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Aphasia > Right Hemisphere Dysfunction (right CVA) > Flashcards

Right Hemisphere Dysfunction (right CVA) Flashcards

1
Q

Hemispheric Asymmetry

A

the right and left hemispheres of the brain are anatomically and functionally asymmetrical

differences are greatest in certain areas surrounding the sylvian fissure

  • sylvian fissure is slightly longer in the left hemisphere than on the right
  • planum temporale is a part of the superior surface of the superior temporal gyrus; this area is larger on the left than the right for most people
  • left temporal opercular region is larger and more infolded on the left than on the right; region is aka Broca’s area
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2
Q

Hemisphere Connections

A

the two hemispheres are well connected via the corpus callosum
contains more than 300 million axons aka commissural fibers

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3
Q

Right Brain

A 
uses feeling
“big picture” oriented
imagination rules
symbols and images
present and future
philosophy and religion
can “get it” (meaning)
believes/appreciates
spatial perception
knows objects function
fantasy based
present possibilities
impetuous and risk takers
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4
Q

Left Brain

A 
uses logic
detail oriented
facts rule
words and language
present and past
math and science
can comprehend
knowing/acknowledges
order/pattern perception
knows object name
reality based
forms strategies
practical and safe
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5
Q

Left Hemisphere

A

Language: Speaking Aloud; Auditory Comprehension; Naming; Reading Comprehension; Reading Aloud; Writing

Constructions: Internal Detail

Calculation: Arithmetic Processing

Memory: Verbal

Miscellaneous: Praxis

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6
Q

Right Hemisphere

A

Language: Auditory Comprehension; Reading Comprehension; Prosodic Expression
Prosodic Comprehension

Constructions: External Configurations

Calculations: Spatial Arrangement

Memory: Visuospatial

Miscellaneous: Facial Recognition

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7
Q

Right Hemisphere Functions

A

The right brain is seemingly responsible for:

  • arousal, orientation and attention
  • visual perception
  • emotional experience and expressions
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8
Q

Arousal

A

(right hemisphere is dominant for)

general readiness to respond to external stimuli; alert; ready to react

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9
Q

Orientation

A

(right hemisphere is dominant for)

directing one’s attention to a specific stimulus, event, or location; know where you’re going

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10
Q

Vigilance

A

(right hemisphere is dominant for)

sustained attention used to detect changes in the stimulus

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11
Q

Selective Attention

A

(right hemisphere is dominant for)

ignoring some stimuli while paying attention to certain specific stimuli

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12
Q

Sustained Attention

A

(right hemisphere is dominant for)

prolonged periods of attention to a task; focused attention

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13
Q

Right Hemisphere appears to process: (visual perception)

A

holistic, gestalt-like stimuli

geometric and spatial information

facial recognition

body image

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14
Q

Right Hemisphere is dominant for:

A

arousal

orientation

vigilance

selective attention

sustained attention

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15
Q

Holistic; Gestalt-like Stimuli

A

looking at big picture; grasping meaning of total picture

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16
Q

Geometric Spatial Information

A

understanding or recognizing spatially organized shapes or figures

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17
Q

Facial Recognition

A

responsible for recognizing familiar faces; 4-10 month old infants will show interest in their mother’s faces (high amplitude sucking)

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18
Q

Body Image

A

helps maintain proper body image and what’s acceptable socially based on life experience, etc.

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19
Q

Right Hemisphere is dominant for: (emotional experiences/expression)

A

emotions

perceptions of temporal order

perception of musical harmony

certain aspects of communication

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20
Q

Emotions

A

the expression of being angry, happy, sad, etc. (all the different emotions); understanding how the emotions impact you based on the stimuli you’re receiving from the environment (amygdala—fight and flight responses, etc); where that info is stored—what it means to be happy, sad, etc.

21
Q

Perceptions of Temporal Order

A

dominant for perceiving the temporal order or sequence of events; understanding of serial-ness of events

22
Q

Perception of Musical Harmony

A

music and processing of acoustic signals; generic music; understanding harmonies, etc.

23
Q

Certain Aspects of Communication

A

slide with blue chart

24
Q

Communication Functions of the Right Hemisphere

A
  • possible interplay b/w the right and left hemispheres with regards to discourse comprehension and production
  • right hemisphere may be less efficient in understanding verbs than nouns
  • right hemisphere may help make inferences implied in verbal exchanges
  • communicative efficiency and specificity may be centered in the right hemisphere
  • understanding alternative and ambiguous meanings
  • understanding or expressing emotional tone of verbal expression
25
Q

Communicative Functions of the Right Hemisphere Cont…

A
  • understanding or expressing prosodic aspects of speech
  • understanding contextual information of verbal expression
-managing pragmatic communication skills:
turn-taking
topic maintenance
social appropriateness of communication
eye contact
26
Q

Etiologies (NEuropatholgies)

A

CVA, tumors, head trauma and various neurological disease processes

Individuals who sustain RHD secondary to posterior lesions do not have motor disabilities; those with frontal lobe damages will have motor disturbances

27
Q

Grouped Symptoms Pts w/RHD might exhibit

A

perceptual and attention deficits

affective deficits

communication deficits

28
Q

Perceptual and Attention Deficits

A

left-neglect
visuospatial impairments
forms of disorientation

29
Q

Left Neglect

A

Reduced sensitivity to stimuli, reduced awareness of space or absence of previously learned responses from stimuli in certain visual fields:

  • neglect can result from damage to any lobe
  • neglect can be right or left dominant
  • right parietal lobe damage produces left-neglect in most pts
30
Q

Left Neglect Characteristics

A

Right focus: stimuli on right side of patient seems to capture and hold attention of patient; left neglect and right focus

Difficulty shifting attention from right-to-left

Failure to perceive left-sided tactile or perceptual stimuli: touch: pinprick, etc on left side; don’t perceive it; may or may not perceive pain on left side, but not something we’d do

Failure to copy the left side of a picture or a geometric design: clock draw

Disownership of left body parts or belongings

Denying illness (anosagnosia)

Left-neglect in reading/writing: starts in the middle and only read right half

31
Q

Prosopagnosia (Facial Recognition Deficits)

A

Prosopagnosia:

  • seen in Pts with posterior right hemisphere damage
  • difficulty recognizing familiar faces
  • difficulty choosing pictures of faces just shown
  • problems naming the pictures of faces of famous persons
32
Q

Constructional Impairments

A
  • problems constructing block designs
  • difficulty reproducing two-dimensional stick figures
  • errors in drawing or copying geometric designs

Often seen in Pts with all kinds of brain damage

  • with left hemisphere involvement: Pt will draw w/difficulty but make fewer mistakes; drawings are better w/models than without
  • with right hemisphere involvement: Pt will draw hastily, make many mistakes, add unnecessary lines to correct mistakes, do not show improvements w/models
33
Q

Attentions Deficits

A

reduced state of arousal: Pt’s w/RHD are described as hypoaroused

difficulty in sustaining attention: Pt’s attention wanders from task to task or from stimuli to stimuli

difficulty paying selective attention: Pt may find it difficult to focus on a particular stimuli in the presence of multiple stimuli

34
Q

Topographic Disorientation

A
  • the inability to orient in the surrounding as a result of focal brain damage
  • may result from the inability to make use of selective spatial information (e.g., environmental landmarks) or to orient by means of specific cognitive strategies such as the ability to form a mental representation of the environment, also known as a cognitive map
  • It may be part of a syndrome known as visuospatial dysgnosia.
35
Q

Geographic Disorientation

A

??

36
Q

Reduplication Paramnesia

A

is the delusional belief that a place or location has been duplicated, existing in two or more places simultaneously, or that it has been ‘relocated’ to another site

although rare, is most commonly associated with acquired brain injury, particularly simultaneous damage to the right cerebral hemisphere and to both frontal lobes.

37
Q

Visual-Perceptual Deficits

A
  • difficulty recognizing line-drawn pictures or incomplete drawings
  • drawings that distort the representation by showing unusual size, dimension or orientation
  • drawings that are superimposed on other drawings
38
Q

Affective Deficits

A

Pts with RHD tend to be emotionally indifferent:

  • difficulty understanding emotions
  • difficulty stating the emotions depicted in pictures
  • problem recognizing emotions expressed in isolated spoken sentences
  • difficulty understanding emotional tone of voice
  • difficulty expressing their own emotions correctly
39
Q

Memory Deficits

A

Nonverbal Amnesia:

  • references impaired recall of nonverbal visual material
  • ex: impairment in the retention of complex visual patterns and faces
40
Q

Neuropsychiatric Disorders: Visual Hallucinations

A
  • claims to see something that the observer cannot see
  • may occur as part of a seizure or may be associated w/visual field deficits
  • most common form of hallucination in persons w/dementia
41
Q

Neuropsychiatric Disorders: Mania

A 
-elated and/or irritable mood lasting at least one week and combined with any of the following:
hyperactivity
flight of ideas 
grandiosity 
diminished sleep
distractibility 
lack of judgment
rapid speech
42
Q

Communication Deficits are different than those associated with left-hemisphere damage:

A

Communication problems are found in about 50% of individuals who have RHD

RHD: no word-retrieval issues
RHD: no significant circumlocutions or paraphasias
RHD: speak in grammatically accurate sentences
RHD: have good comprehension

pts w/RHD do exhibit: prosodic deficits; impaired discourse; semantic problems; pragmatic deficits

43
Q

Prosodic Deficits

A

prosody references: stress patterns, intonation, rhythm, melodious qualities of speech that convey meaning

output may be:
monotone
impaired in stress patterns; may change intensity levels
reduced rate of speech
devoid of emotion
impaired in prosodic comprehension; difficulty understanding the emotional tone heard

44
Q

Impaired Discourse

A

Discourse is a set of social communication skills; may involve narration, procedures, expository discourse

Pts with RHD exhibit:

  • difficulty distinguishing significant from irrelevant information
  • difficulty understanding implied meanings, abstract words, metaphors, irony and humor
  • premature and incorrect inferences
  • confabulation and excessive speech
45
Q

Semantics

A

left hemisphere: active in promptly and quickly understanding concrete meanings of words

right hemisphere: involved in understanding or producing words w/complex, abstract, metaphoric, and multiple meanings

46
Q

Semantic Difficulties

A

pts w/RHD exhibit:

  • difficulty understanding implied, alternative or abstract meanings
  • failure to grasp the overall meaning of situations, events, stories or pictures (miss the central message)
  • difficulty understanding idioms, proverbs and metaphors
  • difficulty naming abstract categories in contrast to the names of individual items in a category
  • difficulty w/irony, humor, and sarcasm
  • problems in understanding logical errors in sentences
47
Q

Pragmatic Difficulties

A

Pragmatic language problems could include:

  • difficulty in conversational turn-taking
  • difficulty with topic maintenance
  • difficulty in maintaining eye contact
  • insensitivity to communicative contexts: assume too much about what their listeners know about the topic of conversation
48
Q

Associated Language Difficulties

A

Right hemisphere’s receptive language capabilities:
-disturbance in comprehension of logical syllogisms (ex. all trees have root systems; all root systems need nitrogen; therefore, all trees need nitrogen)
-pictorial interpretations of metaphors (ex.it’s raining cats and dogs)
-concrete interpretation of proverbs/idioms; abstract verbal tasks pose problems
(ex. the greatest talkers are the least doers;
a heavy heart)

Aphasia (7 decks)

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