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ALD > L9: Right Hemisphere Brain Injury > Flashcards

L9: Right Hemisphere Brain Injury Flashcards

1
Q

it is now consensually accepted that the contribution of both hemispheres …

A

is required to reach a functional level of communication

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2
Q

RHBI can occur due to

A

stroke, trauma, tumour, degenerative disease, vasculopathy, infection

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3
Q

of the patients with RHBI, _____ are right-handed adults

A

50% to 90%

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4
Q

RHBI impairments are _____, due to…

A

diverse

size and site of lesion, type of stroke

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5
Q

RH contributes to …

A

behaviours and multiple cognitive systems and processes

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6
Q

RH role in language is less clear but a growing area of literature…. only _____% of patients w RHBI referred for SLP services, ____ not the focus

A

45

communication

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7
Q

what are the 4 theoretical accounts of RHBI? (aka hypotheses)

A

Bilateral Activation Integration and Selection (BIAS)

Suppression Deficit Hypothesis

Cognitive Resource hypothesis

social cognition deficits hypothesis

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8
Q

describe Bilateral Activation Integration and Selection (BIAS) in terms of LH and RH responsibilities

A

both hemispheres process semantic info

LH responsible for fine semantic coding (activates features related to dominant, literal or contextually relevant meaning)

RH responsible for ‘coarse’ semantic coding (activates distant and unusual semantic features - evident in inferencing and nonliteral language interpretations)

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9
Q

describe Bilateral Activation Integration and Selection (BIAS) in terms of what RHBI leads to

A

reduced activation and limited selection of distant conceptual/lexical relationships

poor comprehension of implied info (ex. indirect requests)

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10
Q

suppression deficit hypothesis: discourse comprehension depends on…

A

heightened activation of info associated w contextually appropriate interpretations

suppressed activation of less appropriate or irrelevant info

AKA activate things that are relevant and suppress things that are not relevant

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11
Q

suppression deficit hypothesis: RHBI results in…

A

a delay in suppressing contextually inappropriate interpretations, especially in narrative comp

activation of competing interpretations

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12
Q

BIAS and suppression deficit hypothesis are not mutually exclusive; both…

A

complimentary for normal comprehension of language but can be differential contributors to cognitive-communication deficits in RHBI

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13
Q

cognitive resource hypothesis: RH assists LH processing when…

observed in…

A

LH’s cognitive resource capacities are exceeded (ex. attentional resources)

aka as cog demands inc RH takes on more of a role

observed in… more complex language tasks such as narrative processing (vs simple lexical decision making like noun vs verb)

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14
Q

cognitive resource hypothesis: RHBI reduces…

A

cognitive support to LH

one’s ability to comprehend complex discourse and pragmatic elements (ex. inferencing, similes, metaphors, sarcasm etc)

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15
Q

social cognition deficits hypothesis: RH plays a role in…

A

theory of mind functions:
- understand and interpret ppl’s mental state and predict and explain their behaviours
- R-dorsomedial frontal and R-temporal region

aka politeness in conversations, using and comprehending interpersonal relationship markers

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16
Q

social cognition deficits hypothesis: RHBI leads to…

A

reduced ability to engage in competent social relations and understand social information; indifference

poor integration of others feelings and perspectives

poor social judgements; reduced and self-monitoring relative to interactions w others

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17
Q

RHBI: Anosognosia is..

A

blunted awareness and insight of illness

more common in R parietal injuries

wide range of severity

linked to poorer functional outcomes

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18
Q

RHBI: prosopagnosia is..

A

impaired recognition of faces of people (famous and/or personal)

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19
Q

RHBI: topographic impairments are…

A

difficulty orienting to extra-personal space

geographic disorientation - environment agnosia

able to recognize general surroundings but not know where they are

20
Q

RHBI: reduplicative paramnesia is…

A

perceive/believe in existence of duplicate places, persons, body parts, or events

21
Q

RHBI: visuospatial impairments are…

A

difficulty w objects, pictures, drawings that are distorted or incomplete or changed from pro-typical appearance
ex. upside down table (cant tell what it is or orient it back to normal)

minimal to no issues w naturalistically displayed visual representations

likely visual organization probs more than perceptual

can occur in LHBI or RHBI - RH more common (parietal/occipital)

22
Q

RHBI: reduced sensitivity to and use of ____ expression,…..

A

facial expression, gestures, and body language

JUST non verbal comm (aprosodia is separate)

23
Q

RHBI: describe attention impairments

A

common to LHBI and RHBI, more salient in RHBI and TBI

attentional resources can be reduced or ineffectively allocated

typically 5 categories of attention organized hierarchically

24
Q

For attention, default mode network is associated with what parts of the brain? what is it responsible for

A

prefrontal cortex, posterior cingulate gyri, and intraparietal sulci

responsible for “stream of consciousness” thinking

ex. what did I eat for breakfast, what am i doing after class

25
For attention, dorsal activation network is associated with what parts of the brain? what is it responsible for
frontal eye field and dorsal parietal lobes top down attentional processes - ex. sustained - voluntary intentional processes (ex. attending to class is top down)
26
For attention, ventral attentional network is associated with what parts of the brain? what is it responsible for
large network involving regions of frontal, temporal and parietal lobes, R>L bottom up attentional processes (ex. attending to a sudden clap or loud sound, involuntary)
27
~25% of RH strokes have _____ neglect
unilateral/hemispatial/left/contralateral
28
RHBI: Unilateral neglect is ...
most often R-parietal failure to attend to stimuli and objects on side of the body opposite of brain injury primarily in vision but occurs in hearing and tactile domains "the pt is looking to their stroke" cannot be explained by sensory or motor impairments may occur in the presence (or absence) of visual field cuts and anosognosia associated w poor functional outcomes
29
in RHBI, executive function problems include...
probs w initiation, response inhibition, task persistance, organization, generative thinking, and self regulation, integration, reasoning and prob solving More specifically (maybe focus on these ones): - poor divergent thinking - probs perceiving relevant properties of a task - poor info integration and inferencing
30
RHBI: memory deficits include...
deficits in recall and recognition in nonverbal episodic memory (linked w attention and perceptual encoding probs) deficits also present in verbal episodic memory (poor performances in story mem recall, word list and paired associate learning)
31
what are the 5 communication impairments in RHBI
receptive and expression aprosodias spontaneous language: discourse impaired comprehension impaired pragmatics reading and writing
32
aprosodia =
difficulty understanding or expressing the emotional aspects of speech
33
RHBI: describe receptive and expression aprosidias
can co-occur or occur in isolation diminished ability to 'read' others slower - equal temporal spacing bw sounds, syllables, words reduced emphasis/stress patterns; flat intonation reduced pitch variability may compensate w propositional forms contributions of affect and dysarthria possible
34
RHBI: there is _____ variability in discourse production
lots of
35
RHBI: discourse considerations; naming errors occur especially for
polysemous words (ex. 'get' = procure, become, or understand)... aka more than one meaning words NOT THE SAME as anomia in those w LHBI
36
RHBI: discourse considerations; confabulatory errors are
made up events and actions
37
RHBI discourse: can sometimes be inappropriate or
terse/rude/crude
38
those with RHBI often have difficulty generating the _____structures more so than the _____structures
macrostructures = overall meaning, initial setting, gist, topic, theme microstructures = words, propositions, clauses, or turns in convo linked to selective attention probs or other cog impairments
39
RHBI 3 other discourse issues...
rambling and confused repetitive tangential and regressive fails to establish relationships among events, places, ppl
40
RHBI: describe the impaired comprehension (compare w LHBI)
most ppl w LHBI do better on discourse comp vs single word comp most ppl w RHBI show opp pattern (better single word comp) except for polysemous words (ex. appointment) probs understanding ambiguous or conflicting elements w multiple possible interpretations (ex. sarcasm, irony, figurative expressions) process narratives and conversations in 'piecemeal' not making connections among/bw characters, events, general topics, sub topics
41
RHBI: In terms of impaired comprehension, these patients can...
understand discourse when info is coherent and consistent generate predictive inferences that are supported by discourse context
42
RHBI: Describe impaired pragmatics
not all w RHBI will exhibit pragmatic deficits reduced eye contact; flat facial affect and intonation interject irrelevant/inappropriate/tangential comments probs using and understanding figurative/non literal forms (ex. metaphors) interpret figurative language literally difficulty extracting morals/themes from stories and making inferences probs understanding humour based on multiple word meanings usually unconcerned about the intent or consequences of their message
43
RHBI: Describe the reading and writing
not well researched beyond visuospatial deficits language and pragmatic findings consistent w the oral and auditory modes probs w visual scanning and tracking vertically and horizontally neglect alexias neglect agraphia
44
neglect alexias are
initial letter substitutions or deletions; performance declines when letters/graphemes are further apart vertical presentation helps reduce neglect
45
neglect agraphia is
over written and misaligned letters or words; spatial relationships dysfunctional overcrowding to R side of page or monitor Wide L-sided margins on page or screen

ALD (12 decks)

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