4: Right Hemisphere Brain Dysfunction (RHD) Flashcards
What is arousal?
readiness to respond to external stimuli
What is orienting?
directing attention to stimulus
What are two big types of attention?
1) sustained
2) selective
What does sustained attention do?
detect changes in stimuli
What does selective attention do?
Pays attention to specific stimuli and ignores others
What are 4 big functions of the right hemisphere?
1) attention
2) visual perception
3) emotional experience/expression
4) communciation/language
What are different types of visual perception?
1) holistic
2) spatial information
3) facial recognition
4) body image
What is body image?
can see the whole body and use accordingly for various tasks
What are the 3 big areas of communciation/lagnauge controlled by the right hemisphere?
1) discourse comprehension
2) discourse production
3) managing pragmatic skills
What is discourse comprehension?
understanding ambiguous meaning, understanding emotional tone/prosodic aspects of speech
What is discourse production?
communicative efficiecy and specificity, complex inferences in verbal exchanges, appropriate emotional expression throguh tone, approapriate prosdic aspects
What are 4 pragmatic skills?
1) turn taking
2) topic maintenance
3) social appropriateness
4) eye contact
What are 3 causes of RHBD?
1) stroke
2) tumors
3) TBI
Damage to what artery most common cause of RHBD?
right MCA
What are the 5 general characteristics of MCA RHBD?
1) visuospatial perceptual impairments
2) anosoagnosia
3) impaired pragmatics
4) impaired attention
5) changes in mood/personality
What are potential other characteristics of MCA RHBD?
1) upper extremity paralysis/paresis - contralateral limb (difficulty ambulating)
2) sensory impairment
What is the visuospatial perceptual impairment that occurs with MCA RHBD?
neglect
What is anosoagnosia?
impaired awareness of deficits
What are 3 effects MCA RHBD can have on language?
1) influence on auditory comprehension
2) verbal expression
3) reading/writing
Damage to PCA causing RHBD general characteristics: (4)
1) rare
2) chronic visual deficits
3) sensory abnormalities
4) motor weakness
What are other symptoms that can occur with PCA RHBD?
acute vision loss
What is the acute vision loss that might occur with PCA RHBD?
homonymous hemianopsia - loss of outer half of visual field in 1 eye and inner half in the other eye
What are the 2 processes of vision?
1) eyes move and take visual info to brain
2) process in interpretation of visual image
How is vision sent to brain?
each eye receives some info from right and left halves of environment, info is combined, corsses, and sent to occipital lobes
what are 5 characteristics of ACA RHBD?
1) confabulation
2) disinhibition
3) unconcern
4) anterograde and retrograde amnesia
5) limited awareness
What are 2 challenges of RHBD?
1) differ in nature/severity depending on location/lesion
2) limited pre-hospitalization info\
What are 2 large common impacted areas with RHD?
1) cognition
2) communcation
What are 3 areas of cognition that can be impacted with RHD?
1) attention
2) executive function
3) deficit awareness
What are 3 areas of communication that can be impacted by RHD?
1) langauge
2) speech
3) pragmatics
What is the impact of visual neglect and anosognia on outcomes?
poor functional outcomes for return to independent living
What are attentional difficulties that can occur with RHBD?
1) focus/maintain/shift attention
2) determining overal situational meaning
3) importnat vs not
4) identifying relationships
5) contration
What is neglect?
impairment in ability to attend to stimuli on opposite side of brain lesion
RHBD attention/neglect issues can influence what motor and/or sensory systems (4)?
1) motor - not full use of left arm/leg
2) sensory tactile - difficulty processing left side info
3) auditory - sounds on left
4) visual (neglect)
What are types of visual neglect (5)?
1) visual (most common)
2) personal
3) peripersonal
4) extrapersonal
5) reading/writing
What is personal neglect
failure to attend to one side of your body
What is peripersonal neglect?
failure to attend to items within arms reach on one side
What is extrapersonal neglect
reduced attention to things on one side beyond extend of the arm
What is reading neglect?
only read info on one side and complain it doesnt make sense
What is writing neglect outcomes? (4)
1) leave large margins on the left
2) slants upward on the right
3) letter/word omission or perseveration
4) extra lines/strokes may be added to letters
Contralateral neglect and common spatial disorders are most often seen with lesions in the _________________ hemisphere, in the _________ lobe
non-dominant
parietal lobe
Why are contralateral neglect and other common spatial disorders most often seen in the non-dominant parietal lobe (2)?
1) lesions on dominant/left typically cause big lang issues that cover up spatial issues
2) non-dominant/right parietal seems to direct attention o both visual worlds (contra- and ipsi-laterla) but dominant parietal only does contralateral (aka rt side more sig loss when affected)
What are the 2 main cognitive areas affected with RHBD?
1) memory
2) executive function
What are areas of executive function that can be impacted by RHBD?
1) organization and sequencing
2) goal directed behaviors
3) problem solving
4) reasoning
5) judgement
6) impulsivity
What are constructional impairments?
decreased performance in drawing/copying geometric figures, creating designs, etc.
What is construvctional impairment not caused by?
visual perceptual or motor imapirment
What are 4 causes of constructional impairments
1) impulsivity
2) awareness
3) decreased self correction
4) disorganized/crowded
What is topographic impairment?
difficulty relating to extrapersonal space
Difficulty with familiar routes, reading maps, and giving directions are examples of what impairment?
topographic
Topographic impairment is different than what 2 things?
1) disorientation
2) confusion
What can help someone with topographic impairment?
talking through the sequence
What is geographic disorientation?
when you can recognize their general surroundings but are mistaken about geographic location (know person, time, reason, but not specific location)
What are visoperceptual impairments?
failure to identify objects, pictures, or drawings that are incomplete/distorted
What is prosopagnosia?
facial recognition deficits - failure to identify familiar people by facial features but can if they are described
What is anosognosia?
denial of illness
Damage to what lobe most often causes anosognosia?
parietal lobe
What is the lowest level of anosognosia?
acknowledge deficit but are indifferent
What is the moderate level of anosognosia?
acknowledge deficit but underestimate severity and minimize effect
What is the severe level of anosognosia?
deny existence of major disabilities (paralysis, sensory loss, visual deficits, etc) and deny ownership of hemiplegic limbs
What are reasons that anosognosia is challenging?
1) often ignore errors
2) confabulate
3) argue
4) justify performance errors
5) think they don’t need therapy
What is the communiation impairement impact with RHDB? (3)
1) non-verbal
2) verbal
3) pragmatic
What is aprosodia?
difficulty expressing and interpreting emotion or intent conveyed through prosody
What are the 2 types of aprosodia?
1) linguistic
2) emotional
What is linguistic prosody?
issues with word emphasis and rising/falling intonation
What is emotional prosody?
intonation that relays emotion
Which type of prosody is more likely to be affected with RHBD?
emotional
What is the communication impairment impact on verbal and written production? (2)
1) reducing efficiency/effectiveness - problems conveying intent
2) disorganized, tangential, overpersonalized (say a lot but with little content)
How might reading and aud comp be affected by RHBD communication impairements?
1) reduced efficiency and effectiveness comprehending message intent
2) misinterpretation of message intent
3) difficulty comprehending nonliteral language (metaphors, idioms, sarcasm)
What effect can RHBD communication impairment have on pragmatics? (5)
1) organization/efficiency
2) eye contact
3) personal space
4) turn taking
5) topic appropriateness
About what percent of individuals with RHBD have 1+ communication impairments?
50-78%
Bilateral lesions to both the right and left PCA can result in:
cortical blindness
Damage to what 3 areas can cause issues of attention/neglect with RHBD?
1) right parietal lobe (inferior parietal lobe/temporoparietal junction/supramarginal gyrus)
2) right inferior frontal lobe
3) subcortical structures (thalamus and basal ganglia)
