Right Hemisphere Disorders (RHD) Flashcards
What are non-dominant stroke patients usually referred for?
- a swallowing problem or motor speech deficit
- an old lesion in the right hemisphere in a patient who recently had a left hemisphere stroke
- communicative difficulties caused by right hemisphere stroke
Language comprehension
- sometimes perform as poorly as aphasic subjects
- can display good word comprehension, with mild deficit when presented with up to 4 semantically similar picture options
- not usually deficient in short term memory span
- may or may not follow complex directions
RHD deficits
- difficulty arranging words into a grammatical sentence
- problems with sentence comprehension with thematic roles in passive sentences
- problems identifying the essence of a paragraph or story.
- subtle
RHD language production
- tend to name common objects effectively
- word finding problems occur on divergent thinking (expansion tasks)
- tend to generate fewer words (verbal fluency)
- more problems with lexical semantics than with phonology and syntax
- errors increase with processes that are less automatic
- may score similarly on clinical tests but for different reasons : because RHD patients have impaired attention, perception and organizational skills. Deficits may be related to cognitive processing and integration.
Ansognosia
lack of awareness or recognition of disease or disability. Lack of insight or an imperceptions of the disease. the patients are unable to become aware of the neurological dysfunction.
but, denial of impairment is a psychological defense mechanism- one who is strictly in denial Is considered to be capable of awareness of deficit.
this is usually observed as lack of awareness of paralysis
visuospatial functions
WAIS scores show a pattern that is reversed relative to aphasia. RHD patients are likely to have a discrepancy score in which the performance IQ which requires visuospatial recognition and reasoning skills, is lowered relative to the verbal IQ; opposite typically seen in aphasia.
Prosopagnosia
Can’t recognize faces. Usually lesions in the right occipital-temporal lobe region.
Neglect
left neglect is more common than right neglect- patients with posterior RHD bump into things on their left, leave food on their left, etc.
Auditory Agnosia
Impaired ability to recognize sounds despite adequate hearing. May refer to deficient recognition of nonverbal or environmental sound (auditory sound agnosia)
emotion
Complex relationship between the limbic and the autonomic nervous systems- a message recognized in the cognitive cortex. Although both hemispheres are involved, the RH dominant for emotion. RHD pts may display flat affect or indifference that accompanies left neglect. Hypoarousal to emotional pictures.
Attention and Reading
tend to misread the beginning of words. Some omit or misread words on the left side of the page. Some have both of these problems. Misreading the left side of words or left side of page indicates a neglect dyslexia.
emotion and prosody
Aprosodia- flat contour or monotone. Failure to identify emotional tone in mundane sentences. unable to detect happy, sad, or angry faces. anterior damage may reflect production deficits and posterior damage may reflect recognition deficits.
interpreting situations
difficulty recognizing emotion or humor in pictured scenes; unlike aphasics. difficulties with sorting implicit themes like love from explicit themes like a hug. Have a problem with inferring the nature of situations when it is not concrete or obvious. Social pragmatics.
Metaphor comprehension
metaphor is a pragmatic convention used for studying comprehensions of speaker- meaning that differs from literal content. interefence is presumed to be necessary.
Discourse
RHDs have problems recalling explicit information. they tend to miss the point. Reduced appreciation of shared knowledge. reduced sensitivity contextual information.
