8.1 - Right Hemisphere Syndrome Flashcards
Every year, more than ________ people in the United States have a stroke.
795,000
About ________ of these are first or new strokes.
610,000
About ________ strokes—nearly one of four—are in people who have had a previous stroke.
185,000
What percentage of stokes are ischemic stokes?
What are ischemic strokes?
About 87%
When blood flow to the brain is blocked.
What is processed by the Right Hemisphere?
2
Gestault
Whole picture
What is processed by the Left Hemisphere?
2
Analytic
Linear processing
What percentage of the population is right handed?
> 90%
In what percentage of right handed people is the left hemisphere is dominant for language?
99%
In what percentage of left handed people is the left hemisphere is dominant for language?
Right hemisphere?
Bilateral dominance?
70%
15%
15%
In what percentage of the ENTIRE population is the left hemisphere is dominant for language?
97%
Those who have experienced a Right Hemisphere Stroke are a __________.
Heterogeneous group
Is the Location and Extent of Lesions the same in those who have experienced a Right Hemisphere Stroke?
No
Are the Presence and Severity of Difficulties caused by Right Hemisphere Stroke the same across patients?
No
What are 6 other factors that influence communication performance in those who have experienced a Right Hemisphere Stroke?
Age
Cognitive ability
Educational level
Time of lesion
Individual response
Handedness
What 3 categories of deficits are seen in Right Hemisphere Disorders?
Pragmatic Deficits
Cognitive-linguistic Deficits
Discourse Deficits
Which category of deficits seen in Right Hemisphere Disorders most often prevents a patient from returning to work?
Pragmatic deficits
___% 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
> 50%
What are the 13 characteristics of Right Hemisphere Syndrome?
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
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.
Abrupt, disinterested and insensitive communication partners
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
Integrate
Interpret
Prosodic, affective and cognitive impairments, including ______, ______, and ______ may accompany and contribute to the communication disorder.
Denial
Attention deficit
Neglect
What are 8 conditions commonly seen in Right Hemisphere Disorders?
Anosognosia
Left neglect
Agnosia
Prosopagnosia
Aprosodia
Initiation problems
Social judgment/pragmatics
Cognitive-communication problem
What is Anosognosia?
2
Denial of illness
Poor self awareness
What is Agnosia?
Inability to process sensory information
What is Prosopagnosia?
Inability to recognize faces
What is Aprosodia?
Inability to communicate prosody
What are the three levels of denial seen in Anosognosia?
Mild
Moderate
Severe
What is MILD Anosognosia?
2
Acknowledge disability but unconcerned about them
Failure to notice and use
What is MODERATE Anosognosia?
Acknowledge disability but underestimate decficits and minimize the effects
What is SEVERE Anosognosia?
Reject the presence of major disabilities (paralysis, sensory loss, visual blindness, hemiplegia) or ownership of limbs
Is someone with SEVERE Anosognosia a good candidate for treatment?
No
What is Left Hemispatial Neglect?
4
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
What are the 2 Subtypes of Left Hemispatial Neglect?
Allocentric
Egocentric
What is Left “Allocentric” Neglect?
Errors on the left sides of individual stimuli (picture), regardless of location in respect to the viewer
What neurological are is Left “Allocentric” Neglect most strongly associated with?
Right superior temporal gyrus
What is Left “Egocentric” Neglect?
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)
What neurological are is Left “ Egocentric” Neglect most strongly associated with?
Right angular gyrus
What 3 Modalities (other than vision) are neglected in Right Hemisphere Disorders?
Tactile Neglect
Olfactory Neglect
Auditory Neglect
What causes Neglect in Right Hemisphere Disorders?
3
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
Does anatomy really matter if there is neglect?
No
Can PCA lesions result in ______ Neglect?
Visual
What types of PCA Lesions can cause Visual Neglect?
Large lesions extending beyond occipital cortex into medial temporal lobe and including hippocampus
What are the 2 Theories of Neglect?
Representational Theories
Attentional Theories
What are Representational Theories?
2
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
What are Attentional Theories?
3
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
What is Neglect seen primarily due to damage in the Right Hemisphere and not the Left Hemisphere?
Left Hemisphere is organized to only receive spatial information from the right hemifield
Right hemisphere is organized to receive spatial information from both hemifields
What 4 Sensorimotor Deficits are seen in Right Hemisphere Syndrome?
Visuosensory Deficits (Hemianopia)
Hemisensory Deficits
Hemiplegia
Hypokinesia
What is the difference between Deficit and Neglect?
Deficit = cannot process information from one side
Neglect = cannot attend to information from one side
Who is aware of their lost visual field: those with visual deficits or those with visual neglect?
Those with visual deficits
What is Agnosia?
2
Loss of ability to recognize objects, persons, sounds, shapes or smells
The specific sense is not defective nor is there any significant memory loss
What senses may be affected in Agnosia?
3
Auditory
Visual
Tactile
What is Prospagnosia?
3
Disorder of Facial Recognition
Inability to recognize a person simply by studying their face
No loss of knowledge of the person
How common is Prospagnosia?
Rare
What is Misidentification Syndrome?
3
Misidentification of place
Misidentification of persons
Misidentification limbs
What is an example of Misidentification of Place?
Reduplicative paramnesia
What is Reduplicative Paramnesia?
Believing that the place you are in has been duplicated and both places exist simultaneously
What is an example of Misidentification of Persons?
Capgras syndrome
What is Capgras Syndrome?
Believing that a known person has been replaced by an identical imposter
What is an example of Misidentification of Limbs?
Somatoparaphrenia
What is Somatoparaphrenia?
Elaborate explanations for lost limbs and/or hemiplegia
What kind of COMMUNICATION difficulties are seen following a right-hemisphere stroke?
(2)
Cognitive-communicative disorder
Not linguistic
What causes the COMPREHENSION difficulties are seen following a right-hemisphere stroke?
(2)
Concreteness
Inability to infer information
What is the most important speech domain to assess after a right hemisphere stroke?
Pragmatics
What is Aprosodia?
2
Impairment of speech prosody
Inability to either produce or comprehend the affective components of speech (emotional tone)
What kind of lesions can cause Aprosodia?
Lesions of the right perisylvian region
What are the 2 types of Aprosodia?
Expressive aprosodia
Receptive aprosodia
What is Expressive Aprosodia characterized by?
“Flat speech”
What kinds of lesions can cause EXPRESSIVE Aprosodia?
Right anterior lesions
What kinds of lesions can cause RECEPTIVE Aprosodia?
Right posterior lesions
What 3 RH Impairments may cause Prosodic Deficits?
Aprosodia
Auditory Affective Agnosia
Dysprosody
What other 3 deficits may be cause perceived pragmatic deficits by RH Impairments?
Motor Speech Deficits
Language Impairments
Psychiatric Conditions
What are 5 Pragmatic Deficits that may be seen in RH Syndrome?
Turn-taking
Topic maintenance
Eye contact
Interjection of irrelevant, tangential, or inappropriate comments
Generally insensitive to rules of conversation
What 2 Linguistic Deficits may be seen in RH Syndrome?
Auditory Comprehension Deficits
Word Retrieval Deficits
What 3 Auditory Comprehension Deficits may be seen in RH Syndrome?
Single Words
Sentences
Multi-Stage Commands
What might Word Retrieval affect in those with RH Syndrome?
Verbal Fluency
What Reduced Discourse Abilities may be seen in RH Syndrome?
5
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
What types of Discourse Deficits may be seen in RH Syndrome?
Expressive
Comprehension
What types of Expressive Deficits may be seen in RH Syndrome?
(8)
Poor macrostructure
Reduced informative content
Reduced flexibility
Reduced specificity
Reduced ability to generate alternatives
Reduced conversation structure
Excessive speech output
Unelaborated speech output
What styles of discourse may those with RH Syndrome experience reduced sensitivity to?
(7)
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
What styles of language do those with RH Syndrome have difficulty with?
(4)
Figurative Language
Indirect Requests
Humor
Confabulation often seen
The brain’s capacity to represent events is ______.
Limited
Attention protects the brains limited capacity through __________ and _______.
Attentional selection
Habituation
Attention is a ______ resource.
Limited
Various forms of processing require __________ of attention.
Different degrees
Attention is ______ and ______.
Unitary
Supervisory
What do we know about the predictors of Recovery in RHD?
2
Little is known
Recovery data is more available for deficits such as neglect than cognitive communicative disorders
