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Neuro Final > Right-Hemisphere Syndrome > Flashcards

Right-Hemisphere Syndrome Flashcards

1
Q

What are the Behavioral and Cognitive Symptoms of Right-Hemisphere Syndrome?

A

there are certain stereotyped characteristics but patients are often heterogeneous and may not have all the symptoms. Depends on severity and site of lesion

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2
Q

Perceptual Impairments of Right-Hemisphere Syndrome?

A

Denial of illness and neglect

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3
Q

Denial ranges from

A

acknowledging their disability but are indifferent to them to completely denying paralysis, visual field blindness or even owning their paralyzed limbs

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4
Q

Do patients with right hemisphere syndrome claim they can do activities that are clearly impossible?

A

True

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5
Q

What do right hemisphere patients do when they are challenged?

A

They may confabulate or argue

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6
Q

Do RHS patients usually have right side neglect?

A

False, RHS patients typically have left hemi-spatial neglect in which they do not perceive stimuli on the left side of the body and do not notice visual or auditory stimuli in the left-side space.

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7
Q

What happens when RHS patients with neglect are reading?

A

They may omit words on the left-side of page & read only words on right side of the page. They complain that what they’re reading doesn’t make sense.

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8
Q

What happens when RHS patients with neglect are reading single words?

A

They may only read letters on the right side of a word.

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9
Q

What do RHS patients with neglect do when a word they are reading doesn’t make a real word?

A

They may substitute letters to make a real word

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10
Q

What do patients with RHS neglect do when copying or describing?

A

Patients may omit scenes from left-side

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11
Q

When writing, what do patients with RHS neglect do?

A

They tend to pull all their words on the right side of the page, leaving a large space on the left, slant their words upward. they omit words or add extra lines or marks to letters.

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12
Q

Patients with severe neglect bump into

A

Things on their left side because they don’t perceive them

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13
Q

Patients with less severe neglect may bump into things on the left but…

A

do notice items on the left

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14
Q

Do patients with RHS have a preference for one side?

A

Yes, they may only use pockets on their right side, place dishes on the right side of cupboards, dress and comb only on right side as well. they might also lean to the right

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15
Q

Myers list of common symptoms of hemispatial neglect

A

failure to respond to people, sounds and objects on their left
attending only to the right side
failure to move or attend to the left arm
bumping into walls doorways on the left
reading only the right side parts of printed materials
diminished awareness of physical and cognitive impairments
disinterest and lack of participation in rehabilitation

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16
Q

Motor neglect

A

failure to use their left limbs even though there is no motor problems with limbs. they may deny that the limb works or that it belongs to them

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17
Q

When can neglect occur?

A

With damage to either hemisphere but is more severe and persistent with right hemisphere damage

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18
Q

What percentage of patients have right hemisphere damage and neglect?

A

2/3

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19
Q

What percentage of patients have left hemisphere damage and neglect?

A

1/3

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20
Q

Constructional Impairment

A

problems with copying or drawing geometric designs, or making designs with blocks, or reproducing 3 dimensional constructions or 2 dimensional stick figures

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21
Q

Can constructional impairment occur with damage to either hemisphere ?

A

Yes but it is more common with right hemisphere damage

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22
Q

Patients with right hemisphere damage make the same mistakes that those with left hemisphere damage

A

False, they make different mistakes

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23
Q

mistakes that people with right hemisphere damage make

A

they tend to act impulsively & quickly, they try to correct mistakes by adding extra lines or rearranging block designs

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24
Q

mistakes that people with left hemisphere damage make

A

they work slowly with false starts and hesitations and typically their mistakes are due to angles and lines being distorted

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25
Q

Topographic impairment

A

when patients have problems with extra personal space which is exhibited as difficulty following familiar routes, reading maps, giving directions

26
Q

What do patients with topographic impairment have trouble with?

A

they may have difficulty recognizing visual cues or familiar landmarks

27
Q

How can you distinguish between RHS and those with disorientation?

A

being able to ‘talk’ themselves through directions to a place

28
Q

Geographic disorientation

A

recognize their surroundings but don’t know the location where they are. they may believe they are in a different city

29
Q

Do patients with RHS have problems recognizing visual stimuli if they are clear and unambiguous?

A

Patients with RHS generally don’t have a problem recognizing.

30
Q

When do RHS patients have problems with visual stimuli?

A

When they are incomplete or distorted

31
Q

Prosopagnosia

A

when patients can’t recognize people’s faces. Can’t differentiate between men and women and old faces from new faces

32
Q

What does the right hemisphere aid in?

A

understanding the expression of emotion in others

33
Q

Are RHS patients good at picking up on prosodic cues of emotions or facial expression?

A

No

34
Q

RHS patients and attentional impairments

A

they commonly have problems maintaining and shifting attention and focusing

35
Q

Characteristics of Diminished Speech Prosody in patients with RHS

A
  • They lack normal intonation, monotonous
  • loudness variability may be lacking
  • reduced gestures to accompany speech
  • speech rate is slower
  • reduced emphasis and stress
  • they may have to explicitly state their emotions because their voice doesn’t indicate emotion
36
Q

What is the reason for the prosody problems with patients with RHS?

A

not clear, some think its due to an underlying affective problems and others think it is due to muscle weakness (cricothyroid muscle)

37
Q

What are the speech characteristics of a person with RHS?

A

connected speech is described as confabulatory, inappropriate, excessive, rambling, irrelevant, tangential, digressive and inefficient. They tend to miss out on the main idea and focus on the details

38
Q

How to differentiate between aphasia and RHS in regards to comprehension of narratives and conversations

A

patients with aphasia comprehend better in discourse because of the context, patients with RHS do not

39
Q

How do patients with RHS deal with nonliteral expressions such as metaphors, figures of speech. etc?

A

they have great difficulty understanding them and may confabulate as to what they mean.

40
Q

RHS patients and pragmatic impairments

A

They have issues such as turn-taking, maintaining topic and eye contact
They begin and end conversations abruptly
They talk too much and ignore cues from communication partner

41
Q

Standardized Tests for Assessing Adults with RHS

A
  • Right Hemisphere Language Battery
  • Mini-Inventory of Right Brain Injury
  • Rehabilitation Institute of Chicago Evaluation of Communicative Problems in Right Hemisphere Dysfunction (RICE)
42
Q

Non-Standardized Tests for Assessing Adults with RHS

A

Some non-standardized protocols have been developed, assessing similar items as the standardized tests

43
Q

How do you test pragmatic abilities?

A

typically assessed through rating scales as in the RICE and RHLB scales

44
Q

Tests of component attentional processes

A

involve being presented with visual stimuli, typically flashes of light, and the pt presses a button for each occurrence. auditory sustained attention tests are done similarly

45
Q

Test for neglect (visual attention)

A

Test for neglect are typically done with pen and pencil and usually cancellation tests. copying and drawing from memory. bisection tests are also used where patients are asked to divide lines into 2 equal parts.

46
Q

tests for Selective attention

A

pt is presented with visual stimuli and the pt presses a button for each occurrence and has distracting and competing stimuli

47
Q

Tests of visual organization

A

pt has to identify incomplete visual stimuli

48
Q

why should clinician wait until neurological recovery is done to assess and treat indifference and denial?

A

to see if the denial gets resolved on its own

49
Q

Therapy techniques for indifference and denial

A

use activities where patients errors can be pointed out, make a list of patient’s pattern of errors and inappropriate responses and go over it. use structured activities to give opportunities to practice

50
Q

working on Sustained Attention

A

use drills to improve various tasks like mazes and listening tasks

51
Q

working on Selective Attention

A

Use drills where patient has to pay attention to the task, with background interference

52
Q

working on Impulsivity

A

work on stop and go signals for patient to practice appropriate times to respond, can use al light or colored card and transition to gesture from clinician

53
Q

working on impaired reasoning and problem-solving

A

use structured practice with tasks requiring reasoning, for example practice giving problems they have to solve as in : The boy fell off his bike and you were watching, what do you do?

54
Q

working on reading impairments

A
  • various reading programs are available
  • use colored markers to get them to attend to the left side
  • matching tasks where item to be matched is on left side
  • say “ look to the left”
  • Instruct patients to ask themselves if something makes sense
  • teach to trace boundaries of an edge or page of book
55
Q

Working on pragmatic impairments

A
  • videotape conversation interactions for baseline to compare
  • discuss turn-taking and topic maintenance
  • view videotape and discuss
  • give pt strategies to use for problems
  • use structured practice, scripts
56
Q

Inference failure and communication impairments

A

work on appreciation of humor, work on appreciation of implied meanings of metaphors, identification of verbal and pictorial absurdities, comprehension of implied information

57
Q

Resource Allocation and RHS

A

pts have performance that varies depending on the processing demands then teach them to use context to facilitate performance.

58
Q

Generalization and RHS

A

pts have trouble generalizing

59
Q

how to teach them to generalize across tasks

A

use a source task where a patient learns a set of responses and have other similar tasks where pts generalize from source task. use as much normal environment as possible

60
Q

Is there a lot of variability within RHS field?

A

yes, it a patients’ abilities can change day to day

Neuro Final (5 decks)

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