What causes RHD?
Same things that cause aphasia: CVA, TIA, TBI, tumors, dementing diseases, anoxic events, toxic substances
Does everyone who has a right hemisphere stroke have rhD?
which has more connectivity, R or left hemispehre?
RHD creates neglect on which side?
do you ahve neglect with TBI?
multiple interpretations with TBI?
no, just RHD
prosody with RHD
prosody with TBI
exec functions rhd v. tbi
production rhd v. tbi
pragmatic rhd v. tbi
what do you do to assess rhd?
1. determine deficits and how impact real life
what are the two important terms for insurance reimbursement?
communication and linguistic
which type of matter more in RH?
right parietal lobe role?
visuospatial tasks and attention
examples of visuospatial tasks
mental visual manipulation, recognizing objects in unfamiliar views, judging distances
sustained, spatial selective, working memory
where is lesion that causes left neglect?
Right inferior parietal
lesion of which area causes deficits of visuospatial and construction functions?
right superior parietal
other parietal lobe lesion deficits
denial of motor deficit, dressing apraxia, spatial orientation, constructional tasks, appreciation of humor and sarcasm, flat emotional affect, inability to recognize emotion in others
what is temporal lobe in R hemisphere responsible for?
rhythm and musical qualities, nonverbal learning and memory, nonverbal auditory sensations
frontal lobe, both sides:
cognition, behavioral spontaneity, initiation, disinhibition, distractibility, inflexibility, perseveration
five aspects of cognition
executive functions, planning, problem solving, divergent thinking, strategy formulation
what does a posterior lesion cause?
minimalize and rationalize their deficits
do all individuals with RHD have communication difficulties?
why are RHD referrals infrequent?
denial aspect, doctors not aware bc boundaries of pragmatics and cognition blurry, doc may not associate SLP, Rh lesions less frequent
features of RHD
1. communication 2. attention and perception 3. cognition
aspects of communication RHD trouble
3. figurative/non-literal language
aspects of attention and perception trouble
4. constructional impairment
6. attentional deficits
aspects of cognition
prosody particularly important for what?
sarcasm, humor and inferencing
problematic aspects of discourse
lack organization, due in part to inability to ID main idea; trouble distinguishing relevant; confabulation; excessive speech
prob with figurative language
lack appreciation of abstract meaning
how does inferencing prob affect expression?
listing of facts rather than cohesive, organized story
what is the crux of RHD probs?
probs with pragmatics
turn-taking, rambling, talk about self, frequent topic shifts, irrelevant details, lack cohesion, presupposition, trouble detecting indirect requests and recognizing sarcasm and humor, trouble with appropriateness, communication breakdown
probs with affect
can experience emotion, but probs with facial expression and tone of voice
the ability to focus on stimuli and filter out unwanted stimuli
cardinal feature of RHD
what percentage of rhd have visuospatial neglect
30 to 90
what percentage deny deficits
visuoperception probs foudn in what percentage of rhd?
what could the naming and pic description deficits be due to?
perceptual deficits--trouble interpreting visual stimuli normally
problems recognizing familiar faces, distinguishing young/old,
what do attentional deficits cause?
1. sustaining attention-vigilance
2. slective attention, tune ohter thigns out
3. difficulties in convo due to attention deficits
4. difficulties in memory
drawign conclusions, making inferences, using stored knowledge or experience
verbal expression RHD affected by
cognition, figurative language, prosody
ac in rhd affected by
attentional deficits, making inferences, figurative language
written expression in rhd affected by
three primary chracteristics of rhd
neglect, inattention, denial
three main categories to discuss deficits
communication, attention adn perception, cognition
can a client have a r hemisphere lesion and have aphasia?
yes, if r hemisphere dominant for language
assessment for rhd consists fo
1. case history
2. interview with patient and family
3. language sample
5. formal assessment
6. informal assessment
7. supplemental testing
why is nonstandardized/informal assessment important?
discrepancy between saying adn doing
problems with standardized tests for RHD
1. only tangentially relevant to theory
2. psychometrically weak
3. standardized on small sample
1. Right Hemisphere Langauge Battery
2. Mini Inventory of Right Brain Injury
4. Ross Information Processing Assessment
5. Pragmatic Protocol
6. Profile of Communicative Appropriateness
what does Right Hemisphere Lang Batt have that aphasia tests don't?
metaphor-picture matching, humor appreciation, NO confrontation naming, reps.
which test criticized for being limited in validity and reliability?
3 things that you don't always do taht you definitely have to do for assessment
informal assessment, structured observation, family interview
how elicit discourse?
storytelling, retelling, picture narration, procedural
if were OK at 2 weeks, should be same after 1 year
initial severity, biographical variables, other variables
what kind of patient good candidate (4)
patients who learn, generalize improvement, retain, exhibit willingness
what difficulty task target?
what three areas improtant prereqs for others
attention, awareness, orientation
4 types of attention
sustained, selective, alternating, divided
how could you target pragmatics?
group, barrier task, PACE, role play, videotape
which deficit is best treate din conjunciton with other deficits?
awareness. get them to estimate how they'll do on a task then tape.
ways to target orientation
external aids, judging passage of time, environmental cues, memory notebooks
to target visualperceptual
scanning exercises then practice in real-life