8e. Neurologically Based Communication Disorders and Dysphagia -- RIGHT HEMISPHERE SYNDROME and TRAUMATIC BRAIN INJURY

Question 1

Functions of the Right Hemisphere

Answer 1

• Understanding holistic gestalt stimuli, visual perception, geometric and spatial information
• Facial recognition, drawing, copying
• Arousal, attention, and orientation
• Emotional experience and expression
• Perception of musical harmony
• Certain prosodic features of communication, understanding ambiguous meanings, expressing and understanding the emotional tone of speech, understanding discourse, and pragmatic language skills

Question 2

Symptoms of R Hemisphere Syndrome/Damage

Answer 2

• Symptoms vary depending on site of lesion, but usu. incl. attentional (perceptual) and affective symptoms; communicative deficits are found in 50% of the cases
• Pure linguistic deficits (of the kind seen in agrammatic aphasia) are not typical of RHD
• R hemisphere syndrome varies in symptom complex
• Posterior lesions do not produce motor problems, whereas frontal lobe injuries do; Pts w/ frontal lobe injuries are hospitalized longer

Question 3

RHD: Attentional and Perceptual Deficits (8)

Answer 3

• Left neglect: reduced awareness of L side of body and reduced awareness of stimuli in L visual field
• Denial of Illness (anosognosia): pt may deny existence of paralyzed arm/leg abd be indifferent to admitted deficits or problems
• Confabulation re: disability: exaggerated claims re: a disabled body part
• Facial recognition deficits
• Constructional probs: diff. reproducing block designs, drawing/copying shapes, reproducing 2-d stick figures
• Attentional deficits: reduced awareness and arousal, difficulty w/ sustained and selective attention
• Disorientation: topographic (confusion about space), geographic (confusion re: where one is), reduplicative paramnesia (e.g., belief in 2 left legs or 2 wives)
• Visuoperceptual deficits: difficulty recognizing line drawings; drawings that are distorted in size, dimension, or orientation; drawings that are superimposed on another

Question 4

RHD: Affective Deficits (5)

Answer 4

• Understanding emotions other people express
• Describing emotions on printed faces in storybooks
• Recognizing emotions in isolated verbal productions
• Understanding emotional tone of voice
• Expressing emotions (diff. from experiencing emotions)

Question 5

RHD: Communicative Deficits [50%]

Answer 5

• Prosodic deficits
• Impaired discourse and narrative skill
• Confabulation and excessive speech
• Diff. understanding implied, alternative, or abstract meanings
• Pragmatic deficits
• Other comm. deficits (naming probs, comprehending complex verbal material, impaired oral reading of sentences)

[intact grammar]

Question 6

Assessment of Right Hemisphere Syndrome

Answer 6

• Standardized tests: MIRBI-2, RHLB-2, Test of Visual Neglect, Bells Test, BIT, etc
• Ct specific measures: lang. samlpes, narratives, discourse, and analysis of these observations; may assess visual-perceptual deficits by asking pt to draw simple pictures (e.g., human face, clock)

Question 7

Treatment of Right Hemisphere Syndrome

Answer 7

• Denial and Indifference: immediate feedback on errors to increase awareness; video/visual feedback
• Impaired attention: drawing attn to tx stimuli, giving specific directions to follow, repeating directions throughout tx, reinforcing attn during discourse training, stopping pt when wandering away from discourse topic
• Impulsive behavior: nonverbal signals to wait
• Pragmatic impairments: freq. reminders, video’d conversation of appropriate pragmatics
• Impaired reasoning: prompt, reinforce
• Impaired inference: reinforce
• Impaired comprehension of metaphors and idioms:…
• Visual neglect: draw thick, colorful line on L margin to force attn to text on that side; teach pt to keep finger on L side of page, pointing to beginning of each line; verbal prompts; reinforcement

Question 8

Traumatic Brain Injury (TBI): Types of TBI

Answer 8

*Penetrating aka open-head injuries
*Nonpenetrating aka closed-head injuries
*Acceleration-deceleration: more serious than
nonacceleration; head set in motion by
physical force (e.g., car accident)
*Nonacceleration: restrained head hit by moving
object

Question 9

Communication Disorders Associated w/ TBI

Answer 9

• Initial mutism that may last varying periods of time
• Confused language
• Dysarthria (spastic or mixed)
• (Confrontation) Naming difficulties
• Perseveration of verbal responses
• Reduced word fluency
• Difficulty initiating conversation
• Lack of turn-taking in conversation
• Topic initiation and maintenance
• Lack of narrative cohesion
• Impaired prosody
• Imprecise language
• Difficulty with abstract language
• Reading/writing probs
• Auditory comprehension deficits
• Generally disturbed social interaction

Question 10

General Assessment of Patients with TBI

Answer 10

Glasgow Coma Scale, BTHI, CLOCS, GOAT, DRS, Rancho Los Amigos Levels of Cognitive Function

Assessment of memory impairments incl. assessment of pre- and posttraumatic amnesia

Question 11

TBI: Treatment Approaches (2)

Answer 11

1. Cognitive Rehabilitation Approach:
   * Clinicians train components such as attention, visual processing, and memory
   * Attempts to improve memory, reasoning skills, and other cog. functions may be better integrated w/ communication treatment
2. Behavioral/Direct Communication Apprach
   * Involves direct behavioral procedures
   * Systematic reinforcement of attending behaviors, appropriate discourse, topic maintainence, self-correction, etc