Right hemisphere brain damage ( RHD ) is the result of an injury to the right hemisphere. The right hemisphere of the brain coordinates tasks for functional communication, which includes problem solving, memory, and reasoning. The deficits caused by right brain hemisphere damage vary depending on the location of the damage.
Video Right hemisphere brain damage
Signs and symptoms
Visual processing
Individuals with right hemisphere damage show deficits in visual processing. It seems as if they can only recognize parts of images, symbols, etc. Instead of looking at the overall picture. This was demonstrated during the experiment when patients with right hemisphere damage had to draw M consisting of small triangles. When they try to re-create the image, they only describe small triangles. This reciprocates the patient with left hemisphere damage capable of drawing M, but leaves a small, fictitious triangle. In addition, people with right hemisphere damage have difficulty changing their perception of the whole picture. They focus on one particular whole and have difficulty changing their perceptions and combining the rest as new information is presented. This phenomenon is called revised inference and individuals with right hemisphere damage because it has a deficit in this area.
Cognitive and communicative
Umum
Patients with right hemisphere brain damage most often have difficulty with attention, perception, learning, memory, recognition and emotional expression, and neglect. Other frequent deficits, though slightly less common, include reasoning and problem solving, awareness, and orientation. It is also common for patients with right hemisphere damage to have a flat effect, lack of emotional expression, while speaking. In addition, these patients usually have difficulty recognizing the emotions of others when expressed through facial expressions and tone of voice. Lack of ability to recognize emotions shows individuals having disturbed theories of mind, the ability to recognize the thoughts and feelings of others outside of themselves. Although this deficit alone may complicate therapy, the patient may also exhibit anosognosia, or ignorance of the disorder. Because of the possibility of anosognosia, it is common for patients not to become frustrated or upset when they can not accomplish the tasks they previously had completed.
Unlike aphasia victims, the individual speech patterns with right hemisphere damage are usually not characterized by "word search issues, paraphasia, circumlocutions, or phonological process disturbances." Circumlocution in people with RHD tends to be centered around general concepts, not specific words. For example, in describing what brings the affected individual RHD to the hospital, even though the patient may remember the word "stroke" and other specific words to describe the situation, the decrease in RHD to the level of discourse and cognitive processes is likely to prevent it from describing the situation by a coherent way.
Linguistic Damage
Sintaksis
The syntax of individuals affected by RHD tends to be "accurate and diverse"; unlike the victims of aphasia, they tend not to have trouble with the taking of words. In addition, people with right hemisphere damage usually understand the literal meaning of most statements. Linguistically, in cases where RHD patients appear to have synthetic deficits, they are usually the result of problems with semantic processing.
semantics
In a 1962 study, Eisenson observed "leniency verbalization" in individuals affected by RHD, noting that the damage to the right hemisphere appears to affect "relatively abstract language formulations," evidence, according to Eisenson, that the right hemisphere probably controls the "super- or" extra language function "In other words, RHD patients experiencing problems with higher level language tasks (associated with semantic and lexical processing) are less common in everyday discourse, on average.In describing semantic deficits in people with right hemisphere damage, differences must be drawn between converging and divergent semantic processing.Tasks involving convergent semantic processing ("relatively simple linguistic tasks where the number of responses is limited"), involving the simplest of words, are not nearly as difficult for RHD patients as tasks involving different semantic processing (tasks that "give rise to possible meanings deviate from a single semantic concept to incorporate non-dominant, alternative, connotative, and/or less familiar meanings ").
In terms of convergent semantic processing, people with RHD do not exhibit semantic disorders at the phonemic level, nor do they tend to have difficulty understanding the primary meaning of individual words. Their understanding of simple and unambiguous sentences also remains intact, as does their basic word taking; This evidence shows that these tasks are a function of the left hemisphere. On the other hand, the right hemisphere is more involved in recognizing the meaning of many and non-primer words, different semantic processing tasks that are impaired in individuals with right hemisphere damage. Along this line, RHD patients have difficulty with verbal fluency; in an experiment in which individuals affected by RHD are asked to mention items in a category, they tend to suggest connected objects in more ways than one (with many of the same characteristics). For example, when asked to name vegetables, people with RHD will mention spinach, cabbage, and lettuce, which share the attributes not only as vegetables but also become "green and leafy." Such results "support a semantic processing model in which [the right hemisphere] is superior in generating many loosely connected meanings with little overlap," a function clearly influenced by right hemisphere damage.
As a result of a pragmatic deficit, individuals with right hemisphere damage have difficulty understanding figurative cues in language and tend to only understand sentences from their literal meaning. For example, if anyone says, Joey took the lion's part, they would think Joey took the lion's share as opposed to everyday meaning - the majority. In the same vein, they also do not understand the underlying pragmatics and underlying language possible. Because of this, implicit orders or suggestions in sentences are lost in people with right hemisphere damage. In addition, they have trouble keeping up on topics during the conversation and therefore showing a deficit in topic maintenance. However some may stick to the main topic, but bury it in their conversation with a large number of details that are not relevant to the main point. They also tend to show a lack of awareness of the knowledge they share with the people they communicate with and will mention people or things that others have no reference to.
Speech Disturbance
Taking into account the highly contextual and often ambiguous nature of discourse, it tends to be the field of communication most affected by right hemisphere damage. RHD is very clear in the inference pattern of the affected individual. Although RHD patients are usually able to make basic conclusions about situations, smoother inferences for speech and conversation are often severely impaired. As Penelope Myers noted, many empirical studies have shown that people with right hemisphere damage "have significant impairment in generating inferences about each of the pictorial scene elements," and, most significantly, in collecting information about individual elements together for understand the situation at large. This damage also applies to written or oral texts. For example, Beeman (1993) cites a patient who mentions his ability to read "direct text" but notes that he has stopped reading novels with many characters such as, in the words of the patient, "I can not unite them all."
Experimentation with Norman Rockwell Paintings
As further evidence of this phenomenon, there is research done with the right hemisphere that destroys patients using Norman Rockwell pieces. In this experiment, participants were shown a painting, with no title attached, and asked to describe what happened at the scene. As one might expect, there is a variation between the answers of people with right hemisphere damage and no brain damage. This experiment has provided further evidence for the idea that individuals with right hemisphere damage have difficulty recognizing the emotions of others because they did not mention them when asked to describe the painting. In addition, this process shows that they do not take relevant cues and have difficulty entering small details they realize together to form a big picture. When really describing the painting, the patient gives too many experiments a description of what happened, without discussing the whole theme of the work, or giving them a basic sentence "description" of what they see. After analyzing and comparing participants' descriptions without brain damage and those with right hemisphere damage, the researchers found that those with right hemisphere damage used twice as many words as those who did not suffer brain damage even after the researchers removed part of the description looks tangential.
Furthermore, individuals affected by RHD experience deficits in inference-revision abilities. For example [from Brownell et al. (1986)], when presented with the sentence, "Barbara became too bored to finish a history book, both the subject of RHD and the control subjects assumed Barbara was reading a book, but when the subject was then presented with the second sentence," She has already spent five years writing it , "the subject of control alters their initial inference, while the subject of RHD shows great difficulty revising their conclusions and drawing broad conclusions and revisions about existing information.The difficulty of RHD patients with understanding non-literal meaning is also a significant cause of discourse disorder As mentioned above, Right hemisphere damage affects the understanding of figurative languages ​​such as idioms, as a result of the role of the right hemisphere in activating non-literal and peripheral meanings.As a result of their difficulty understanding the meaning and making of alternative situational inferences, people with right hemisphere damage faced significant challenges in discourse.
Difficulty in communicating tends to be associated with the cognitive deficits of the patient. For example, communication disruption may occur because a patient with right hemisphere brain damage fails to observe appropriate social conventions or because the patient may be babbling and fail to recognize the exact time to take a conversation turn. The patient may also have difficulty understanding sarcasm, irony, and other paralinguistic communication aspects. Although they do not understand irony, it has been found that patients with right hemisphere damage can provide a cute joke for jokes, but disappear when the funny has to connect some ideas or themes. Along with sticking to the main point of a story, the patient may find it difficult to extract the theme of the story, or set the sentence based on the theme of the story.
Nespoulous, Code, Virbel and Lecours studied their speeches with various types of aphasia and created a term for their speech patterns that have the right hemisphere damage. According to them, these patients are involved in a "modalize" speech that consists of speeches about the patient's perspective in the real world. They found that those with right hemisphere damage contrasted them with Aphasia Wernicke as patients using referential speeches that Nespoulous et al. identifying it as a speech relating to the real world and what's going on inside it. With referential speech, patients describe what they do, but abandon their attitude toward it. In modernizing speech, the description of the real world does not exist, but it includes their emotional attitudes
Motor and sensory
A common motor deficit is left-sided hemiparesis (in stroke affecting motor cortex). Motor deficiency that is less common in this population is dysphagia.
Patients with right hemisphere brain damage often display sensory deficits such as left ignorance, where they ignore everything in the left visual field. This abandonment can be present in many daily activities including reading, writing and self-care activities. For example, individuals with left negligence usually leave details on the side of a derelict image or try to pull all the details on the unaffected side. Homonymous hemianopsia is another sensory deficit that is sometimes observed in this population.
Maps Right hemisphere brain damage
Cause
Stroke is the most common source of damage for right hemispheric damage. Stroke for this disorder occurs in the right hemisphere of the brain. Other etiologies that cause right hemisphere damage include: trauma (traumatic brain injury), illness, seizure disorders, and infections. Depending on the etiology that causes damage to the right hemisphere, different deficits can be accounted for. "The level of deficits or irregularities experienced by individuals with right hemisphere damage depends on the location and extent of damage.The small right focal hemisphere stroke can produce very specific deficits and leave most of the cognitive and perceptual processes intact, while very large strokes in the right hemisphere more than likely outcomes in some deep deficits. "Adults with right hemisphere damage may exhibit behaviors that can be characterized by insensitivity toward others and preoccupation with oneself; unconsciousness of the social context of the conversation; and verbose, rambling and tangential speech.
Diagnosis
Right hemisphere brain damage is diagnosed by a medical professional. Computerized tomography (CT) scans and magnetic resonance imaging (MRI) are often used to determine where damage occurs and how severe (ASHA).
Standard assessment is used by speech-language pathologists to determine the presence and severity of right hemisphere brain damage. The three most popular standard assessments include:
- Inventory of Right Brain Mini Injury - Second Edition (MIRBI-2) - standardized tests that can be used to identify the presence, severity, and identify the strengths and weaknesses of patients.
- Battery of the Right Hemisphere Language - Second Edition, (RHLB-2) -a comprehensive test battery for evaluation of right-sided injured adults.
- The Chicago Rehabilitation Institute Evaluates Communicative Issues on Right Revisited Hemisphere Dysfunction (RICE-R) -includes nine subtests that include patient interviews and face and written expression ratings and severity ratings for each subtest.
Non-standard tests can also be useful in determining the communicative deficits of adults with right-hemisphere brain damage. Such procedures include tests: Visual and Spatial Perceptions, Attention, and Organization, Processes of Visual Components and Organizations. [Does the "test" listed previously need to be capitalized?] Other non-standard tests that may be used include:
- The Boston Diagnostic Aphasia Exam (BDAE) - Understanding understanding, oral expression, and reading subtes
- Changed Token Test
- The Boston Naming Test
- Word Flattening Test.
Treatment
Treatment for right hemisphere damage is given by a speech-language pathologist. Not much research has been done on the efficacy of care for right hemisphere damage. Studies have shown that people with right hemisphere damage benefit from therapy in the chronic and acute recovery phase for language. Research also shows that the treatment provided by speech-language pathologists to people with right hemisphere damage results in improvements in the areas of problem solving, attention, memory, and pragmatics.
Different treatment approaches can be used to treat various symptoms of right hemispheric damage including neglect, visuospatial awareness, prosody, and pragmatics. Therapy for each person is individualized to its symptoms and severity. Interventions should focus on people's needs in communication and functional aspects.
Data from the American Speech-Language-Hearing Association (ASHA) show that treatment for individuals with right hemisphere damage tends to focus on areas other than communication, including swallowing, memory, and problem solving. Deficits in language expression, language comprehension, and pragmatics are discussed much less frequently (22%, 23%, and 5% of individuals respectively). The lack of research focusing on the treatment of communication is cited as a possible explanation for this low percentage. Small-scale and pilot studies have been conducted in recent years to fill in the gaps identified in the treatment literature. The evidence presented is discussed below.
Prosody
Right hemisphere damage can cause aprosodia - the inability to produce or understand the emotional prosodies of language. Emotional prosodies are usually conveyed and interpreted through changes in tone, rhythm, or loudness (Leon et al., 2005). The broken right hemisphere of the patient has the greatest difficulty with the type of sentence that revolves around pitch and inflection. The types of sentences include: declarative, because there is a decrease in the tone at the end; interrogative, because there is an increase in tone for yes/no questions and decreases when there is a pronoun asked; and the type of imperative sentences in which there is even a note until an intensity rise is made at the end of the command. The research so far has focused primarily on motor-imitative and cognitive-linguistic approaches to prosodic treatment. In a motor-imitative approach, the client imitates the clinical model sentence that is generated with emotional prosodic targets. Modeling and cues are gradually reduced following a six-step hierarchy until the client reaches independent production. In the cognitive-linguistic approach, clients are asked to produce sentences with the help of the instruction card. Cues include the name of the target emotion, the emotional tone vocal characteristics, and the corresponding facial expression images. Again, the cues are gradually removed as the client evolves toward independent production. Clinical studies of small groups of participants (four participants, 14 participants.) Reveals statistically significant results in the production of emotional prosodies after treatment. Additional research is needed to replicate the results of limited studies that have been done so far, to evaluate the efficacy of additional treatment approaches, and to compare the relative efficacy of different approaches.
Results
It seems as though individuals with right hemisphere damage retain their real-world knowledge and their mental scripts about what the world looks like and what to expect from common scenarios; they can not translate it when they see it. These descriptions, right hemisphere damage can cause deficits in the ability of discourse, including difficulties with abstract language interpretation, drawing conclusions, and understanding nonverbal cues. In particular, individuals with right brain damage struggle with the use of a skillful context for interpreting and expressing ideas. A study of five participants with right hemisphere damage found that participants' ability to interpret metaphors orally was statistically improved significantly after five weeks of structured training interventions. The training program includes five phases that are focused on facilitating the use of word and semantic meaning to enhance participants' understanding of metaphors. Another study of three participants found that contextual stimulation treatment enhanced participants' ability to efficiently activate distantly related meanings and to suppress contextual meaning that was not context-appropriate. Again, additional research is needed to replicate and expand the results, but the emerging literature is a small step towards evidence-based treatment for right hemisphere damage.
Prognosis
Sex Differences
Studies have shown that women are more likely to be the dominant left hemisphere, and men are more likely to be dominant right hemispheres. Therefore, women recover faster than left brain damage, and men are more likely to recover faster than right hemisphere damage. Men who suffer from right hemisphere stroke also have much better rehabilitation results than men who suffer a left hemisphere stroke. Functional functional recovery is often greater in stroke survivors than in women, especially in areas of daily life activity.
Ignore
Left escape is common in patients who recover from right hemisphere damage because the right hemisphere controls the left half of the body. The presence and severity of omissions have been shown to influence functional outcomes as well as the length of rehabilitation after a stroke.
Patients with negligence for peripersonal spaces (chamber in range) are most likely to recover at most during the first 10 days after stroke, but further improvement from 6 months to 1 year post-onset is not possible. However, the prognosis for patients who ignore private body space or ignore the space is much better. This type of omission is more likely to recover fully or almost completely after 6 months after onset. Although there may be some lasting effect of negligence of various degrees by type, many patients with omissions tend to increase over time (Appelros et al., 2004).
Functional results
The Functional Independence Measurement (FIM) is often used to determine the functional skills a patient has at various times after their brain damage. Studies have shown that patients with more severe omissions are less likely to perform functional improvement than patients with less severe ignorance based on FIM scores. In addition, patients with abandonment rates tend to reduce cognitive and functional communication skills than patients without neglecting (Cherney et al., 2001).
Rehabilitation
Patients with neglect have been shown to require longer rehabilitation than patients suffering from right hemisphere damage that do not result in negligence. On average, patients with negligence stay in hospitalized rehabilitation facilities one week longer, and this length of stay is no different for patients with more or less severe omissions (Cherney et al., 2001).
Anosognosia
Anosognosia is a lack of awareness or understanding of the loss of function caused by brain injury and often occurs in individuals who have suffered a right hemisphere stroke. Because patients with anosognosia may not be aware of their deficits, they may be less likely to seek treatment once they are released from the hospital. Lack of proper care can lead to higher levels of dependence later on. To make functional recovery benefits, right hemisphere stroke patients should receive rehabilitation services, so patients with anosognosia should be encouraged to seek additional care. However, due to anosognosia, these patients often report a higher perceived quality of life than other right hemispheric stroke victims due to the unconsciousness of the resulting deficit (Daia et al., 2014). Those with right hemisphere damage can brainstorm, or make up stories to help explain what's going on in their minds compared to what's really going on in the outside world. For example, one patient who suffered right hemisphere damage was in a wheelchair and kept his left hand on the fingers. When the nurse asked her to stop, she looked down and said, "That's not my hand." Because the right hemisphere controls motor function for the left side of the body, the patient does not recognize the actions of his own hands and makes the story to explain what is going on. This often happens because what really happens to them is so disturbing that their mind needs a way to overcome it. Patients with smaller lesions often recover faster than anosognosia than patients with larger lesions resulting in anosognosia (Hier et al., 1983).
Other effects
Age: Younger patients usually recover faster than older patients, especially with regard to prosopagnosia (difficulty recognizing faces)
The size of the lesion: Patients with smaller lesions usually recover more quickly from negligence and hemiparesis (unilateral body weakness) than patients with larger lesions (Hier et al., 1983).
History
For much of the nineteenth century, the left hemisphere's brain was the main focus of clinical research on language disorders (Brookshire, 2007). In the twentieth century, the focus gradually shifted to include damage to the right hemisphere (Brookshire, 2007). It is now well established that language and cognition can be seriously disrupted by unilateral right hemisphere brain damage. Specific cognitive tests can help diagnose right hemisphere brain damage and differentiate symptoms from left brain damage. Unlike aphasia, caused by left brain damage and generally resulting in focused language deficits, right hemispheric brain damage can lead to diffuse deficits that complicate formal testing of this disorder (Brookshire, 2007). These formal tests assess areas such as understanding humor, metaphors, sarcasm, facial expressions, and prosody. However, not all individuals with right hemisphere brain damage have problems in language or communication and some may not have visible symptoms. Indeed, about half of patients with right hemisphere damage have intact communication skills (Brookshire, 2007).
See also
- Agnosia
- Afasia
Literature
- Blake, Margaret Lehman (2017). Right Hemisphere and Cognition and Communication Disorder: Clinical Theory and Practice . San Diego, Plural Publishing, Inc.
References
Source of the article : Wikipedia
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