Right Hemisphere Disorder (RHD)

Question 1

Right hemisphere disorder/dysfunction

Answer 1

Cognitive linguistic disorder resulting from damage to right cerebral hemisphere of brain

Question 2

Characteristics of RHD

Answer 2

Anosognosia: Lack of awareness of cognitive linguistic deficits and unrealistic “denial” of illness

Left-neglect: Neglect of all information from left side of body. Not a visual impairment but perceptual

Impaired judgment and self-monitoring

Prosopagnosia: Poor visual recognition and discrimination of faces

Poor scanning and tracking

Strong, unimpacted structural language skills but impacted pragmatics
Aprosodia
Difficulty understanding and using emotional language
Personality change due to changed perceptions
Tendency to use wordy expressions
Difficulty understanding higher level cognitive linguistic skills
Co-occurring dysarthria and dysphagia
Impacted memory

Question 3

RHD Assessment

Answer 3

Requires comprehensive speech language assessment as part of an interdisciplinary team assessment
Examples:
Mini inventory of right brain injury (MIRBI)
BURN brief inventory of communication and cognition

Question 4

Assessment challenges of RHD

Answer 4

No clear definition of typical vs. impaired functional pragmatics and cognition in adulthood
Most measures have metacognitive demands which affect performance (is it a deficit or because of the level of demand?)
Participation and quality of life measures rely on self-report

Question 5

RHD intervention/treatment

Answer 5

Overview:
Knowledge of treatments limited
70-80% of patients improve problem-solving, attention, memory, and pragmatics with speech therapy although level of improvements vary with severity

Question 6

Visuospatial neglect treatments effective when:

Answer 6

Intensive
Encourages active scanning
Internal cueing vs. clinician driven cueing
Involves left limb movements and scanning tasks

Question 7

RHD intervention targets

Answer 7

Management of attention
Visual disruptions
Higher level cognitive linguistic tasks
Pragmatic skills

Question 8

EBP for RHD

Answer 8

Communication intervention as part of broader interdisciplinary approach results in greater independence
Treatment studies few and includes relatively small number of participants

Aprosodia: Imitation and cog-ling treatment

Receptive language: Prestimulation of word meaning