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 are recommended for
clinicians working with RHD patients. These include
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,
Therapy for Neglect
and Visuospatial Processing Problems (Myers and Mackisack,
This technique is
one way to help the patient learn to recognize the
boundaries of relevant space.
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.
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.
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.
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.
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.
steps one through five, but enlarge the grid to include
eight spaces (four in one row on the top and four on the
Bookness (Myers and
Bookness is also
designed to help patients attend to stimuli on the left. It
should be used after edgeness, since it involves
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.
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.
the patient to read sentences from the book. He/she will have
to look to the left in order to read entire
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.
Designed to Improve Pragmatic Skills
Promoting Aphasics' Communicative Effectiveness (PACE) by
information between patient and clinician.
mode of communication.
Therapist participate equally in sending and receiving.
(see section D Therapy for the Aphasic Patient)
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).
- To practice
identifying themes or main ideas, ask the patient to read
paragraphs and synthesize them into one sentence
- Help the
patient develop steps to order the information contained
in narratives from least to most important.
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.
- 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.
activities are designed to help patients learn to appreciate
figures of speech and the connotative meanings of
- Ask the
patient practice reading jokes and then explaining the
punch line to you.
- Ask the
patient to practice explaining metaphors or
- Ask the
patient to explain pictorial or verbal
information to the patient using indirect language and
ask her to explain the real meaning of your