Right Hemisphere Disorders
(RHD)
In 1974, William O. Douglas,
Associate Supreme Court Justice
suffered a stroke
He recovered quickly, checked himself out of rehab.
In court he dozed and asked irrelevant questions and
rambled on. He was asked to resign------ “he came back
to his office, buzzed for his clerks and asked to
participate in, draft, and even publish his own opinions
separately; and he requested that a tenth seat be placed
at the Justices’ bench.” (Gardner, 1982)
Ok, the history
Historically, non-dominant hemisphere strokes
were not referred to slp clinics
Mainly because the primary disorders are related
to nonverbal cognitive systems
Don’tdisplay word-finding and grammatical deficits
associated with aphasia
Zoom to today, (history lesson
is done!!)
Non dominant strokes now referred usually for:
Pt has a swallowing problem or motor speech deficit
Pt has an old RHD recently suffered a left
hemisphere stroke
Pt has communicative difficulties caused by right
hemisphere stroke---as with Justice Douglas
Language Evaluations
Wemight typically begin with an aphasia
assessment tool, but:
RHD pts are most often not aphasic in that they can
normally process most words and sentence in
isolation
Language Comprehension
Sometimes perform as poorly as aphasic
subjects
Can display good word comprehension, with mild
deficit when presented with up to 4 semantically
similar picture options
Not usually deficient short term memory span
Can follow directions (Token Test)
Difficulty arranging words into a grammatical
sentence
Problems with sentence comprehension with
thematic roles in passive sentences
Subtle!
RHD: Language Production
Tend to name common objects effectively
Word finding problems occur on divergent
thinking (expansion) tasks
Tend to generate fewer words (fluency)
More problems with lexical semantics than with
phonology and syntax
Errors increase with processes that are “less
automatic”
RHD: language production
May score similarly on clinical tests but for
different reasons!
Because RHD pts have impaired attention,
perception and organizational skills
So let’s look at the primary cognitive impairments
caused by right hemispheric stroke
RHD: awareness of deficits
Anosognosia: lack of awareness or recognition of
disease or disability
“lackof insight” or “imperception of disease”
Essentially, pts are unable to become aware of the
neurological dysfunction
But,denial of impairment is a psychological defense
mechanism---a pt who is strictly in denial is considered
to be capable of awareness of deficit
Anosognosia isusually observed as lack of
awareness of paralysis
Selfawareness of deficits was not correlated with
actual task performance (Pendley and Ramsberger,
19960
Visuospatial Functions
WAIS scores show a pattern that is reversed
relative to aphasia
RHD pts are likely to have a discrepancy score in
which the Performance IQ (requires visuospatial
recognition and reasoning skills) is lowered
relative to the Verbal IQ
Left neglect is more common that right neglect---
pts with posterior RHD bump into things on their
left, leave food on the left side of a plate, dress
only the right side, draw on the right side of an
object
Wheel chair accidents!
Crossing Out Test, Line cancellation Test, etc.
Auditory-Vocal Modalities
Auditory agnosia:impaired ability to recognize
sounds despite adequate hearing
May refer to deficient recognition of nonverbal or
environmental sounds (auditory sound agnosia)
Emotion
Complex relationship between the limbic and the
autonomic nervous systems---a message
recognized in the cognitive cortex
Although both hemispheres are involved, the RH
is dominant for emotion
RHD pts may display flat affect or indifference
that accompanies left neglect
Hypoarousal to emotional pictures
Attention and Reading
RHD: tend to misread the beginning of words,
Some omit or misread words on the left side of
the page
Some have both of these problems
Misreading the left side of words or left side of a
page indicates neglect dyslexia
Emotion and Prosody
Aprosodia:
Flat contour or monotone
Failure to identify emotional tone in mundane
sentences
Unable to detect happy, sad or angry faces
Interpreting Situations
RHD: difficulty recognizing emotion or humor in
pictured scenes; unlike aphasics!
RHD: difficulties with sorting implicit themes like
“love” from explicit themes like getting a hug
Suggests that RHDs have a problem with inferring
the nature of situations when it is not concrete or
obvious
Metaphor comprehension
“Metaphor is a pragmatic convention used for
studying comprehensions of speaker-meaning
that differs from literal content” (Marquart, 2000)
Inference is presumed to be a necessity
Interpreting idioms like “bury the hatchet” or
“shoot the bull”
Discourse
RHDs recall main ideas better than details and
explicit information
Tend to “miss the point”
