Midterm Flashcards
WHO-ICF: Impairment Level (1) Decontextualized Environment
- Specific Drill Tasks
- Just you and the patient
- No education for care team or family
- Generalization does not occur
- Target difficulties in a decontextualized setting
Must have the end goal planned out
WHO-ICF: Activity Level Treatment (2) Generalization
- Continuing to target what is wrong, but in semi-contextualized setting
- Almost at participation level BUT continues to provide strategies to use when they are independent (using your support, providing education and or instruction to caregivers, use sabotage to create a breakdown - teachable moment”
WHO-ICF: Participation-Level Treatment
- Providing patient tools they need to communicate in real world
- Use the strategies you taught throughout treatment
- Bridge gap between treatment and life participation
- Data collection (functional, have the patient involved)
What does the left hemisphere govern?
- Literal, analytic, specific, and serial in processing and perception
- Left is “rules” : Syntax and vocabulary
- denotative meaning: dictionary definition - the first definition that comes to your mind
What does the right hemisphere govern?
- Figurative, global in view, spatial and simultaneous in perception and processing
- Gestalt: big picture (combining spatial information)
- Melody processing
- Affect/emotion
- Facial expression interpretation
- Facial recognition: temporal lobe - fusiform gyrus
- Processing spatial information
- Langauge: interpretive meanings, deriving larger meaning from details, recognizing context of situation
- Pragmatics: comprehension of emotion, comprehension of context (e.g. given new contract)
- Vocabulary: connotative meaning (alternatives to dictionary meaning - not primary meaning) - idioms
- Literal (left hemisphere) vs figurative (right)
- Spatial and holistic elements
- Face recognition
- Has greater functional interconnectivity than the left hemisphere (LH) - more connected white matter
- Possible that aging affects RH more than LH and older adults demonstrate more RHD like syndromes
Anosognosia
Reduced awareness of deficits
Anosodiaphoria
Reduced concern of deficits
Coarse Coding Deficit Hypothesis
activation in the RH is maintained for a longer period of time than in the LH. For example, when presented with the word apple, features such as red, crunchy, and round may be activated in the LH. In the RH, the activation will also include more distant features such as rotten.
Suppression Deficit Hypothesis
- Don’t have the ability to suppress what they need to suppress
- When in conversation, multiple words and meanings are being processed (coarse coding, linguistic knowledge, and world knowledge)
- After activation of this, another process is activated; suppression of all the information that is of no use to us when comprehending in conversation
Cognitive Resources Hypothesis
- We use working and attention during conversation, we have to have heard what someone says and are going to say back while remembering what they said in the first place (working memory)
- with RH damage, working memory and attention are often affected which leads to conversational breakdowns
- In conversation we both use both working memory and attention in high demands, with RHD working memory and attention are often affected, in conversation RHD patients don’t have the attentional resources to hold attention and working memory to taks
Social cognition deficit hypothesis
- RH is dominant in terms of social cognition
- Due to deficits in social cognition they can have deficits in social behaviors
- Less social
- The right hemisphere is dominant in terms of social cognition (knowledge of what to do in social situations, evaluating, understanding, and reacting to interpersonal cues
- Due to deficits with social cognition, this can inhibit competent social relations and understanding of social information - indifferent, impaired social judgements, reduced affect and goal directed behavior, self monitoring deficits
Graded Salience Hypothesis
- Literal vs non literal language
- Left hemisphere is responsible for activation of both literal and dominant or salient, nonliteral interpretations (these typically are activated first)
- Right hemisphere is for less common and less salient meanings
Production affects reception in left only (PARLO)
- When you are saying something the RH usually tries to predict what word you are going to use
- Left hemisphere uses context predictively to pre-activate semantic representations most likely to complete the meaning constructed
- Right hemisphere is more “wait and see” to integrate items as they appear in a building context
What is affected by RHD?
- Aprosodia (difficulty with conveying and comprehension of emotional prosody)
- Patients use less prosodic cues in emotional utterances to emphasize communication
- Don’t use prosody enough to make changes in discourse structure
- Monotone or hyper melodic
- Judging emotion from speech decreased
- Prosodic decoding
- Prosody
Aspects of assessments for the symptomology of RHD: Assessing comprehension
- Various tasks including discrimination, identification, and recognition
- Dynamic assessment not standardized
Aspects of assessments for the symptomology of RHD: Assessing Production
- repetition
- cued production
- spontaneous production
Aspects of assessments for the symptomology of RHD: Assessing Discourse Production (levels)
Macrostructure
- overall meaning or gist of narrative
Microstructures
- Local discourse entitles such as words, propositions, clauses, turn taking in conversation
Superstructures
- stored cognitive representations of elements of discourse genres like narratives and conversations
Evaluation of performance in various tasks including genres, communication, situations and partners
Discussions with family members
Obtaining and analyzing language samples
Aspects of assessments for the symptomology of RHD: Discourse comprehension assessment
- RHD batteries do include discourse subtests but are limited
- The Discourse Comprehension Assessment
Neurcognitive factors that can impact recovery, quality of life, length of stay, etc.
Anosognosia
- Global
- Specific
PARLO Hypothesis
- It purports that the LH uses context predictively to pre-activate semantic representations most likely to complete the meaning being constructed.
- The RH instead uses a “wait and see” approach to integrate items as they appear in a building context. This makes the RH important for re-interpretation when predictions from the LH turn out to be incorrect.
PARLO
Production affects reception in left hemisphere only
Graded salience hypothesis
- initially developed to explain processing of literal versus nonliteral language
- Right hemisphere is less common, less salient meanings (non-literal langauge)
Suppression deficit hypothesis
- Individuals with RHD have difficulties suppressing ambiguous (open to more than one interpretation) content
- The inefficiency of suppression was related to general discourse comprehension, suggesting that the inefficient semantic processing had a broad effect on comprehension.
Course code deficit hypothesis
- The left hemisphere is in charge of semantic coding activating a small semantic field = inhibits all but a small subset of features.
- i.e. “round” and “red” for apple
Object centered neglect (allocentric)
Inattention effects the L side of any object/stimulus regardless of where it falls in the visual field.
Viewer centered neglect (egocentric)
“left” is defined by the viewpoint of the client. Items (stimuli, objects, people) that fall in the client’s left visual field may not be fully processed.
What is theory of mind?
Theory of mind is the ability to attribute mental states - beliefs, desires, emotions, knowledge, etc. - to oneself, and to other’s and to understand that others have beliefs, desires, intentions, and perspectives that are different from one’s own.
How can you identify a right hemisphere stroke?
People with RHD may demonstrate cogntion deficits as characterized by anosognosia (do not seem to be aware of their deficit), executive functioning deficits, amd metacognitive skills ( planning, mental scripting, positive self-talk, self-questioning, self-monitoring and a range of other learning and study strategies).
They may also have aprosodia, monotony, hypermelodicity, narratives, macro, micro, and superstructures), difficulty with pragmatics (right hemisphere plays an important role in pragmatics)
Difficulty with recalling details or main ideas.
Difficulty with lexical ambiguity such as metaphors, difficulty attending, slow processing times, response times or preservation.
Neglect due to attention (view centered or object centered, personal, peripersonal or extrapersonal.
Memory difficulties.
Why is it hard to identify a right hemisphere stroke?
People with RHD may have anosognosia or anosodiaphoria therefore they may not realize that they have a deficit or they may have a reduced awareness of the deficit leading to a longer response time to receive the necessary services. Most assessements are deisgned to identify left hemiphere strokes in which aphasia presents as a primary symptom
