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Neuro Final Sarah > Right-Hemisphere Syndrome > Flashcards

Right-Hemisphere Syndrome Flashcards

1
Q

Perceptual Impairments of Right-Hemisphere Syndrome?

A
  • Denial of illness
  • Neglect
  • Constructional Impairment
  • Topographic impairment
  • geographic disorientation
  • Visuoperceptual impairments
  • Facial recognition deficits
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2
Q

Denial of illness

A
  • Common in pts. with parietal lobe damage
  • Ranges from acknowledging their disability but are indifferent to them to completely denying paralysis, visual field blindness or even owning their paralyzed limbs.
  • claim they can do activities that are clearly impossible and when challenged may confabulate or argue.
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3
Q

Neglect

A
  • RHS pts. have auditory and visual left side neglect
  • Reading: omit words on left side/complain what they are reading doesn’t make sense
  • Single Words: read letters on right side. May substitute letters to turn into a real word (baseball=ball)
  • Copying or describing drawing: omit scene from left side
  • Writing: write all words on right side, tend to slant words upwards, may omit words or add extra lines or marks to letters
  • Bump into objects on left side (ex. wheelchairs on doorways)
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4
Q

Neglect Continued

A
  • May notice objects on left side but still bump into them. May only use pockets on right side of body, place dishes on right side of cupboard
  • Limbs: might not use left ones even if there is no motor problem. Neglect even to the point of danger (tangle on wheelchair)
  • May lean on right
  • Neglect can occur w/ damage to each hemisphere but it’s more severe and persistent with RH damage
  • 2/3 pts. w/ right hemisphere have neglect
  • 1/3 pts. w/ left hemisphere damage have neglect
  • Occurs more with right parietal lobe damage
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5
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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6
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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7
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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8
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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9
Q

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

A

Patients may omit scenes from left-side

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10
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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11
Q

Patients with severe neglect bump into

A

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

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12
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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13
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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14
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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15
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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16
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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17
Q

What percentage of patients have right hemisphere damage and neglect?

A

2/3

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18
Q

What percentage of patients have left hemisphere damage and neglect?

A

1/3

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19
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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20
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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21
Q

Patients with right hemisphere damage make the same mistakes that those with left hemisphere damage (in respect to constructional impairment)

A

False, they make different mistakes

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22
Q

mistakes that people with right hemisphere damage make (in regards to constructional impairment)

A

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

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23
Q

mistakes that people with left hemisphere damage make (regarding constructional impairment)

A

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

24
Q

Topographic impairment

A

-When patients have problems with extra personal space which is exhibited as difficulty following familiar routes, reading maps, giving directions
-they may have difficulty recognizing visual cues or familiar landmarks
To compensate, they are able to ‘talk’ themselves through directions to a place- differentiates them form disorientation

25
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

26
Q

Visuoperceptual Impairments

A
  • Patients with RHS generally don’t have a problem recognizing visual stimuli if they are clear and unambiguous.
  • If the stimuli are ambiguous or distorted, they might have trouble understanding what they are
27
Q

Facial Recognition Deficits

A

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

28
Q

Recognition and Expression of Emotion

A
  • The right hemisphere (particularly in right handed people) aids understanding the expression of emotion in others
  • RHS pts. can’t pick up on prosodic cues of emotions or facial expression cues
29
Q

Attentional impairments

A

they commonly have problems maintaining and shifting attention and focusing

30
Q

Characteristics of Diminished Speech Prosody in patients with RHS

A
  • They lack normal intonation, monotonous, lacking pitch variability at end and beginning of questions
  • loudness variability may be lacking
  • lacks emotion
  • reduced gestures to accompany speech
  • speech rate is slower and robotic
  • reduced emphasis and stress
  • they may have to explicitly state their emotions because their voice doesn’t indicate emotion
  • unknown why it happens: affective problem or muscle weakness
31
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)

32
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
  • May let personal experiences spill over in the narrative/description
33
Q

Impaired Comprehension of Narratives and Conversations

A
  • Patients with aphasia comprehend better in discourse because of the context, patients with RHS do not
  • Pts. w/ RHS have difficulty with metaphors and figures of speech. May confabulate on meaning
  • Difficulty understanding humor
  • Don’t identify irrelevant or absurd comments
34
Q

Communicative Impairments Associated with RHD

A
  • Diminished speech prosody
  • Anomalous Content and organization of connected speech
  • Impaired comprehension of narratives and conversations
  • Pragmatic impairments
35
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
36
Q

Standardized Tests for Assessing Adults with RHS

A
  • Right Hemisphere Language Battery: 7 subtests- looks at metaphors, inferences, humor, discourse and emphatic stress
  • Mini-Inventory of Right Brain Injury: 10 categories- visual scanning, reading + writing, affective language, humor, absurdities, incongruities, fig lang.
  • Rehabilitation Institute of Chicago Evaluation of Communicative Problems in Right Hemisphere Dysfunction (RICE)
37
Q

Non-Standardized Tests for Assessing Adults with RHS

A

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

38
Q

How do you test pragmatic abilities?

A

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

39
Q

Tests for Assessing Adults with RHS

A
  • Standardized tests
  • Non-standardized tests
  • Test of Pragmatic Abilities
  • Tests of Visual Spatial Perception, Attention & Organization
  • Tests of Component Attentional Processes
  • Tests of Visual Organization
40
Q

Tests of Visual Spatial Perception, Attention & Organization

A
  • Test for neglect are typically done with pen and pencil and usually cancellation tests
  • Pts. w/ neglect tend to miss the stimuli on the contralateral side of injury
  • Bisection tests are also used where patients are asked to divide lines into 2 equal parts. RHS patients divide the line too far to the right
  • Copying and drawing are used to assess for neglect
  • Visual Scanning tests: pts. are given papers with numbers or other items and are asked to cross off every target item (ex. cross all the Cs)
41
Q

Tests of Component Attentional Processes

A

Visual Attention Tests: pt is presented with visual stimuli, typically a flashing light and the pt presses a button for each occurrence. Can be auditory as well
Selective Attention Test: similar to the above but has distracting and competing stimuli (ex. beep vs chirp, only presses for beep)

42
Q

Tests of visual organization

A
  • pt has to identify incomplete visual stimuli

- figure ground tests are used as well

43
Q

Treatment for Adults with RHD

A
  • Cognitive and Behavioral Abnormalities

- Communicative Impairments

44
Q

Therapy techniques for indifference and denial

A
  • Wait until neurological recovery is done to see if denial goes away
  • 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
45
Q

Attention Impairments and Distractionability

working on Sustained Attention

A

use drills to improve various tasks like mazes and listening tasks, pen and pencil tasks, auditory listening tasks

46
Q

working on Selective Attention

A

Use drills where patient has to pay attention to the task, with background interference, such as radio playing

47
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

48
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?

49
Q

Communicative impairment- 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
  • Give them words where right side doesn’t make sense-> encourage them to look to the left
  • overlapping pictures encourage to look to left
  • limb movements
  • prime attention to left hemisphere: tapping left foot, moving left arm before doing left neglect work
50
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 (card to remind of eye contact, verbal cue from clinician)
  • use structured practice, scripts- good for turn taking skills
  • topic maintenance, identify when pt. goes off topic
51
Q

Inference failure and communication impairments

A
  • work on appreciation of humor: jokes, let pt. choose punchline from different choices
  • work on appreciation of implied meanings of metaphors: give metaphor, choose meaning from choices
  • identification of verbal and pictorial absurdities: show absurd picture and have pt. identify absurdity
  • comprehension of implied information - pt. listens to discourse and answers questions on implied info
  • pt. retells story by paraphrasing and interpreting it rather than telling it exactly as he heard it
52
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.
-Generalization

53
Q

Generalization and RHS

A

pts have trouble generalizing

54
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
  • Example: pt. learns how to greet in clinic
55
Q

Behavioral and Cognitive Symptoms of RHS

A
  • Perceptual impairments
  • Recognition and Expression of emotion
  • Attentional Impairments

Neuro Final Sarah (5 decks)

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