

• facial affect (make facial expressions/name emotions)

• prosodic deficits (vary intonation)

• inferencing (give details to see if they know the season)

• discourse deficits (conversational tsaks)

• neglect (Catherine Bergergo scale)

• sustained and selective attention (provide task with music)

• alternating and divided attention (sort cards by color when prompted)

What are examples of informal assesments for negelct?

• Cancelation tasks (cross out all T’s)

• observation (only looking at right side)

• line bisection (cutting a line in half)

• line drawings (draw a clock)

• catherine bergego scale

What is the Catherine Bergego Scale used for?

To informally assess multiple areas of neglect in space (body, personal, extrapersonal).

What are examples of formal testing for RHD?

• the RH language battery

• mini inventory of right brain injury

• communication activities of daily living

• arizona battery for commnication fisorders of demntia

• ross infromation procesing assesment

note that SLPs draw components from all of these to assess RHD since the assessments aren’t as universal like for aphasia. We’re usually assessing areas of language like:

• comprehension of humor, metaphor, sarcasm, facial expression, and prosody

What is the Right Hemisphere Language Battery?

A formal test used to assess language comprehension in individuals with RHD

What are the types of therapy for individuals with RHD that SLP’s can work on?

1. Comprehension

2. Expression

3. Discourse

4. Visual Scanning

5. Sustained, selective, alternation, divided attention

6. Facilitating attention

What's an example of expression therapy?

teach patients to produce facial expressions that reflect their true emotional state (not w/PTs that have depression

How can visual scanning be improved in therapy?

By using tasks that require attention shifts toward neglected space, often with verbal cueing.

ex: shift attention far enough left to find the edge of paper

What's an example of discourse therapy?

have patients apply social skills in their interactions and detect/repair social problems.

or teach turn taking by using scripts

What is divided attention and therapy?

The ability to maintain conversation while performing another task, such as writing.

therapy: maintainting conversation while card sorting

What strategies can facilitate attention in therapy?

Reducing distractions, speaking clearly, speak one thing at a time to PT’s, and taking breaks during communication.

What's an example of comprehension therapy?

Teach patients how to discriminate changes in pitch and prosody by listening to SLP produce the same utterance with different prosody

What is alternating attention and therapy?

The ability to shift focus between different tasks or stimuli.

therapy: reading a passage then doing worksheet back & fourth

What is the Stroop task used for? (selective attention therapy)

introducing competing or distracting stimuli to a sustained attention task

What is an example of sustained attention therapy?

sorting tasks, playing UNO or board games with set set rules