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ECU Cognitive/Linguistic Impairment in Brain-Injured Adults > 8.1 - Right Hemisphere Syndrome > Flashcards

8.1 - Right Hemisphere Syndrome Flashcards

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1
Q

Every year, more than ________ people in the United States have a stroke.

A

795,000

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2
Q

About ________ of these are first or new strokes.

A

610,000

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3
Q

About ________ strokes—nearly one of four—are in people who have had a previous stroke.

A

185,000

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4
Q

What percentage of stokes are ischemic stokes?

What are ischemic strokes?

A

About 87%

When blood flow to the brain is blocked.

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5
Q

What is processed by the Right Hemisphere?

2

A

Gestault

Whole picture

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6
Q

What is processed by the Left Hemisphere?

2

A

Analytic

Linear processing

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7
Q

What percentage of the population is right handed?

A

> 90%

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8
Q

In what percentage of right handed people is the left hemisphere is dominant for language?

A

99%

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9
Q

In what percentage of left handed people is the left hemisphere is dominant for language?

Right hemisphere?

Bilateral dominance?

A

70%

15%

15%

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10
Q

In what percentage of the ENTIRE population is the left hemisphere is dominant for language?

A

97%

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11
Q

Those who have experienced a Right Hemisphere Stroke are a __________.

A

Heterogeneous group

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12
Q

Is the Location and Extent of Lesions the same in those who have experienced a Right Hemisphere Stroke?

A

No

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13
Q

Are the Presence and Severity of Difficulties caused by Right Hemisphere Stroke the same across patients?

A

No

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14
Q

What are 6 other factors that influence communication performance in those who have experienced a Right Hemisphere Stroke?

A

Age

Cognitive ability

Educational level

Time of lesion

Individual response

Handedness

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15
Q

What 3 categories of deficits are seen in Right Hemisphere Disorders?

A

Pragmatic Deficits

Cognitive-linguistic Deficits

Discourse Deficits

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16
Q

Which category of deficits seen in Right Hemisphere Disorders most often prevents a patient from returning to work?

A

Pragmatic deficits

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17
Q

___% of individuals experiencing a right hemisphere stroke will exhibit characteristics of right hemisphere disorders resulting in communication issues that lead to inadequate or
inappropriate social interactions

A

> 50%

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18
Q

What are the 13 characteristics of Right Hemisphere Syndrome?

A

Difficulty with facial recognition

Left visual neglect

Poor awareness of deficits

Poor self-monitoring

Impulsive behavior

Poor initiation and motivation

Disorientation

Impaired attention/memory

Difficulty with organization and reasoning/problem - solving

Difficulty with social aspects of language

Difficulty understanding humor

Difficulty with word retrieval

Monotone and flat affect

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19
Q

Patients with Right Hemisphere Syndrome appear ____________, who may take little account of social communication conventions, perhaps interrupting and failing to make eye contact, or alternatively as a verbose, rambling communicator whose discourse shows tangential associations.

A

Abrupt, disinterested and insensitive communication partners

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20
Q

Patients with Right Hemisphere Syndrome exhibit impairments in the ability to ______ and _______ incoming information may also be impaired, leading to difficulties with some aspects of comprehension

A

Integrate

Interpret

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21
Q

Prosodic, affective and cognitive impairments, including ______, ______, and ______ may accompany and contribute to the communication disorder.

A

Denial

Attention deficit

Neglect

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22
Q

What are 8 conditions commonly seen in Right Hemisphere Disorders?

A

Anosognosia

Left neglect

Agnosia

Prosopagnosia

Aprosodia

Initiation problems

Social judgment/pragmatics

Cognitive-communication problem

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23
Q

What is Anosognosia?

2

A

Denial of illness

Poor self awareness

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24
Q

What is Agnosia?

A

Inability to process sensory information

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25
Q

What is Prosopagnosia?

A

Inability to recognize faces

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26
Q

What is Aprosodia?

A

Inability to communicate prosody

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27
Q

What are the three levels of denial seen in Anosognosia?

A

Mild

Moderate

Severe

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28
Q

What is MILD Anosognosia?

2

A

Acknowledge disability but unconcerned about them

Failure to notice and use

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29
Q

What is MODERATE Anosognosia?

A

Acknowledge disability but underestimate decficits and minimize the effects

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30
Q

What is SEVERE Anosognosia?

A

Reject the presence of major disabilities (paralysis, sensory loss, visual blindness, hemiplegia) or ownership of limbs

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31
Q

Is someone with SEVERE Anosognosia a good candidate for treatment?

A

No

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32
Q

What is Left Hemispatial Neglect?

4

A

Failure to respond to information presented on the side opposite (contralateral) to their brain lesion

Reduced attention to left-side input

Reduced use of left limbs

Reduced awareness of and recognition of left-sided body parts

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33
Q

What are the 2 Subtypes of Left Hemispatial Neglect?

A

Allocentric

Egocentric

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34
Q

What is Left “Allocentric” Neglect?

A

Errors on the left sides of individual stimuli (picture), regardless of location in respect to the viewer

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35
Q

What neurological are is Left “Allocentric” Neglect most strongly associated with?

A

Right superior temporal gyrus

36
Q

What is Left “Egocentric” Neglect?

A

Viewer does not see (errors) anything from the midline to the left

(The “midline” may be skewed to the right or left of the viewer)

37
Q

What neurological are is Left “ Egocentric” Neglect most strongly associated with?

A

Right angular gyrus

38
Q

What 3 Modalities (other than vision) are neglected in Right Hemisphere Disorders?

A

Tactile Neglect

Olfactory Neglect

Auditory Neglect

39
Q

What causes Neglect in Right Hemisphere Disorders?

3

A

Lesions of the right hemisphere most common cause

Damage involving the right inferior-parietal lobe or nearby
temporo-parietal junction

May be caused by lesions of inferior frontal lobe and lesions in the posterior cerebral artery

40
Q

Does anatomy really matter if there is neglect?

A

No

41
Q

Can PCA lesions result in ______ Neglect?

A

Visual

42
Q

What types of PCA Lesions can cause Visual Neglect?

A

Large lesions extending beyond occipital cortex into medial temporal lobe and including hippocampus

43
Q

What are the 2 Theories of Neglect?

A

Representational Theories

Attentional Theories

44
Q

What are Representational Theories?

2

A

The representation of space and spatial relations is mapped topographically across
hemispheres

Contralateral half of these mental representations is under-represented in patients with neglect

45
Q

What are Attentional Theories?

3

A

Reduced ability of brain to attend to information in left space

Neglect is the result of abnormalities in the distribution of attention

When attention is cued to the contralesional side, neglect is almost reduced

46
Q

What is Neglect seen primarily due to damage in the Right Hemisphere and not the Left Hemisphere?

A

Left Hemisphere is organized to only receive spatial information from the right hemifield

Right hemisphere is organized to receive spatial information from both hemifields

47
Q

What 4 Sensorimotor Deficits are seen in Right Hemisphere Syndrome?

A

Visuosensory Deficits (Hemianopia)

Hemisensory Deficits

Hemiplegia

Hypokinesia

48
Q

What is the difference between Deficit and Neglect?

A

Deficit = cannot process information from one side

Neglect = cannot attend to information from one side

49
Q

Who is aware of their lost visual field: those with visual deficits or those with visual neglect?

A

Those with visual deficits

50
Q

What is Agnosia?

2

A

Loss of ability to recognize objects, persons, sounds, shapes or smells

The specific sense is not defective nor is there any significant memory loss

51
Q

What senses may be affected in Agnosia?

3

A

Auditory

Visual

Tactile

52
Q

What is Prospagnosia?

3

A

Disorder of Facial Recognition

Inability to recognize a person simply by studying their face

No loss of knowledge of the person

53
Q

How common is Prospagnosia?

A

Rare

54
Q

What is Misidentification Syndrome?

3

A

Misidentification of place

Misidentification of persons

Misidentification limbs

55
Q

What is an example of Misidentification of Place?

A

Reduplicative paramnesia

56
Q

What is Reduplicative Paramnesia?

A

Believing that the place you are in has been duplicated and both places exist simultaneously

57
Q

What is an example of Misidentification of Persons?

A

Capgras syndrome

58
Q

What is Capgras Syndrome?

A

Believing that a known person has been replaced by an identical imposter

59
Q

What is an example of Misidentification of Limbs?

A

Somatoparaphrenia

60
Q

What is Somatoparaphrenia?

A

Elaborate explanations for lost limbs and/or hemiplegia

61
Q

What kind of COMMUNICATION difficulties are seen following a right-hemisphere stroke?

(2)

A

Cognitive-communicative disorder

Not linguistic

62
Q

What causes the COMPREHENSION difficulties are seen following a right-hemisphere stroke?

(2)

A

Concreteness

Inability to infer information

63
Q

What is the most important speech domain to assess after a right hemisphere stroke?

A

Pragmatics

64
Q

What is Aprosodia?

2

A

Impairment of speech prosody

Inability to either produce or comprehend the affective components of speech (emotional tone)

65
Q

What kind of lesions can cause Aprosodia?

A

Lesions of the right perisylvian region

66
Q

What are the 2 types of Aprosodia?

A

Expressive aprosodia

Receptive aprosodia

67
Q

What is Expressive Aprosodia characterized by?

A

“Flat speech”

68
Q

What kinds of lesions can cause EXPRESSIVE Aprosodia?

A

Right anterior lesions

69
Q

What kinds of lesions can cause RECEPTIVE Aprosodia?

A

Right posterior lesions

70
Q

What 3 RH Impairments may cause Prosodic Deficits?

A

Aprosodia

Auditory Affective Agnosia

Dysprosody

71
Q

What other 3 deficits may be cause perceived pragmatic deficits by RH Impairments?

A

Motor Speech Deficits

Language Impairments

Psychiatric Conditions

72
Q

What are 5 Pragmatic Deficits that may be seen in RH Syndrome?

A

Turn-taking

Topic maintenance

Eye contact

Interjection of irrelevant, tangential, or inappropriate comments

Generally insensitive to rules of conversation

73
Q

What 2 Linguistic Deficits may be seen in RH Syndrome?

A

Auditory Comprehension Deficits

Word Retrieval Deficits

74
Q

What 3 Auditory Comprehension Deficits may be seen in RH Syndrome?

A

Single Words

Sentences

Multi-Stage Commands

75
Q

What might Word Retrieval affect in those with RH Syndrome?

A

Verbal Fluency

76
Q

What Reduced Discourse Abilities may be seen in RH Syndrome?

5

A

Reduced ability to generate inferences

Reduced ability to comprehend and produce
main concepts and central themes

Reduced level of informative content

Reduced ability to manage alternative meanings

Reduced sensitivity to communicative content

77
Q

What types of Discourse Deficits may be seen in RH Syndrome?

A

Expressive

Comprehension

78
Q

What types of Expressive Deficits may be seen in RH Syndrome?

(8)

A

Poor macrostructure

Reduced informative content

Reduced flexibility

Reduced specificity

Reduced ability to generate alternatives

Reduced conversation structure

Excessive speech output

Unelaborated speech output

79
Q

What styles of discourse may those with RH Syndrome experience reduced sensitivity to?

(7)

A

Gist of narratives (spoken & written)

Intended/implied meaning

New info. or revision of old info

Emotional content

Paralinguistic information

Conversation rule and conventions

Communicative setting; purpose, and role of the participants

80
Q

What styles of language do those with RH Syndrome have difficulty with?

(4)

A

Figurative Language

Indirect Requests

Humor

Confabulation often seen

81
Q

The brain’s capacity to represent events is ______.

A

Limited

82
Q

Attention protects the brains limited capacity through __________ and _______.

A

Attentional selection

Habituation

83
Q

Attention is a ______ resource.

A

Limited

84
Q

Various forms of processing require __________ of attention.

A

Different degrees

85
Q

Attention is ______ and ______.

A

Unitary

Supervisory

86
Q

What do we know about the predictors of Recovery in RHD?

2

A

Little is known

Recovery data is more available for deficits such as neglect than cognitive communicative disorders

ECU Cognitive/Linguistic Impairment in Brain-Injured Adults (23 decks)

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