Exam 2: RHS Flashcards
50% of adults with RH strokes have
cog-comm disorders
50% of adults with LH strokes have
aphasia
~95% of adults with aphasia receive
inpatient speech-language rehab treatment
~80% of adults with cog-comm disorders associated with RHS receive
inpatient speech-language rehab treatment
attention problems
50% divided attn
35% selective attn
Anosognosia
lack of awareness of deficit
*improves over time
suppression
inhibition of contextually-irrelevant meanings
semantic lang probs
suppression
figurative language
prag language probs
conversation
affect & emotion
theory of mind
nonlinguistic deficits
attn deficits
lack of awareness
visuoperceptual deficits
cog/executive dysfunction
neglect
attn deficits
may be hyper- or hypo-aroused or have difficulty sustaining attn, especially on the left side
visuoperceptual deficits
object recognition
constructional tasks (puzzles, blocks)
spatial orientation (familiar routes, moving from point A to point B)
neglect
pt. fails to report, respond, or orient to stimuli on side opposite of brain lesion (contralateral) despite the motor and sensory capacity to do so
may be one manifestation of a larger, more generalized attentional impairment; considered an intellectual and not just a perceptual deficit
neglect
Neglect in LHS
often resolves
Neglect in RHS
may persist
subtypes of neglect
viewer-centered (egocentric)
stimulus/object centered (allocentric)
egocentric neglect
“left” shifts w person’s visual focus
allocentric neglect
“left” side of objects is neglected regardless of placement in visual field
evaluation nonlinguistic deficits
cancellation
scanning
line bisection
drawing tasks
oral reading tasks
writing tasks
linguistic deficits
word discrimination
naming
following commands
word definitions
word fluency
reading & reading comp
writing
often, linguistic deficits are
mild and do not affect communication significantly
to evaluate linguistic deficits:
traditional language Ax
understanding of implied meaning of complex narratives
extralinguistic deficit
understanding humor, irony, and sarcasm
extralinguistic deficit
expressing their own intended meaning
extralinguistic deficit
using extralinguistic cues that convey emotion
extralinguistic deficit
occasionally, confabulation
extralinguistic deficit
extracting and integrating bits of info
extralinguistic deficit
generative alternative meanings
extralinguistic deficit
comprehending and expressing emotion
extralinguistic deficit
comprehending and producing prosody
extralinguistic deficit
to evaluate extralinguistic deficits
language sample (structure & content)
picture description
tell a joke and ask pt. to explain why it is funny
apragmatism
a disorder in conveying and/or comprehending meaning or intent through linguistic, paralinguistic, and/or extralinguistic modes of context-dependent communication
context of apragmatism
convo partners
environment
cultural considerations
goal of the interaction
Impact of RHS deficits on outcomes, cognitive deficits, unilateral neglect, and anosognosia
mortality
functional status on discharge
long term recovery
quality of life
dependence in ADLs
length of stay
discharge to dependent setting
participation-level outcomes
impact of apragmatism
lack of empathy
poor reader of non-verbal cues
Why do RH strokes fall through the cracks?
have to be more severe before they can be identified as easily as LH strokes
anosodiaphoria
seem indifferent to the problem (may make them less likely to seek help)
RH stroke patients are less likely to:
*get the the ED within the first 3 hours
*get clot busting drug Tx than LH strokes (but twice as likely to get tPA if they demonstrate neglect)
*undergo longer hospital stays because they typically arrive at the ED later than pts w LH strokes
social interactions will uncover deficits
better than test scores
