Slpa 986 - Right Hemisphere Dysfunction - Exam 1

Front 1

What is the cause of RHD?

Back 1

occurs secondary to focal or diffuse damage to the right hemisphere

Front 2

What is focal damage for RHD?

Back 2

damage (often from strokes) occurs with equal frequency to right and left hemisphere

Front 3

What is diffuse damage for RHD?

Back 3

damage to entire brain (such as that from TBIs) including damage to the right hemisphere and, therefore, can result in RHD

Front 4

___% of people with RHD admitted to rehab have at least one cognitive or communication deficit, but only ___% are referred for SLP eval or tx.

Back 4

94%; 45% referred

Front 5

True or false: People with RHD are often unaware of cognitive and communication deficits.

Back 5

True

Front 6

Trure or false: There are many tx studies for most cognitive and communication challenges associated with RHD.

Back 6

False; few studies, therefore, little guidance for tx

Front 7

What are some anatomical differences between hemispheres?

Back 7

-posterior portion of sylvian fissure angles upward in right
-sulci are deeper in left language region (greater amount of cortex)
-right frontal lobe is longer
-left occipital lobe is longer
-60-75% of people have larger left ventricles

Front 8

What role does the left hemi play in communication?

Back 8

-reading aloud
-writing
-naming
-comprehending auditory info
-speech

Front 9

What role does the right hemi play in communication?

Back 9

-prosody
-emotional content
-humor
-figurative language
-recognizing facial expressions

Front 10

What role does the left hemi play in visuospatial construction?

Back 10

-internal details (specifics)

Front 11

What role does the right hemi play in visuospatial construction?

Back 11

-external details
-general orientation

Front 12

What role does the left hemi play in calculation?

Back 12

math symbolization (order matters)

Front 13

What role does the right hemi play in calculation?

Back 13

visuospatial organization of digits

Front 14

What role does the left hemi play in memory?

Back 14

verbal memory

Front 15

What role does the right hemi play in memory?

Back 15

nonverbal memory (e.g., places, people's faces, things you see)

Front 16

The left hemi processes info bound by _________. The right hemi processes novel input ________________.

Back 16

rules; for which there are no rules

Front 17

What are the characteristic deficits of RHD?

Back 17

-visual-perceptual deficits
-visual-motor deficits
-attention deficits
-communication deficits
-affective deficits

Front 18

What are the visual-perceptual deficits of RHD?

Back 18

-homonymous hemianopsia
-left neglect
-anosognosia
-achromatopsia
-visual hallucinations
-prosopagnosia
-environmental agnosia

Front 19

Describe visual field.

Back 19

-refers to what you see with each eye
-divided into 4 quadrants (upper, lower, right, left)
-image crosses over and flips on retina

Front 20

What is a visual field cut? and when does it occur?

Back 20

-blindness in a portion of the visual field
-occurs when there is a lesion in the optic tract extending from the eye to the occipital lobe (most common type for RHD is left homonymous hemianopsia)

Front 21

What is the retina? and what is it responsible for?

Back 21

-very thin layer of tissue that lines the inner part of the eye
-responsible for capturing light rays that enter eye and changing them into electrical signals

Front 22

What are the photoreceptor cells? and where are they located?

Back 22

-rods and cones: when light hits a cell, a chemical reaction occurs that sends an electrical signal to brain
-located in retina

Front 23

Describe rod cells.

Back 23

-photoreceptor cell
-for dim light or night vision
-many more in humans than cones
-more sensitive to motion and light than cones

Front 24

Describe cone cells.

Back 24

-photoreceptor cells
-fatter than rods
-fewer than rods in humans
-3 types (sensitive to: red, green, blue)

Front 25

What are bipolar cells?

Back 25

-info from rods and cones is transmitted to front part of retina thru bipolar cells
-transmit info to ganglion cells in anterior layers of retina

Front 26

What are ganglion cells?

Back 26

-converge at optic disc (near center of retina)
-at disc, axons turn posteriorly to exit eyeball as the optic nerve
-cause blind spot in each eye

Front 27

Describe the optic tract.

Back 27

-optic nerve from each eye travels posteriorly to join nerve from other eye
-joining point is called optic chiasma ("optic cross")
-at optic chiasma, about 1/2 of axons cross midline (contralateral)
-axons continue posteriorly to lateral geniculate body of thalamus
-here, axons synapse
-neurons enter cerebral hemispheres thru internal capsule and form optic radiation (2nd neuron pathway)
-optic radiation splits into 2 loops (meyer's and parietal)

Front 28

Describe Meyer's loop.

Back 28

-one of 2 loops split from the optic radiation of the optic tract
-upper visual field
-loops forward and goes back to occipital lobe

Front 29

Describe the Parietal loop.

Back 29

-one of 2 loops split from the optic radiation of the optic tract
-lower visual field
-goes straight back to occipital lobe

Front 30

If you have a lesion after the optic chiasm but before the lateral geniculate body, you have?

Back 30

left homonymous hemianopsia

Front 31

If there is a lesion after the lateral geniculate body, you have?

Back 31

damage to only part of left visual field

Front 32

From the lateral geniculate bodies, info from upper retinal fields (i.e., ?) goes thru WHAT loop to WHAT part of the primary visual cortex of occipital lobes?

Back 32

(i.e., lower visual fields)
-Parietal loop
-upper part

Front 33

Info from lower retinal fields (i.e., ?) goes thru WHAT loop to WHAT part of the primary visual cortex of occipital lobes?

Back 33

(i.e., upper visual fields)
-Meyer's loop
-lower part

Front 34

What is ipsilateral anopsia? and what causes it?

Back 34

damage to optic tract anterior to optic chiasma results in monocular field deficit
-usually from damage to eye itself

Front 35

What is bitemporal hemianopsia? and what causes it?

Back 35

-damage to medial portion of optic chiasma results in loss of peripheral vision in each eye
-caused by tumors of pituitary gland

Front 36

What is nasal hemianopsia? and what causes it?

Back 36

-very unlikely to have a binasal
-damage to lateral portion of optic chiasma results in a loss of nasal visual field of ipsilateral eye
-caused by aneurysm at place where internal carotid artery splits into branches
-would still see everything because left eye would compensate

Front 37

What is homonymous hemianopsia? and what causes it?

Back 37

-damage to optic tract posterior to optic chiasm, in optic radiations, or in optic cortex results in a loss of contralateral visual fields of both eyes
-caused by strokes

Front 38

What is superior quadrantopsia? and what causes it?

Back 38

-damage to optic tract posterior to lateral geniculate body, in meyers loop, results in a loss of contralateral upper visual fields of both eyes
-caused by stroke in temporal lobe

Front 39

What is inferior quadrantopsia? and what causes it?

Back 39

-damage to optic tract posterior to lateral geniculate body, in parietal loop, results in a loss of contralateral lower visual fields of both eyes
-caused by strokes in parietal lobe

Front 40

What is neglect?

Back 40

failure to respond to info presented on the side opposite the brain lesion
-can happen with either left or right hemi (right is more common and severe)

Front 41

True or false: Neglect can occur on multiple modalities.

Back 41

True; most common with vision but can occur in auditory, tactile (touch, pain, temp), hearing, smell

Front 42

True or false: Left neglect will compensate for deficit.

Back 42

false; won't; hemionopsia will

Front 43

What are the theories about underlying cause of neglect symptoms?

Back 43

-perceptual disorder (visual problem)
-deficit in representation of space
-directional impairment (orientation problem)
-attention deficit (most accepted theory)

Front 44

What are associated problems of neglect?

Back 44

-anosognosia
-poor motivation
-apathy
-decreased arousal and responsiveness
-confabulation

Front 45

What is anosognosia?

Back 45

"not to know yourself"
-lack of awareness of your deficits

Front 46

What level of severity do people with neglect typically have?

Back 46

either very mild or very severe (not a lot in the middle)

Front 47

What types of tests are available for assessment of neglect?

Back 47

-tests of extinction
-tests of visual neglect

Front 48

What is extinction?

Back 48

failure to respond to stimulation on one side of the body when both sides are stimulated simultaneously

Front 49

What tests are available for tests of visual neglect?

Back 49

-line bisection
-cancellation
-picture description
-drawing
-reading
-writing
-ADL tasks (baking tray task)

Front 50

What txs are available for visual neglect?

Back 50

-visual spatial training
-optokinetic stimulation
-virtual reality
-limb activation
-sustained attention training
-vestibular stimulation
-neck muscle vibration and trunk rotation
-prisms
-eye patching

Front 51

Describe high-tech methods for visual spatial training for left neglect.

Back 51

computer software/displays requiring identification of lights/images

Front 52

Describe low-tech methods for visual spatial training for left neglect.

Back 52

-line cut-outs to isolate a single line of text
-visual cue to indicate left side of page (e.g., highlight)
-tactile cue to indicate left side of page (scan with hands til they hit other hand on left side)
-auditory cues to scan to left

Front 53

How effective is visual spatial training for left neglect?

Back 53

-appears to help in specific situation in which cuing occurs and in which individual is struggling to locate objects in left field
-generalization to other instances and situations appears to be minimal

Front 54

Describe optokinetic stimulation for left neglect tx.

Back 54

-uses a computer display of images (dots or horizontal lines) moving to left side of screen at various rates
-this creates an optical illusion that the screen is moving, thus the individual's gaze is shifted leftward

Front 55

How effective is optokinetic stimulation for left neglect?

Back 55

with 5 reps of 45-min sessions within 2week period, substantial improvement in performing both structured (e.g., digit cancellation, line bisection) and unstructured (e.g., reading) scanning tasks
-not done a lot because of lack of equipment

Front 56

Describe virtual reality for tx of left neglect.

Back 56

-computer stimulation of virtual reality using "DataGlove"
-task is to reach and grasp real and virtual objects placed in different visual fields
-person receives correct info about object's location on some trials and incorrect info on others. Intent is to force person to remap his/her visual space

Front 57

How effective is virtual reality for tx of left neglect?

Back 57

-after repeated trials, tx was effective for people with lesions that spared the inferior parietal/superior temporal regions of the right hemi
-no maintenance or generalization testing performed, so do not yet know whether changes are long-lasting

Front 58

Describe limb activation for tx of left neglect.

Back 58

Different procedures:
-use functional e-stim to induce contraction of muscles in affected limb
-use active movement of patient's left arm in left hemi
-Neglect Alert Device- emits a loud buzzing noise and a red light if the switch is not pressed with the left hand within a predetermined time interval

Front 59

How effective is limb activation for tx of left neglect?

Back 59

-some case studies have reported good results, but studies with larger numbers of participants and greater control have reported little functional change
-patients must have recovered at least some contralateral limb movement prior to participating in this type of tx unless using functional e-stim (must be active movement of limb, not passive)

Front 60

What are the tx steps for sustained attention training for tx of left neglect?

Back 60

-1st: person performs a particular test and spatial error are pointed out
-2nd: person performs the task again while trainer knocks loudly and unpredictably on the table every 20-40 secs and says "attend" in a loud voice
-last: person performs task again to see if s/he has learned to "self-alert"

Front 61

How effective is sustained attention training for tx of left neglect?

Back 61

-only one single-case study reported (2 participants, no follow-up)
-without further research, not possible to conclude whether this technique is useful for rehab
-appropriate?

Front 62

Describe vestibular stimulation for tx of left neglect.

Back 62

-idea is to enhance the automatic orientation toward the left space without the requirement of language-mediated attentive learning
-first sensory stimulation to be used
-insert cold water in ear canal

Front 63

How effective is vestibular stimulation for tx of left neglect?

Back 63

-results in a short-term (mins) "remediation" of left visuo-spatial neglect
-improvements following vestibular stimulation depend on the modulation of cortical areas and non-cortical areas implicated in or capable of influencing spatial cognition

Front 64

How effective is neck muscle vibration and trunk rotation for tx of left neglect?

Back 64

-improvements noted in most patients; however, changes were short-lived
-increased visual direction within the left hemi, straight ahead judgment, and neglect hemianesthesia
-with the assistance of a shoulder strap or a corset, improvements of visual detection and exploration toward left hemispace occurred

Front 65

How effective is the use of prisms to tx left neglect?

Back 65

-relatively new method
-has resulted in relatively good long-term gains with short-term usage of prism glasses
-several researchers have demonstrated generalization across different measures

Front 66

How effective is eye patching for tx of left neglect?

Back 66

-some promising evidence of an improvement on ADLs using right half-field patches
-too few studies to warrant a firm conclusion regarding the long-term effects of eye patching

Front 67

What is achromatopsia?

Back 67

-person loses all color vision
-sometimes occurs in only one portion of the visual field

Front 68

What is prosopagnosia?

Back 68

-difficulty recognizing familiar faces
-in severe cases, may not distinguish objects from faces
-developmental form exists (more common in autism)

Front 69

How do people compensate for prosopagnosia?

Back 69

rely on unique features to recognize specific people (mustache, mole, glasses, hair style,....)

Front 70

What is environmental agnosia?

Back 70

-aka disorientation
-effects orientation to time, person, place, and situation

Front 71

List visual motor deficits. (be able to describe them)

Back 71

-constructional apraxia
-eye opening apraxia
-dressing apraxia
-drawing apraxia
-written apraxia
-limb apraxia

Front 72

What is attention?

Back 72

the ability to:
-detect sensory events
-monitor internal states
-be responsive to, but not overwhelmed by, the external environment (e.g., autism)
-be aware of, but not distracted by, internally generated thoughts and states (e.g., mental illness)

Front 73

What are the different types of attention?

Back 73

-arousal
-orienting
-vigilance
-sustained attention
-selective attention
-divided attention
-alternating attention

Front 74

Describe arousal attention.

Back 74

a person's awareness of environmental events and readiness to respond; fundamental to all other attentional operations

Front 75

Describe orienting attention.

Back 75

direction of attention toward a specific stimulus or location

Front 76

Describe vigilance attention.

Back 76

a state of directed alertness despite the presence of only intermittent stimuli or of distractions (refers to a very repetitive task-- distractions are built into the task)

Front 77

Describe sustained attention.

Back 77

maintenance of attention over time

Front 78

Describe selective attention.

Back 78

capacity to focus on one stimulus to the exclusion of others (distractions are separate events)

Front 79

Describe divided attention.

Back 79

ability to focus attention on 2 tasks simultaneously

Front 80

What are other ways of conceptualizing attention?

Back 80

-phasic vs. tonic
-narrow vs. broad
-voluntary vs. automatic

Front 81

Compare phasic vs. tonic attention.

Back 81

-Phasic: ability to recognize changes in the external environment (relates to arousal, orienting, and vigilance)
-Tonic: ability to maintain responsiveness despite a static environment (driven by internal motivation, relates to sustained attention) (related to vigilance, sustained, and selective attention)

Front 82

Compare broad vs. narrow attention.

Back 82

-Broad: gestalt; expansive; seeing the "big picture" (relates to arousal and orienting)
-Narrow attention: attention to specific details (left hemi) (relates to selective attention)

Front 83

Compare voluntary vs. automatic attention.

Back 83

-Voluntary attention: initiated by the person rather than by external input (under conscious control)
-Automatic attention: operates independently of and in the absence of directed focus (fast, effortless, unavailable to conscious awareness)

Front 84

What aspects are most frequently affected by RHD for attention deficits?

Back 84

-arousal
-vigilance
-orienting

Front 85

What are the 2 theories about the brain's management of attention?

Back 85

-left hemi dominance theory
-right hemi dominance theory

Front 86

Describe left hemi dominance theory.

Back 86

-left hemi is dominant for all aspects of attention
-in the normal brain, right hemi attentuates (calms) left hemi's dominance; therefore, person attends to entire personal space
-with right hemi damage, left hemi becomes disinhibited and prompts strong contralateral bias (i.e., attention to right space only)
-over-attend to right space

Front 87

Describe right hemi dominance theory.

Back 87

-right hemi is dominant for all aspects of attention
-in normal brain, right hemi has the capacity to attend to stimuli both in the right and left hemi-spaces, whereas left hemi only has the capacity to attend to stimuli in the right hemi-space
-with right hemi damage, person has only the left hemi attending to the right hemi-space
-right hemi dominance theory has greater credence and experimental evidence to support it than left theory

Front 88

True or false: Focal damage anywhere in the brain can interfere with attention; however, the LH appears to play a specific role in attention operations.

Back 88

False: RH plays specific role