It is even more
important than usual to focus on establishing rapport and
building trust during initial contact with right hemisphere
involved patients. Since RHD patients are frequently unaware
of their cognitive and communicative impairments, and are
not usually having any trouble finding words, using grammar,
or articulating, they may be reluctant to participate in
speech therapy. Also, according to Myers (1997), RHD
patients might realize that they are having some trouble
thinking and communicating but be afraid to admit it for
fear of seeming unbalanced. In this case, the patient may be
reassured when told that many people who suffer RHD
experience the same kinds of symptoms and that they are not
a sign of mental illness.
Several standardized tests have been
developed for use with RHD patients. One such test is
Mini Inventory of Right Brain Injury by Pimental and Kingsbury
(1989). Among other things, this battery examines body
image, visual scanning, reading, writing, visuomotor skills
and speech intonation. It is a very thorough test.
Right Hemisphere Language Battery (Brian, 1989) tests mainly
for extralinguistic problems, evaluating comprehension of
metaphors and inferred meanings, appreciation of humor, and
the production of emphatic stress as well as other
communication abilities, such as discourse analysis.
(Myers and Mackisack, 1990)
A clinician can
easily devise tasks to be used in the evaluation of RHD
- If the patient
seems to have some of the specific language problems
usually seen in aphasia, give them an aphasia battery
like the BDAE.
- Assess the
patient's orientation, insight, and memory for recent
events using open-ended questions.
- Obtain a
sample narrative by asking the patient to explain the
events occurring on a picture card, like the "cookie
theft" picture from the Boston. This is a good way to
check for inability to use context, a tendency to
interpret information in a concrete manner and also for
left side neglect.
- Evaluate the
patient's memory. This can be done by, for example,
telling him/her a short story and then asking him/her to
re-tell it, or by asking them to repeat a series of
random numbers (digit span-the average unimpaired person
can repeat 7 forward and 5 backward).
attention. There is no need to include a specific
procedure for this in testing. Instead, the clinician can
note how well the client is able to attend and and stay
on task during the entire evaluation procedure.
extralinguistic abilities. To do this, the clinician
could rate the patient's ability to produce efficient,
well-organized responses to open-ended questions. Also,
the patient's ability to abstract the main point from a
paragraph or picture card and to maintain a topic when
telling a story should be evaluated. During conversation,
note the patient's ability to make use of non linguistic
cues like body language and facial expression, and to
comprehend figurative language.
- Check for left
side neglect. This can be done by asking the patient to draw
symmetrical objects or bisect horizontal lines. Number or
letter cancellation tasks, in which the patient is
instructed to draw a line through every representation of
a particular number or letter in an array can also be
used. Sentence reading can also be used to identify
neglect; the patient who exhibits neglect will not see
the first word or two of the sentences.