Right Hemisphere Stroke (RHD) and Disorder Notes

Right Hemisphere Disorder (RHD) typically arises from a stroke or other acquired injuries affecting the right hemisphere of the brain.
Commonly underreported as patients may lack insight into their deficits and practitioners may not easily identify symptoms compared to left hemisphere strokes.
Studies indicate that approximately 40-50% of stroke cases involve right hemisphere strokes (data from 2013, 2015, and 2022).

Right hemisphere strokes occur in a similar rate to left hemisphere strokes across various age groups and stroke types (transient ischemic attack, ischemic, hemorrhagic).
There may be a slight increase in left hemisphere strokes due to differences in vascularization.

Popular belief: "Left-brained = logical, analytical" vs. "Right-brained = artistic, creative" is inaccurate.
Brain functions are more integrated than this classification suggests.
Left hemisphere excels in detail-oriented tasks, especially linguistic information, while the right hemisphere is adept at big-picture and spatial processing.

Pragmatics: Difficulty in conveying or comprehending social language and context.
Discourse: Challenges with producing and understanding extended verbal and written communication.
Cognitive Communication: Impairments in attention, memory, and executive functioning.
Anosognosia: Reduced awareness of their neurological deficits, often leading to safety concerns.

Prosody: Approximately 50-75% of individuals may experience asprosody, affecting the natural intonation and emotional quality of speech (speaking in a flat, emotionless tone).
Visual Inattention/Neglect: Inability to process sensory information from the left visual field due to brain damage. This includes:
- Spatial Neglect: Reduced awareness of stimuli on one side of the visual field, primarily the left.
  - Personal Neglect: Disregarding personal hygiene or body parts on the neglected side.
  - Neglect Dyslexia: Reading deficits where letters are missed or misinterpreted.

Examples of Discourse Production: Patients with RHD may accurately describe minute details (like paper quality) but fail to grasp the broader context (like a cookie theft image).
Patient Drawings: Patients might skip drawing or acknowledging details on the neglected side (missing numbers on a clock or petals on a flower).

Behavioral Intention Test: Measures severity of left visual field neglect through tasks such as line crossing and letter cancellation.
Mini Inventory of Right Brain Injury (MERBI): Evaluates visual attention, cognitive communication and figurative language understanding.

Tasks incorporated into broader tests (e.g., circling shapes or completing lines) can help identify neglect symptoms, even if not specifically designed for RHD.

Providing feedback on task performance to boost understanding of deficits.
Encourage patients to predict outcomes and reflect on performance to raise awareness of their limitations.

Utilize visual scanning tasks encouraging leftward gaze, leveraging verbal or tactile cues to direct attention (e.g., bright tape).
Present sentences or tasks that extend across the page to engage both visual fields.

Incorporating family and caregivers into treatment to reinforce concepts taught during sessions and enhance patient awareness.

Utilize virtual reality or apps designed to improve visual attention and neglect by providing immediate feedback on performance during interactive tasks.