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Neuro Exam 2 > Right Hemisphere Syndrome (RHS) or Dysfunction (RHD) > Flashcards

Right Hemisphere Syndrome (RHS) or Dysfunction (RHD) Flashcards

1
Q

Until the mid 1800s, neuroanatomists believed that the human brain was functionally and physically _____

A

symmetrical

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2
Q

Behavioral and cognitive symptoms of right-hemisphere BI: characterized as…

A
  • self absorbed
  • insensitive to others; preoccupied with self
  • oblivious to social conventions
  • unconcerned/unaware/ inattentive about physical and mental impairments
  • verbose
  • tangential
  • rambling in speech
  • insensitive to the meaning of abstract or implied material
  • unable to grasp the overall significance or meaning of complex events
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3
Q

Some adults with RH BI are characterized as behaviorally passive, meaning…

A

They are:

  • unresponsive to social/environmental stimuli
  • short utterances that lack emotional inflection (dysprosody)
  • can be passive, emotionally flat and having problems with attention (for more than a few seconds)
  • present with left hemi-spatial neglect
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4
Q

Why might patients with RH BI have trouble in therapy?

A
  • they don’t think they need it (poor/reduced awareness and/or defensitivity)
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5
Q

Why is there a poor understanding of diversity within this population? (group studies)

A

Group studies of adults with RH BI:

  • report results for heterogeneous groups lacking disclosure of the location/severity of BI
  • report the average performance of groups
  • do not include a control group
  • include disproportionately large numbers of participants with frontal lobe injuries
  • RH adults with posterior lesions (no paralysis) and are discharged EARLY from hospital
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6
Q

Describe neglect

A

affected individuals fail to respond to stimuli on the side of the body opposite the side of the BI

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7
Q

T/F Neglect may be caused by BI in L or R hemisphere, but is more frequent, severe, and persistent following R hemisphere BI

A

true

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8
Q

T/F Although neglect will present in injuries in several regions of R hemisphere, most common/severe after R temporal lobe injury

A

false; right PARIETAL lobe injury

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9
Q

Neglect occasionally results after _____ injury

A

subcortical (thalamus & basal ganglia)

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10
Q

Sometimes concomitant with partial or completely blind in the ____ visual field (L or R)

A

left

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11
Q

T/F Neglect usually improves or resolves days/weeks after the BI

A

true

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12
Q

RH adults with left neglect may not respond to…

A

touch on L side of body, or attend to visual or auditory stimuli in L-sided space

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13
Q

Freebie: these individuals may… (reading)

A
  • fail to include words on L side of page when reading
  • produce neglect-related errors when reading single words as well as text (reading ‘mistake’ as ‘take’)
  • leave out left half of compound words (‘blackboard’ as ‘board’)
  • substitute/add letters to make word (reading ‘chain’ as ‘train’ or ‘fearless’ as ‘careless’)
  • longer words are more likely to be read incorrectly than are shorter words
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14
Q

Freebie continued: these individuals may… (writing)

A
  • use only R side of the paper when writing words/sentences
  • often their writing slants upward from left to right
  • omit letters/words when writing (especially at the beginning of the word)
  • may add extra lines and strokes to printed letters (page 399)
  • bump into objects on the L whether walking or in a wheelchair
  • attend to only R-side of pockets, drawers, cupboards
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15
Q

Freebie: Myers (1999) common signs of left neglect

A
  • diminished/poor awareness of deficits

- diminished/lack of participation in rehab

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16
Q

Name the proposed theories to explain neglect (4)

A
  1. Representational
  2. Arousal
  3. Attentional engagement
  4. Attentional disengagement
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17
Q

Representational theories

A

Neglect is caused by disturbed mental representation of external space

18
Q

Arousal theories

A

R-hemisphere injured persons are less responsive to stimuli in neglected space

19
Q

Attentional engagement theories

A

Individuals w/ neglect have difficulty shifting attention to stimuli in neglected space

20
Q

Attentional disengagement theories

A

Stimuli in non-neglected space capture and hold the person’s attention, preventing him/her from shifting attention to stimuli on neglected side

21
Q

What is anosognosia?

A
  • denial of illness

- ranges from mild to profound

22
Q

What is a constructional impairment?

A

inability to draw or copy geometric designs

23
Q

Freebie

A

adults with RH BIs:

  • respond quickly and impulsively
  • make frequent errors
  • try to correct by adding more lines to drawings or by aimlessly rearranging stick or block designs
  • leave out details (or everything) on L side
  • drawings look fragmented, disorganized, and crowded
  • displaced to R side of page
24
Q

What is a topographic impairment?

A

denotes a condition in which the affected person has difficulty orienting to extra personal space (difficulty following familiar routines, reading maps, giving directions)

25
Q

What is geographic disorientation?

A
  • recognize general nature of surroundings but are mistaken about where they are
26
Q

T/F Geographic disorientation is less common than topographic impairment, but they often occur together

A

true

27
Q

Describe reduplicative paramnesia

A
  • believe in existence of duplicate persons, places, body parts, or events
  • may be related to disturbed spatial perception and impaired visual memory
28
Q

What do pts with visuoperceptual impairments have difficulty with?

A
  • recognizing objects, pictures, or drawings presented in unusual formats
  • line drawings
29
Q

What is prosopragnosia?

A

facial recognition deficits– unable to recognize otherwise familiar persons by their facial features

30
Q

What do pts with attentional deficits have difficulty with?

A
  • focusing, maintaining, and shifting attention

- participating in tx activities

31
Q

Many of the same individuals who fail to communicate emotion via speech prosody also fail to…

A

appreciate emotions conveyed by others’ speech prosody and facial expression thereby suggesting an underlying affective impairment

32
Q

T/F Patients with RHS use more words but produce less information

A

true

33
Q

Narratives for patients with RHS are described as…

A

fragmented, lack cohesion, overall theme, or point

34
Q

Impairments in ______ _______ reflect many of the same underlying disabilities that compromise their production of narratives AND undermine their ability to get along in daily life

A

discourse comprehension

35
Q

RHS pragmatics impairments

A

language impairments may include:

  • turn-taking, topic maintenance, social conventions, and eye contact
  • may begin/end conversations abruptly
  • poor at obtaining and/or maintaining eye contact
  • talk excessively & without regard for their listener
  • difficulty staying on topic
  • interject irrelevant, tangential, and inappropriate comments
  • fail to make conversational repairs
  • insensitive to rules governing conversational turn-taking
36
Q

T/F Focal RH BI produces less diffuse effects than focal LH BI

A

false; produces more diffuse effects

37
Q

Tx for impulsivity

A
  • “fall risk”

- use of stop and go signals

38
Q

Tx for impaired reasoning and problem solving

A

prescriptive and structured approach:

  • ID a problem
  • think of several possible solutions
  • evaluative the feasibility and potential consequences of each solution
  • choose the best solution
  • apply it
  • evaluate the results
39
Q

Tx for affective communication/prosody

A
  • show individual pictures of faces expressing various emotions
  • replace card which carry names of emotions
  • educate pt, family members/ loved ones
40
Q

Tx for reading

A

attend to the left side of printed texts

  • colored vertical lines
  • colored dots
  • rulers placed at the left margin
  • use of finger
  • verbal cues
  • feel the end of the page
41
Q

Tx for pragmatics

A
  • videotape
  • cues to improve eye contact
  • turn-taking rules
  • structured practice (games in small groups)
  • PACE
42
Q

Freebie: Generalization from Treatment to Daily Life

A
  • Provide enough training trials to consolidate and stabilize responses so that patients can produce them in novel or stressful contexts
  • Train a variety of related responses (e.g., eye contact, turn-taking and relevance in conversations) rather than single responses
  • Train responses and strategies in a variety of tasks and present the tasks in a variety of texts
  • Incorporate aspects of the target environment into treatment activities
  • Train self-instruction and verbal mediation
  • Enlist the help of family members, friends, and caregivers

Neuro Exam 2 (4 decks)

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