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Aphasia > Right Hemisphere Dysfunction > Flashcards

Right Hemisphere Dysfunction Flashcards

1
Q

Hemispheric Asymmetry

A
  • the right and left hemispheres of the brain are anatomically and functionally asymmetrical
  • differences are greatest in certain areas surrounding the sylvian fissure
  • sylvian fissure is slightly longer in the left hemisphere than on the right
  • planum temporale is a part of the superior surface of the superior temporal gyrus; this area is larger on the left than the right for most people
  • left temporal opercular region is larger and more infolded on the left than on the right; region is aka Broca’s area
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2
Q

Hemisphere connections

A
  • the two hemispheres are well connected via the corpus callosum
  • contains more than 300 million axons aka commissural fibers
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3
Q

Right Brain

A
  1. uses feeling
  2. “big picture” oriented
  3. imagination rules
  4. symbols and images
  5. present and future
  6. philosophy and religion
  7. can “get it” (meaning)
  8. believes/appreciates
  9. spatial perception
  10. knows objects function
  11. fantasy based
  12. present possibilities
  13. impetuous and risk takers
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4
Q

Left Brain

A
  1. uses logic
  2. detail oriented
  3. facts rule
  4. words and language
  5. present and past
  6. math and science
  7. can comprehend
  8. knowing/acknowledges
  9. order/pattern perception
  10. knows object name
  11. reality based
  12. forms strategies
  13. practical and safe
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5
Q

Left Hemisphere:
1. Language (6)

  1. Constructions
A
  1. Speaking Aloud

Auditory Comprehension

Naming

Reading Comprehension

Reading Aloud

Writing

  1. Internal detail
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6
Q

Left Hemisphere:
1. Calculation

  1. Memory
  2. Miscellaneous
A
  1. Arithmetic processing
  2. Verbal
  3. Praxis
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7
Q

Right Hemisphere:
1. Language

  1. Constructions
A
  1. Auditory Comprehension

Reading Comprehension

Prosodic Expression

Prosodic Comprehension

  1. External configurations
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8
Q

Right hemisphere:
1. Calculation

  1. Memory
  2. Miscellaneous
A
  1. Spatial arrangement
  2. Visuospatial
  3. Facial recognition
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9
Q

Right hemisphere functions

A
  • the right brain is seemingly responsible for:

— arousal, orientation and attention

— visual perception

— emotional experience and expressions

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10
Q
  1. Arousal
  2. Orientation
  3. Vigilance
A
  1. Arousal- general readiness to respond to external stimuli (alert, ready to react)
  2. Orientation- directing one’s attention to a specific stimulus, event, or location
  3. Vigilance- sustained attention used to detect changes in a stimulus
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11
Q
  1. Selective attention

2. Sustained attention

A
  1. ignoring a distracting stimuli while paying attention to the relevant stimuli
  2. prolonged attention to a task (sustain your focus)
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12
Q

Visual Perception:

The right hemisphere appears to process:

A
  1. holistic, gestalt-like stimuli
  2. geometric and spatial information
  3. facial recognition
  4. body image
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13
Q
  1. holistic, gestalt-like stimuli
  2. geometric and spatial information
  3. facial recognition
  4. body image
A
  1. Holistic, gestalt-like stimuli- looking at the big picture- grasping the meaning of the total picture
  2. Geometric and spatial information- understanding, recognizing spatially organized shapes or figures
  3. Facial recognition- responsible for recognizing familiar faces. Your four to ten month old infants will show an interest in their mother’s face
  4. Body image- Helps you maintain a proper body image. Feelings of an acceptable body image, what you feel is acceptable socially
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14
Q

The right hemisphere is dominant for:
1. emotions

  1. perceptions of temporal order
  2. perception of musical harmony
  3. certain aspects of communication
A
  1. emotions: expression of being angry, happy, sad, etc. and understanding how those emotions effect you based on the stimuli you are getting from the environment
  2. perceptions of temporal order: dominate for perceiving the temporal order or sequence of events
  3. perception of musical harmony: music and processing of acoustic signals
  4. certain aspects of communication: pragmatics, prosody, semantics, and discourse
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15
Q

Communicative Functions 1

A
  • possible interplay b/w the right and left hemispheres with regards to discourse comprehension and production
  • right hemisphere may be less efficient in understanding verbs than nouns
  • right hemisphere may help make inferences implied in verbal exchanges
  • communicative efficiency and specificity may be centered in the right hemisphere
  • understanding alternative and ambiguous meanings
  • understanding or expressing emotional tone of verbal expression
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16
Q

Communicative Functions 2

A
  • understanding or expressing prosodic aspects of speech
  • understanding contextual information of verbal expression
  • managing pragmatic communication skills

– turn-taking

– topic maintenance

– social appropriateness of communication

– eye contact

17
Q

Neuropathologies of Right Hemisphere Dysfunction

A
  • etiologies: CVA, tumors, head trauma and various neurological disease processes
  • individuals who sustain RHD secondary to posterior lesions do not have motor disabilities; those with frontal lobe damages will have motor disturbances
18
Q

Functional Involvement

common grouping of deficits

A
  • varied symptoms Pts w/RHD might exhibit may be grouped according to:
  • perceptual and attention deficits
  • affective deficits
  • communication deficits
19
Q

Perceptual and attention deficits

A
  • left-neglect- - reduced sensitivity or absence of responses on their left side or left visual field
  • visuospatial impairments
  • forms of disorientation
20
Q

Left Neglect

A
  • reduced sensitivity to stimuli, reduced awareness of space or absence of previously learned responses from stimuli in certain visual fields

– neglect can result from damage to any lobe

– neglect can be right or left dominant

– right parietal lobe damage produces left-neglect in most pts

*** Goal draw focus to the left side, do all therapy on the left side.

21
Q

Left Neglect Characteristics (6)

A
  1. Right Focus
  2. difficulty shifting attention from right-to-left
  3. failure to perceive left-sided tactile or perceptual stimuli
  4. failure to copy the left side of a picture or a geometric design
  5. disownership of left body parts or belongings
  6. denying illness (anosagnosia)
22
Q
  1. right focus
  2. Difficulty shifting attention from right to left
  3. Failure to perceive left sided tactile or perceptual stimuli
A
  1. stimuli on the right side seems to capture and hold the patients attention
  2. Can only focus on the right side
  3. cannot feel a pinprick on the left side
23
Q
  1. Failure to copy the left side of a picture or a geometric design
  2. auditory neglect
  3. Prosopagnosia
A
  1. will left the left side of an image off, or left neglect when reading
  2. ignores sounds from the left side of the room but reflexes are intact, motor is okay.
  3. Inability to recognize familiar faces, hard for families to deal with.
24
Q

FACIAL RECOGNITION DEFICITS

A
  • prosopagnosia
  • seen in Pts with posterior right hemisphere damage
  • difficulty recognizing familiar faces
  • difficulty choosing pictures of faces just shown
  • problems naming the pictures of faces of famous persons
25
Q

Constructural Impairments

A
  • problems constructing block designs
  • difficulty reproducing two-dimensional stick figures
  • errors in drawing or copying geometric designs
  • often seen in Pts with all kinds of brain damage
  • with left hemisphere involvement: Pt will draw w/difficulty but make fewer mistakes; drawings are better w/models than without
  • with right hemisphere involvement: Pt will draw hastily, make many mistakes, add unnecessary lines to correct mistakes, do not show improvements w/models
26
Q

Attention deficits

A
  • reduced state of arousal: Pt’s w/RHD are described as hypoaroused
  • difficulty in sustaining attention: Pt’s attention wanders from task to task or from stimuli to stimuli
  • difficulty paying selective attention: Pt may find it difficult to focus on a particular stimuli in the presence of multiple stimuli
27
Q

Disorientation (3)

A
  • topographic disorientation: inability to orient in the surrounding
  • geographic disorientation: inability to orient to city/state/country
  • reduplication paramnesia: is the delusional belief that a place or location has been duplicated, existing in two or more places simultaneously, or that it has been ‘relocated’ to another site
28
Q

Visual Perceptual Deficits

A
  • difficulty recognizing line-drawn pictures or incomplete drawings
  • drawings that distort the representation by showing unusual size, dimension or orientation
  • drawings that are superimposed on other drawings
29
Q

Affective Deficits

A
  • pts with RHD tend to be emotionally indifferent
  • difficulty understanding emotions
  • difficulty stating the emotions depicted in pictures
  • problem recognizing emotions expressed in isolated spoken sentences
  • difficulty understanding emotional tone of voice
  • difficulty expressing their own emotions correctly
30
Q

Memory Deficits

A
  • nonverbal amnesia

— references impaired recall of nonverbal visual material

— ex: impairment in the retention of complex visual patterns and faces

31
Q

Neuropsychiatric Disorders
1. Visual Hallucinations

  1. Mania
A
  • visual hallucinations

— claims to see something that the observer cannot see

— may occur as part of a seizure or may be associated w/visual field deficits

— most common form of hallucination in persons w/dementia

  • mania

— elated and/or irritable mood lasting at least one week and combined with any of the following:

— hyperactivity; flight of ideas; grandiosity; diminished sleep; distractibility; lack of judgment; rapid speech

32
Q

Communication Deficits

A
  • communication problems are found in about 50% of individuals who have RHD

— difficulties are unlike those associated w/left-hemisphere damage

— RHD: no word-retrieval issues

— RHD: no significant circumlocutions or paraphasias

— RHD: speak in grammatically accurate sentences

— RHD: have good comprehension

— pts w/RHD do exhibit: prosodic deficits; impaired discourse; semantic problems; pragmatic deficits

33
Q

Prosodic Deficits

A
  • prosody references: stress patterns, intonation, rhythm, melodious qualities of speech that convey meaning
  • output may be:

— monotone

— impaired in stress patterns; may change intensity levels

— reduced rate of speech

— devoid of emotion

— impaired in prosodic comprehension; difficulty understanding the emotional tone heard

34
Q

Impaired discourse

A
  • discourse is a set of social communication skills; may involve narration, procedures, expository discourse
  • pts with RHD exhibit:

— difficulty distinguishing significant from irrelevant information

— difficulty understanding implied meanings, abstract words, metaphors, irony and humor

— premature and incorrect inferences

— confabulation and excessive speech

35
Q

Semantics

A
  • left hemisphere: active in promptly and quickly understanding concrete meanings of words
  • right hemisphere: involved in understanding or producing words w/complex, abstract, metaphoric, and multiple meanings
36
Q

Semantic Difficulties

A
  • pts w/RHD exhibit:

— difficulty understanding implied, alternative or abstract meanings

— failure to grasp the overall meaning of situations, events, stories or pictures (miss the central message)

— difficulty understanding idioms, proverbs and metaphors

— difficulty naming abstract categories in contrast to the names of individual items in a category

— difficulty w/irony, humor, and sarcasm

— problems in understanding logical errors in sentences

37
Q

Pragmatic Difficulties

A
  • pragmatic language problems could include:

— difficulty in conversational turn-taking

— difficulty with topic maintenance

— difficulty in maintaining eye contact

— insensitivity to communicative contexts: assume too much about what their listeners know about the topic of conversation

38
Q

Associated Language Difficulties (3)

A
  • right hemisphere’s receptive language capabilities
    1. disturbance in comprehension of logical syllogisms

— all trees have root systems

— all root systems need nitrogen

— therefore, all trees need nitrogen

  1. pictorial interpretations of metaphors

— it’s raining cats and dogs

  1. concrete interpretation of proverbs/idioms

— abstract verbal tasks pose problems

— the greatest talkers are the least doers

— a heavy heart-

Aphasia (13 decks)

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