The Neuroscience on the Web Series:
CMSD 636 Neuropathologies of Language and Cognition

CSU, Chico, Patrick McCaffrey, Ph.D

Chapter 15. Right Hemisphere Involvement: Therapy

Therapy for the RHD patients usually involves teaching compensatory techniques that can be used to overcome problems in everyday living caused by perceptual and attentional deficits.

Commercially Available Materials

Some commercially available materials are recommended for clinicians working with RHD patients. These include Cognitive Reorganization by Holloran and Brestler, and Recovery from Right Hemisphere Brain Damage by Anderson and Miller, which are both available from CC Publications, P.O. Box 23699, Tigard, Oregon, 97223.

Therapy for Neglect and Visuospatial Processing Problems (Myers and Mackisack, 1990)


This technique is one way to help the patient learn to recognize the boundaries of relevant space.

Phase 1

Start using a board divided into four segments and four cubes, each painted a different color. It is best that the grid and its divisions be three dimensional in order to provide tactile cues for the patient so that s/he can establish boundaries. Tell the patient to trace the edge of the grid with her eyes and with her fingers. Then, while she is looking away, place one of the blocks in the segment on the right-hand side of the board. Ask the patient to retrieve the block. The task should be repeated with the therapist placing the block in segments progressively closer to the left side of the board and thus increasing the difficulty of the exercise. Before each retrieval, be sure to instruct the patient to trace the grid visually and tactically increase her changes of success. If, even after tracing, the patient is unable to do the task, use physical prompts.

Phase 2

Now, place two blocks of the same color on the board at the same time, one in each of the two top segments, and ask the patient to retrieve them both. The patient should continue to trace the board before each retrieval attempt during this and all the following phases.

Phase 3

Again, put two blocks on the board simultaneously. This time, however, one block should be placed in the right-most segment and the other should be in the segment immediately to the left of the mid-line. This means that the block on the right will not cue to the patient to look for the other to be found on the left.

Phase 4

Use two blocks again, place one in the segment immediately to the right of the mid-line and put the other in the segment to the far left.

Phase 5

Re-do steps one through four, but now make the task more complicated by consistently using a block of a particular color for left side placements and one of a different color for all segments to the right.

Phase 6

Repeat steps one through five, but enlarge the grid to include eight spaces (four in one row on the top and four on the bottom).

Bookness (Myers and Mackisack, 1990)

Bookness is also designed to help patients attend to stimuli on the left. It should be used after edgeness, since it involves reading.

Step 1

First, place a thick, closed book in front of the patient at midline. Then ask the patient to tell you everything she knows about books, including their physical characteristics and how they are read. Also, tell the patient to trace the outline of the book with her eyes and fingers and describe it to you.

Step 2

As a pre-reading task, show the patient an array consisting of two pages. On the left page, write one letter of the alphabet. On the right page, write several letters including the one shown on the left page. Then, ask the patient to find the letter on the right page which matches the one shown on the left.

Step 3

Ask the patient to read sentences from the book. He/she will have to look to the left in order to read entire sentences.

Therapy for Prosopagnosia

Patients can learn to identify familiar people using non-visual cues like voice.

The therapist can help the patient to develop a checklist of verbal cues that will allow them to identify important people in their lives. For example a patient might learn something like "my wife has brown hair, blue eyes and a dimple in her chin...." The patient could rehearse these checklists with pictures and then learn to repeat them silently when trying to identify a person face to face.

Therapy Activities Designed to Improve Pragmatic Skills

Use Promoting Aphasics' Communicative Effectiveness (PACE) by Davis, 1981)

Exchange new information between patient and clinician.

Patient chooses mode of communication.

Patient and Therapist participate equally in sending and receiving.
(see section D Therapy for the Aphasic Patient)

The techniques described below are intended to increase patients' ability to communicate effectively by teaching them to discriminate between relevant and irrelevant material, use contextual cues, follow conversational rules, and avoid confabulation (Myers and Mackisack, 1990).

  1. To practice identifying themes or main ideas, ask the patient to read paragraphs and synthesize them into one sentence each.
  2. Help the patient develop steps to order the information contained in narratives from least to most important.
  3. Record conversations with the patient and play them back for him. Ask him to identify times when he digressed from the topic, was verbose or ignored turn-taking rules.
  4. If a patient has special trouble with turn-taking, the clinician could ask him to watch video tapes of material containing models of both good and poor turn-taking. Television talk shows might serve as the good example, while political round tables will most likely illustrate poor turn-taking skills very adequately.

Inference Activities

These activities are designed to help patients learn to appreciate figures of speech and the connotative meanings of language.

  1. Ask the patient practice reading jokes and then explaining the punch line to you.
  2. Ask the patient to practice explaining metaphors or proverbs.
  3. Ask the patient to explain pictorial or verbal absurdities.
  4. State information to the patient using indirect language and ask her to explain the real meaning of your message.

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Other courses in the neuroscience on the Web series:
CMSD 620 Neuroanatomy | CMSD 642 Neuropathologies of Swallowing and Speech

Copyright, 1998-2008. Patrick McCaffrey, Ph. D. This page is freely distributable.