Focal Lesions - PowerPoint PPT Presentation

1 / 63
About This Presentation
Title:

Focal Lesions

Description:

Thus, no disorder syndrome is entirely independent of any other. ... out or inside out, and/or the left and right may be inverted or the up and down. ... – PowerPoint PPT presentation

Number of Views:145
Avg rating:3.0/5.0
Slides: 64
Provided by: cmol
Category:
Tags: body | down | dress | facts | focal | free | human | lesions | listen | male | map | music | picture | see | syndrome | the | through | tv | view | world

less

Transcript and Presenter's Notes

Title: Focal Lesions


1
Focal Lesions
2
Left Hemisphere Lesions
  • The left hemisphere plays a major role in the
    neural processes governing the production and
    comprehension of propositional (meaningful)
    language.
  • For this reason, it has been designated the
    dominant hemisphere.
  • It is well-suited to processing linguistic
    elements and information sequentially and
    analytically.
  • Cortical representations of linguistic processes
    are not static nor are they subject to exact
    demarcations.
  • Rather, language representation exists in
    functional fields within which specific abilities
    (modules) overlap with other linguistic and
    symbolic abilities.

3
Left Hemisphere Lesions
  • Language processing, then, is subserved by
    regions that form integrated cerebral networks
    based on neural intercommunications.
  • Thus, no disorder syndrome is entirely
    independent of any other.
  • For over a century, people with brain damage have
    been recognized as displaying different
    combinations of symptoms related to specific
    sites of brain injury.

4
Left Hemisphere Lesions
  • When damage occurs in certain functional areas,
    such as the primary or association cortices, a
    certain form of impairment in linguistic element
    processing may result.
  • When damage is not discrete, as in cases of
    diffuse axonal injury, the resulting pattern of
    impairment often presents a mixture and overlap
    of symptoms.
  • The discrete symptoms we are going to discuss
    should be thought of as prototypes of core
    damage localized to a specific area of grey and
    white matter.

5
Left Hemisphere Lesions
  • Although we will utilize the term aphasia in
    connection with these prototypic disturbances in
    language function, keep in mind that aphasia is
    an umbrella term encompassing a wide variety of
    language dysfunctions, on the receptive/comprehens
    ion and expressive/production continuum.
  • We will also look at communication function
    within the left hemisphere along the horizontal
    organization continuum of the posterior to
    anterior regions.

6
Posterior Language Zones
  • The posterior language zone in the dominant left
    hemisphere includes the middle and posterior part
    of the first, second, and third temporal gyri,
    Heschls gyrus, the inferior parietal lobule,
    including the supramarginal and angular gyri.

7
Posterior Language Zones
  • The nuclear region of the posterior language zone
    is situated in the posterior part of the first
    temporal gyrus (unimodal Wernickes area) and in
    the adjacent areas of the middle first temporal
    gyrus, Heschls gyrus, the posterior portion of
    the second temporal gyrus, and the angular gyrus.

8
Posterior Language Zones
  • In the syndromes of posterior aphasia, the
    following characteristics are frequently present
  • addition of functional words in expressive
    speech
  • disturbances of phrase comprehension
  • alienation of word meaning
  • disorders of naming
  • semantic and phonemic paraphasias
  • decreased awareness of verbal expression errors
  • problems with auditory phoneme and word
    comprehension
  • sensory aprosody and
  • increased speech activity.

9
Superior (1st) Temporal Gyrus
  • Comprised of Heschls gyrus anteriorly and a
    portion of unimodal Wernickes area posteriorly,
    the superior temporal gyrus is the site of
    auditory input language interpretation.

10
Superior (1st) Temporal Gyrus
  • Damage to this area makes for difficulty
    discriminating speech sounds, distinguishing
    syllables/words which sound familiar, analyzing
    words into component sounds, or resynthesizing
    them.

11
Superior (1st) Temporal Gyrus
  • Words become vague and undifferentiated,
    affecting comprehension.
  • A module for auditory sequential memory is
    thought to reside just lateral to Heschls gyrus.
  • Word repetition may be made difficult by
    instability of retained auditory sequences.
  • Expressively, language is empty, frequently
    circumlocuted, and littered with semantic
    paraphasias.
  • Neologisms for nouns and verbs are common.

12
Angular Gyrus (Area 39)
  • The angular gyrus, at the juncture of the
    temporal, parietal, and occipital lobes, is
    thought to be the module site for word meaning.
  • A lesion to this area disturbs naming and
    alienates word meaning for body parts and
    space-time relationships.
  • With lesion extension into the occipital and
    parietal areas, alexia and agraphia may result.

13
Supramarginal Gyrus (Area 40)
  • The supramarginal gyrus, found curving around the
    lateral sulcus, is thought to be the module site
    for abstraction and integration of sensory
    information necessary for naming.

14
Supramarginal Gyrus (Area 40)
  • A lesion in this area produces phonological
    processing errors, called phonemic paraphasias,
    in contextually appropriate lexical items in the
    form of substitutions (dite/kite), deletions
    (reen/green), and transpositions
    (predesent/president).

15
Anterior Language Zone
  • The anterior language zone in the dominant left
    hemisphere includes the posterior part of the
    third frontal gyrus, also known as Brocas area,
    the lateral operculum, the insula, and the
    posterior part of the first and second frontal
    gyri.

16
Anterior Language Zone
  • On the mesial surface of the left hemisphere,
    this zone includes the supplemental motor area
    and the anterior cingulate gyrus.

17
Anterior Language Zone
  • Syndromes of anterior aphasia are generally
    characterized by
  • telegraphic style, with a predominance of
    substantive words
  • lack of grammatical functor words
  • impoverishment of speech, reduced to short
    phrases and high-frequency words
  • relatively preserved comprehension and naming.
  • In anterior aphasia, motor elements are present
    and consist of deformation of articulation, motor
    dysprosody, aphonia, hypophonia, and decreased
    speech activity.

18
Brocas Area (44)
  • Delineated as a premotor zone in the inferior
    (3rd) frontal gyrus, Brocas area is the module
    site thought to program the oral and phonatory
    mechanism for speech movements.
  • A lesion in this area would likely produce
    phonetic-articulatory sequencing deficits in
    syntactically normal utterances, evidencing motor
    dysprosody and perseverations.

19
Premotor Gyrus (Area 6)
  • A lesion in the left premotor gyrus may result in
    a nonfluent aphasia characterized by strings of
    content words, lacking grammatical functors
    (agrammatism).
  • Impaired prosody is usually reflected in a
    tendency to drop unstressed syllables,
    inflections, and auxiliaries.

20
Supplemental Motor Area (Area 8)
  • A lesion in the supplemental motor area, located
    in the medial frontal cortex, may result in
    partial mutism initially, eventually resolving to
    some spontaneous speech, some repetition, and
    naming.
  • Difficulty initiating spontaneous speech usually
    prevails.

21
Anterior Cingulate Gyrus (Area 24)
  • Bilateral damage to the anterior cingulate gyrus
    results in akinetic mutism, with no evidence of
    preserved language comprehension.
  • With recovery, speech returns through aphonic
    whispering and hoarseness.
  • Aphasia and motor speech components are absent.

22
Mixed Anterior-Posterior Zones
  • Lesions can involve aspects of both anterior and
    posterior language zones.
  • Salient symptoms of mixed aphasia include loss of
    expressive speech, graphic, and gestural output,
    and a noticeable lack of auditory comprehension.
  • This is an apparently global aphasia.

23
Right Hemisphere Lesions
  • Damage to the right hemisphere results in some of
    the most bizarre and complex syndromes observed
    in clinical medicine.
  • Visual hallucinations, denial of illness,
    unilateral neglect, amnesia for nonverbal
    material, and loss of speech prosody are among
    the unusual usual symptoms exhibited by clients
    with RH injury.
  • Direct categorization of clinical syndromes by
    specific modules/regions is difficult because
    there is frequent regional overlap.
  • Instead, disorders are categorized by the
    underlying neuropsychological processing
    abnormalities.

24
Right Hemisphere Lesions
  • Generally, deficits associated with occipital
    lobe damage include disorders of color
    perception, disorders of visual processing, and
    disorders of visuoverbal processing.
  • Right parietal lobe damage results in difficulty
    with recognizing visuospatial information,
    impaired recognition of objects in unfamiliar
    views, and difficulty with spatial orientation.
  • Other deficits associated with right parietal
    damage include difficult sustaining attention,
    hemispatial neglect on the side contralateral to
    the lesion, unawareness or denial of deficits,
    and difficulty with orientation and location in
    space.

25
Right Hemisphere Lesions
  • Difficulties associated with right temporal lobe
    damage include deficits in processing music and
    deficits in nonverbal memory.
  • Deficits associated with frontal lobe damage
    include difficulty with planning and
    problem-solving, decreased behavioral initiation
    and spontaneity, distractibility, perseveration,
    and poor memory for order of sequence of events.

26
Occipital Lobe Damage
  • Lesions to the occipito-parietal and
    occipito-temporal areas produce a variety of
    visual processing difficulties.
  • Prosopagnosia, or agnosia for faces, is an
    acquired deficit in the recognition and
    identification of previously known and familiar
    human faces (e.g., Oliver Sacks The Man Who
    Mistook His Wife for a Hat).
  • Patients have adequate visual acuity, but they
    are unable to recognize or identify family,
    friends, famous persons, or even their own
    reflection in a mirror.

27
Occipital Lobe Damage
  • If the disorder is severe, patients may be unable
    to distinguish between male and female, human and
    animal, and young and old faces.
  • They often recognize people known to them by
    their voice, clothing and accessories, body size,
    hair color, or gait.
  • Topographagnosia, or environmental agnosia, is
    the acquired loss of the ability to recognize
    visual stimuli relating to a persons
    environment.
  • The environment is perceived as different,
    unfamiliar, or unrecognizable.
  • The person has trouble finding his/her room,
    home, locating public buildings in a specified
    area, or drawing a map of how to get to a
    specific location.

28
Occipital Lobe Damage
  • A lesion to the inferior visual association
    cortex, in the absence of retinal pathology,
    results in achromatopsia, an acquired disorder of
    color perception, characterized by a loss of
    color vision in all or part of (quadrant or
    hemifield) the visual field.
  • Lesions in the right occipital cortex can produce
    reading problems that arise from gaze
    instability, spatial neglect, or other defects in
    visual processing, as opposed to more
    linguistically based disorders of reading.

29
Occipital Lobe Damage
  • Hemialexia, the loss of reading ability in one
    visual hemifield, may occur in the RH patient
    with severe neglect.
  • The left side of words or sentences may be
    neglected with varying degrees of awareness.
  • The majority of reading problems that occur as
    sequelae of right hemisphere injury are derived
    form some combination of visual processing
    deficits, including visuoperceptual,
    visuospatial, and/or visuoverbal decoding
    difficulties.

30
Parietal Lobe Damage
  • A salient feature of RH syndromes is a group of
    related disorders characterized by deficits in
    corporeal awareness.
  • Patients experience impaired awareness of self
    and alterations in their body image, ranging from
    uncritical underestimation to explicit,
    intractable denial of phenomena.
  • Autopagnosia is the inability to indicate various
    parts of the body, either by pointing to them on
    command, naming them, or matching them to
    pictures or parts on the examiners body.

31
Parietal Lobe Damage
  • Anosodiaphoria is a term first coined by Babinski
    in reference to the lack of concern shown by
    patients with hemiplegia.
  • Although aware of their paralysis, some patients
    exhibit carefree indifference and inadequate
    insight as to the implications/consequences of
    the condition.
  • Unilateral neglect is a syndrome in which the
    ability to direct attention to important events
    in one half of personal and extrapersonal space
    is compromised.
  • The patient fails to attend to, respond to, or
    report stimuli in that hemispace.
  • Motor, sensory, visual, and auditory modalities
    can be affected.

32
Parietal Lobe Damage
  • Asomatognosia refers to the feeling of
    nothingness described by some patients with
    hemiplegia who report they feel the limb is
    missing or that there is nothing to the left of
    midline of the body.
  • Hyperschematia refers to a disorder in which the
    patient feels as though the affected appendages
    are swollen or heavy.
  • Some have referred to these appendages as dead
    wood or dead meat.
  • Misoplegia is hatred of the paralyzed limb.
  • Personification refers to the attempt by the
    patient to name or otherwise anthropomorphize the
    affected limb, treating it as another person.

33
Parietal Lobe Damage
  • Somatoparaphrenia refers to a paranoid reaction
    to the paretic limb, specifically the belief that
    the paretic limb has undergone some sort of
    horrid transformation by some mechanical
    manipulation.
  • Supernumerary phantom refers to a condition in
    which the patient imagines that there is an extra
    or third limb on the affected, hemiplegic side,
    which is not in the position in space where the
    actual limb lies.
  • These additional limbs are often reflected in
    patient drawings.
  • Denial syndromes are also common with parietal
    lobe damage.
  • Denial involves negation or refusal to accept a
    disability or condition.

34
Parietal Lobe Damage
  • Denial can be explicit or implicit.
  • Explicit denial ranges from minimization and
    temporal displacement of the disability to
    complete denial or projection of the disability
    outside the self.
  • Example 1 A man with a self-inflicted gunshot
    wound to the head which penetrated the brain
    attempted to explain his skull fracture and
    subsequent hospitalization by stating that he had
    tripped over the cat and hit his head on a gulf
    ball.

35
Parietal Lobe Damage
  • Example 2 A woman with a right CVA and severe
    left hemiplegia stated that she was in the
    hospital for the examiners wedding and was just
    resting until the ceremony began.
  • Implicit denial involves disinterest in,
    inattention to, or lack of reaction to the
    paralyzed side of the body.
  • The individual may fail to dress that side of the
    body or respond to threatening or painful stimuli
    on that side of the body.

36
Parietal Lobe Damage
  • Disorders of praxis are disorders of learned
    movement that cannot be adequately explained on
    the basis of attentional deficits, weakness of
    musculature, sensory loss, or comprehension
    deficits.
  • Common with right posterior or parietal lobe
    lesions are dressing apraxia and constructional
    apraxia.
  • Dressing apraxia is an impairment in the ability
    to dress oneself due to complex visuospatial
    deficits and sequencing difficulties.
  • Body-garment disorientation is characterized by
    the inability to orient ones body part to the
    appropriate garment or portion of the garment to
    accomplish the logistics of dressing.

37
Parietal Lobe Damage
  • The garment may be turned backwards out or inside
    out, and/or the left and right may be inverted or
    the up and down.
  • Constructional apraxia is manifested as a
    difficulty in putting together one-dimensional
    units so as to form two-dimensional figures or
    patterns.
  • People with this disorder do not have difficulty
    making most types of skilled movements with their
    arms and hands.
  • They have no trouble using objects properly,
    imitating their use, or pretending to use them.
  • The primary deficit in constructional apraxia
    appears to involve the ability to perceive and
    imagine geometrical relations.

38
Parietal Lobe Damage
39
Parietal Lobe Damage
  • The defect can be seen in copying a visually
    presented object or design, assembling block or
    stick patterns, or in free drawing.
  • Because of this deficit, a person cannot draw a
    picture, say, of a cube, because he/she cannot
    imagine what the lines and angles of a cube look
    like, not because of difficulty controlling the
    movements of his or her arm and hand.

40
Loss of Hemispheric Integrity
  • Various disorders of language processing, general
    behavior and psychic integrity, and visual
    symbolic processing arise when the right
    hemisphere is damaged and there is loss of
    bihemispheric integrity.
  • Right hemisphere damage can affect the following
    language processing skills prosody, affective
    language, integrative appositional language and
    pragmatics.
  • Although the experience of emotion is mediated by
    the limbic system, a system with bilateral
    representation, expression of both emotion in the
    voice and face and the perception of emotion in
    voices and faces is dependent upon lateralized
    right hemispheric mechanisms.

41
Loss of Hemispheric Integrity
  • Right-sided lesions can impair speech prosody
    without altering the propositional content of
    verbal output.
  • Specifically, a lesion in the right frontal and
    anterior parietal area may result in a patient
    demonstrating good comprehension of speech
    prosody, but impaired spontaneous and imitative
    prosody.
  • In patients in whom the lesion affects only the
    parietal area, comprehension of prosodic speech
    elements may be lost, but not the propositional
    content of language.
  • Such patients may also have difficulty with
    imitative prosody.

42
Loss of Hemispheric Integrity
  • Because the right hemisphere processes language
    more holistically than the left hemisphere,
    damage to the right hemisphere may cause problems
    in utilizing context to extract the main point or
    moral of a story, or to draw inferences, in spite
    of the fact that the ability to recall isolated
    details may be preserved.
  • Right hemisphere injured individuals may also
    have problems interpreting abstract and
    figurative language, such as proverbs, idioms,
    and metaphors.
  • Typically, they render a more concrete and
    literal interpretation of abstract language.

43
Loss of Hemispheric Integrity
  • Comprehension of humor also appears impaired.
  • Individuals with pre-central right hemisphere
    lesions demonstrate more exaggerated responses to
    humor, while individuals with post-central
    lesions demonstrate an overall flattened
    response.
  • Inappropriate use of humor or off-color remarks
    in conversation is also frequently noted.
  • The conversational style of RH individuals has
    been characterized as verbose and tangential.

44
Loss of Hemispheric Integrity
  • Frequently, insignificant details and
    inappropriate personal remarks, and knowledge
    presupposition accompany the verbosity.
  • Individuals may also have difficulty organizing
    and ordering information, and making a point in
    conversation.
  • In addition to problems with organizing
    information, individuals with RH injury often
    have difficulty with the social uses of language
    interaction.

45
Loss of Hemispheric Integrity
  • Some areas in which pragmatic disturbances are
    evidenced include proxemics, use of gesture,
    question formulation, comment interjection,
    assertion, requesting, conversational initiation,
    especially of a novel topic, topic change, topic
    selection, topic maintenance, turn-taking, repair
    and revision, and judging pause time between
    turns and interrupting.
  • The quality of verbal and non-verbal feedback to
    the speaker may also be impaired, e.g., eye
    contact.
  • They may be perceived as rude by family
    members, friends, and staff as the result of
    their lack of impulse control and social
    appropriateness, characterized by such things as
    undue familiarity, talking excessively, and
    violating the polite rules of conversation.

46
Loss of Hemispheric Integrity
  • Alterations in sexual behavior and sexual
    function including inappropriate sexual advances
    and lewd comments have been noted in patients
    following RH injury.
  • Altered sexual behavior may range from open
    masturbation, exposure, and overt verbal and
    physical sexual advances toward staff members to
    delusions with sexual content and confabulations
    concerning sexual activity.
  • Some of these individuals may become preoccupied
    with body functions, such as bowel and bladder
    control, and may insist on receiving a physical
    means of expression, such as touch, from their
    caregivers.

47
Loss of Hemispheric Integrity
  • Weinstein and Kahn (1955) described the case of a
    63-year-old woman with left homonymous
    hemianopsia, left astereognosis, reduced
    two-point discrimination, position sense, and
    point location in the left hand, right-left
    discrimination problems, dressing apraxia,
    topographic disorientation, and left neglect
    secondary to thrombotic obliteration of the
    middle cerebral artery.
  • She was delusional and thought the man visiting
    her roommate was a mechanical dentist.

48
Loss of Hemispheric Integrity
  • In her conversation with the examiner, she
    stated, Do you mind if I bother you?well, I
    like to be hot and bothered. Im propositioning
    you. I havent been hot and bothered for a long
    time.
  • The same patient remarked that her roommate was
    noisy because she want to be laid.
  • Reportedly, the patient exposed herself
    constantly and had to be placed in restraints due
    to frequent picking of her anus and genital area.

49
Loss of Hemispheric Integrity
  • Disturbance of mood is also common with right
    hemisphere injury.
  • Flatness or indifference reaction (indifference
    to or minimization of symptoms) is seen in most
    patients with only minor right hemisphere injury
    in contrast to the emotion-laden catastrophic
    reactions of left brain injured patients.
  • Depression is difficult to diagnosis in RH
    individuals because of external affective
    disturbances (i.e., sad-looking face, vocal tone,
    flat affect).
  • The individual may actually harbor a full
    component of concern, even to the extent of
    suicidal depression, without being able to
    physically express it.

50
Loss of Hemispheric Integrity
  • Conversely, the patient may appear depressed
    because of the depressed affect, but not be
    experiencing depression.
  • Some RH individuals may experience agitated
    confusion, delirium, disorientation, and various
    psychotic states.
  • Agitated confusion is characterized by incoherent
    thought patterns, severe reduction in attention
    span, extreme distractibility, restlessness,
    disruption of goal-directed behavior,
    disorientation, and sometimes violent outbursts.
  • Psychotic symptoms can include hallucinations and
    paranoid delusions.
  • These symptoms may pass in a few days or, in some
    cases, may last for months.

51
Loss of Hemispheric Integrity
  • Although rare, several specific delusions have
    been associated with RHD.
  • Together they can be called misidentification
    syndromes.
  • These include misidentification of place,
    persons, or body parts.
  • Often these delusions occur in isolation without
    other symptoms of confusion.
  • Misidentification of persons and place, or
    reduplicative paramnesia, results in patients
    thinking that familiar persons or places have be
    duplicated.

52
Loss of Hemispheric Integrity
  • With misidentification of place, they may
    recognize that they are in a hospital, but
    confuse it with a hospital they were in
    previously.
  • They may think they are in their bedrooms at home
    or that the hospital is attached to their houses,
    etc.
  • Misidentification of persons, or Capgras
    syndrome, refers to the delusion that others, but
    not the self, have been replaced by doubles..
  • Typically, people with Capgras syndrome consider
    the duplicates or doubles as dangerous or
    frightening.

53
Loss of Hemispheric Integrity
  • Another form of misidentification of persons is
    Fregoli syndrome.
  • This form of misidentification involves the
    delusion that the known person is changing his
    appearance dramatically.
  • For example, a RHD patient was convinced that the
    woman in the bed next to her was her husband, and
    that he was flirting with the nurses.
  • She became angry and confused when her actual
    husband came to see her on his daily visits.

54
Summary of RHD
  • Patients with RHD can have a variety of deficits,
    some of which can affect communication and
    cognition directly, and some of which exert
    indirect effects on the ability to participate in
    communicative events and to interact successfully
    with the environment.
  • Just as not all adults with damage to the LH are
    aphasic, not all RHD adults have problems in
    perception, cognition and/or communication.
  • The typical RHD patient almost always
    communicates adequately in superficial
    conversation.

55
Summary of RHD
  • There may be a flatness in the voice and affect
    and a general sense of reduced arousal, but as
    long as the conversation is brief and covers
    familiar territory, one might not detect any
    communication deficits.
  • Problems begin to emerge in more extended and
    complex conversation.
  • Patients may seem disinterested and somewhat
    insensitive as communicative partners.
  • They may begin and end conversations abruptly,
    fail to follow social conventions, and even
    appear rude.

56
Summary of RHD
  • They may interrupt and fail to make eye contact.
  • If they are no longer interested in what someone
    is saying, they may turn without apology to
    something else, apparently unaware of the
    disruption to the conversational flow.
  • They may be perfunctory, making the least
    effortful response to questions, regardless of
    the consequences of their answers.
  • Alternately, they may be verbose and rambling.
  • They may have trouble getting to the point.

57
Summary of RHD
  • Their discourse may seem to be made up of an
    assembly of facts without the glue that holds
    them together in an overriding structure.
  • They may be led by internal associations to
    related but tangential issues, as if they are
    thinking out loud, rather than having a
    conversation.
  • As listeners, they may focus on bits of
    information in a piecemeal way without
    integrating them into the larger picture.

58
Summary of RHD
  • They may fail to respond to situational variables
    that specify the nature of the communicative
    eventlighthearted banter, serious discussion,
    superficial social exchange.
  • They may have problems recognizing when people
    are kidding, sarcastic, or ironic.
  • Patients with RHD may appear distant, remote,
    bound up in themselves.
  • They may have trouble adopting other peoples
    point of view, or recognizing what their
    listeners know and what they do not know.

59
Summary of RHD
  • The may show little appreciation for shared
    knowledge and may not take contextual variables
    into consideration.
  • Vague references to unfamiliar people, places,
    and events, may force the listener to make the
    connections that have been omitted.
  • Their capacity to attend may be reduced or fade
    in and out so that they miss crucial information.
  • They may have trouble interpreting others
    intended meanings, and have difficulty conveying
    their own.
  • They may have difficulty following the gist of a
    conversation, written narratives, television
    news, etc., if the information is presented too
    quickly or when the core concepts are subtle and
    require high levels of inference.

60
Summary of RHD
  • Failure to admit to confusion and uncertainty can
    accompany reduced insight about physical and
    cognitive problems.
  • Denial of deficit or denial of illness often
    gives the impression that RHD patients are
    unconcerned about their current status and future
    adjustments.
  • Failure to respond appropriately to their
    deficits is characteristic of patients who have
    left-neglect.
  • These patients may not notice their left arm
    dragging in their wheel chair spokes.
  • They may not attend to people, events, or even
    sounds to their left.

61
Summary of RHD
  • If patients have diffuse RHD, affective
    disturbances such as agitated confusion and
    certain types of delusions may be apparent.
  • Patients with more focal RHD who are not
    otherwise confused may confabulate elaborate
    justifications to cover for cognitive
    uncertainty.
  • It can occur as they try to negotiate information
    that is conflicting, ambiguous, makes no sense to
    them, and/or makes no sense to others.
  • Rather than questioning, reflecting, analyzing,
    or dismissing it, they construct elaborate
    explanations to justify it, as if all must be
    right with the world or something may be wrong
    with them.

62
Summary of RHD
  • Finally, patients with RHD may appear
    unresponsive to the emotional tone of the
    exchange and may have problems conveying their
    own emotions through prosody, facial expression,
    gesture, and body language.
  • Their speech may be flat and uninflected.
  • Their words may be embedded in some sort of
    stereotypic prosodic pattern that does not
    differentiate well among sentence types or
    emotional content, making listening difficult.
  • Some patients, because of the size and/or site of
    their lesions, or because of the way their
    particular brains are wired, may be almost free
    of these signs.

63
Summary of RHD
  • Among those that do have cognitive and
    communicative deficits, there is a range of
    impairment.
  • Communication disorders may be obvious or subtle,
    however for the listener, there is a sense of
    someone using language, but not as effectively as
    expected.
  • In other words, there is a sense that someone is
    communicating, but not quite connecting.
Write a Comment
User Comments (0)
About PowerShow.com