Module 5 RHD Flashcards
Principle of Lateralization:
the two cerebral hemispheres are structurally ? byt functionally?
LH -> ?
-verbal
-math
-verbal ?
all aspects of ?
RH ->?
similar / distinct
sequential processing:
verbal expression, WM
-mathematics
verbal logic, analysis of cause and effect
global processing
Localization of Right Hemisphere:
no clear pattern of ?
don’t get ? from damage in the RH
some believe that the RH is less ? than the left
but it is clear
deficits from specific lesions
borcas or wernickes
less focally organized
RH has diff. functions than left
RH functions:
non-verbal:
thought
mental
moti?
communication:
in..
non-literal
emotion ?
many …cues
organization
-mental flexibility (following someone else’s topic change)
-motivation
intonation
non-literal change
emotional comprehension and expression (intonation and facial expression)
-many nonverbal cues
What is Split Brain Syndrome:
occurs after.. surgically severed in order to alleviate
have anomie when ? but ca ?
when stimuli presented on left they can?
corpus callosum
seizures
anomia. presented on left/ can draw it
say it
causes of right hemisphere disorder:
..most common
–
stroke
tumor
brain injury
Consequences of stroke:
RHD-CCD
linked to
poorer outcomes
Characteristics of RHD-CCD:
cognitive deficits:
attention:
unilateral ?
executive function:
reduced awareness of ?
communication deficits:
prosody -
comprehension:
non-literal
ambig…
use of context to
production:
complex lingusitic material:
specificity of
discourse characterized by:
focused, sustained attention, alternating and divided attention
-unilateral neglect
organization, sequencing, problem solving, reasoning, judgment, insight
deficits
tone of voice and intonation to express meaning and emotion
non-literal language
-ambiguities
-use of context to determine intended meaning
efficiency and effectiveness
eye contact, facial expressions, turn taking
specificity of information, humor, morals and themes
overpersonalization, tnagential ideas, and poor organization
Cognitive deficits: attention deficits:
focused attention
selective attention
sustained attention
alternating attention
divided attention
hemispheric attention vs visual field deficits:
hemispheric attention:
this attention refers to the brain’s ability to ?
therefore inattention or neglect is a ?
inattention is NOT a loss of ?
perceive information on the contralateral side of each hemisphere
perceptual loss
loss of sight
Visual field deficits: this refers to the loss of ?
visual field deficits often result from ?
sensory information received from your eyes and sent to your brain
damage to the visual tracts
Hemispheric Visual Attention: the right hemisphere is more important than the ?
left hemisphere attends only to the ?
right hemisphere can attend to
left hemisphere for attention
right visual field
both visual fields
Hemispheric asymmetry in attention:
right parietal lobe atttends to both
right hemisphere =
left hemisphere lesion= right neglect not as
right hemisphere intact and still ?
bilateral lesion= attention to both visual fields is ? only way you can get ?
left and right hemisphere
left neglect
not as severe
attends
impaired / right hemisphere neglect
Neglect syndrome:
patients do not respond to any ?
-..info
-…info
-…info
more common with ? than ?
-hallmark for ?
-…/140 RH strokes had ?
information presented on opposite side of brain lesion
-visual info
-auditory info
-proprioceptive info
Right brain damage / left
-RHD
-78/140
Forms of Neglect:
left neglect:
-more
-more
lasts
right neglect (due to LHD)
-less
-may be masked by other
-resolves more
-usually as a result of
common
severe
longer
common
-masked by other deficits
-severe
-more quickly
-bilateral damage
Unilateral Neglect:
reduced attention to ?
NOT a ?
-but can co-occur with ?
not an ? disorder
various types of
varies by
varies over
varies depending on ?
motor neglect: reduced use of
tactile neglect: reduced ?
auditory neglect: reduced processing of ?
-poorer ?
contralesional space
-visual deficit
-hemianopsia (visual field cut)
all or none disorder
-neglect
-region of space
-over time
-stimuli, task, complexity, other attentional demands
one side of body
response/recognition of tactile stimulation
auditory stimuli from left side
-localization of sounds from left
Neglect phenomena:
magnetic ?
neglect is worse with both ?
unable to disengage attention from ?
attentional imbalance: stronger
extinction: failure to resond to ?
respond to ? but not to left stimulation when ?
attraction to right side
-R and L sided stimuli
-from right sided item to move attention to left
stronger pull to right than left
double simultaneous stimulation
-left stimulation alone/ right is also present
Types of unilateral neglect: region of space affected
personal space: one’s own ?
neglect to ?
peri-personal space: within ?
-most ?
extra-personal space: beyond?
one’s own body
-shave, dress, comb left side
within reaching distance
-common
arm’s reahc
Types of unilateral Neglect: frames of reference
viewer centered: left defined by
-… neglect
…% of cases
stimulus/object centered: … defined for each object
…neglect
..% of cases
putting things on the … won’t help
client’s view/visual field
-egocentric neglect
-28%
left defined for each object
-allocentric neglect
5% of cases
-right side
Functional problems with Left Hemispatial Neglect:
problems reading ?
-depends on
-problems with ?
need a ? like a red line across page
reduced (sometimes greatly( awareness of ?
reduced ability to complete ?
eating only what is on ?
localizing ?
left half of reading materials
-severity
-margins and spacing when writing
-visual cue
left side of body
ADLS
-right side
sounds on left
Neglect and Language:
can affect ?
neglect ?
neglect ?
begin writing in ?
… perseverations
reading and writing
-neglect alexia
dysgraphia
-middle or right side of page
letter and line
Other perceptual and attentional deficits:
… to tasks
excessive attention to ?
neglect may also occur across other ?
these pt’s have now lost their ?
prosopagnosia:
a problem of ?
impulsivity, distractability, and poor attention to tasks
irrelevant information
modalities such as tactile, olfactory, and sensory motor
independence so also psychosocial and emotional components
visual pattern recgonition necessary to idneotfy a face
Cognitive deficits: executive function deficits
pevalence ?
anecdotal evidence that adults with RHD have ?
assessment and treatment based on research with other
unknown
have exec. function deficits
other populations
Cog. deficits in RHD:
dis…
impaired ?
difficulty with ?
poor integration of ?
difficulty with ?
impaired comprehension of ?
difficulty understanding ?
lack of ?
-
decreased ?
disorientation to ?
disorientation
impaired attention
memory
information
logic, reasoning, planning and problem solving
inferred meanings
understanding humor
motivation
impulsivity
alertness
time and direction
Affective deficits in RHD:
difficulty expressing:
difficulty recognizing:
delusions and ?
depres..
apparent lack of
…
emotions
emotions of others
-facial expressions, gestures, postures
delusion and confused states
-agitated delirium, confabulations, disorientation
depression
apparent lack of motivation
apathy
Anosognosias:
occurs in… % of those with RHD
-hard to
-can resolve during
-awareness influenced by ?
anosognosia:
unilateral
physical
comm. ?
consequences of ?
7-77%
-assess
-resolve during spontaneous recovery
-motivation, fatigue, complexity
unilateral neglect
physical deficits
comm. deficits
consequences of deficits
anosognosia: reduced awareness of deficits
impacts ?
more intensive rehab recommended for ?
impacts rehab and post-rehab:
poorer
longer treatment prior to
lower ?
poorer outcome with?
impacts ?
greater distress with greater ?
referrals
-patients with greater unawareness
compliance and participation
-treatment prior to return to work
-functional status upon discharge
outcome with employment
distress with unawareness
Right hemisphere disorder and langauge:
overall impairments related to difficulty integrating ?
linguistic AND?
-complex ? sequencing? .. instructions
difficulty picking out ?
difficulty with ? oganization and complex ?
-emotional components of
-abstract
-nonverbal ?
-.. vs. ..langiage
information
-linguistic and non-linguistic
complex stories, sequencing information, verbal instructions
important versus unimportant info
thougth organization and complex linguistic forms:
-emotional components of language
-abstract forms
-nonverbal comm.
-literal versus fig. langauge
Comm. deficits: prosody
comm. functions of prosody
-pragmatic
grammatical
affective
indexical
aprosodia: inability to comprehend
prevalence:
impact
-limited
spouses cargeivers rate aprosodia as?>
draw attention to specific info
-segmenting clauses, differentiate words and sentence types
conveys emotion and mood
idiosyncratic speech patterns
or produce prosody
20-80% of people with RHD
information
-as important
Prosodic deficits: affect and comm.
aprosodia after RHD
-may affect
more commonly affects ? resulting in attenuated variation in ?
-expressive
receptive:
affect after RHD: reduced use of ?
emotional processing after RHD:
use fewer ? decreased ? and ? of emotions
-patient may appear ?
linguistic
-affective prosody / variation in stress, duration and funcamental frequency
expressive: flat, monotone
receptive: diff. interpreting others mood or emotion or intended meaning
facial expression
emotionally-laden words, decreased expression and comprheension of emotions
-rude, odd, inattentive
Comprehension process:
construction phase:
activate ?
-multiple meanings of ?
RHD can cause deficits in this stage -
integration phase:
menaings integrated into
less appropriate ?
RHD can cause deficits at this stage which impact
construct meaning of words, phrases, sentences
-ambiguous words
this stage - activation of less-common meanings
context
-meanings suppressed/inhibited
impact general comprehension
Comm. deficits: non-verbal
flat affect (facial expression)
can accompany
difficulty interpreting ?
aprosodia
body language and facial expression
Non-literal language and inferencing:
deficits after RHD:
generation of ?
can make
don’t always use at ?
revision of ?
slow/inefficient revision of ?
appreciation/use of ?
inferences
-can make inferences
-don’t aleays use relevant cues so inferences aren’t always correct
interpretation
-inference/interpretation
humor
Comm. Deficits: discourse production and pragmatics
discourse production:
pragmatics:
many studies of RHD and pragmatics:
many facotrs
no clear ?
RHD most often results in:
… discourse production
reduced
reduced use of
organization, topic selection, coherence
eye contact, turn taking, topic selection
considered
no clear patterns of deficits
disorganized, tangential, overly-personalized discourse
eye contact, turn taking
emotionally-laden words
Comm. deficits: discourse
verbal:
poor ? and diff. with ? rules
difficulty organizing and ? ideas
may have diff. staying on
tend to have excessive
understanding speaker
reduced ?
may not understand ?
reduced ?
turn taking/ conversational rules
organizing and sequencing ideas
topic
speech output
speaker intentions or internal motivations of others
flexibility
gist
informative content
Non-verbal discourse deficit:
impairment in
…
recall of
mental
unusual
comprehending and using gestures appropriately
prosopagnosia
visual forms
rotation
views
Theory of Mind:
the ability to understand that others have ?
can be affected after
might affect ?
-diff. interpreting ?
poor ?
ideas, thoughts, beliefs, feelings and emotions that differ from one’s own
RHD
language and comm.
jokes and sarcasm
coherence
