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

CSU, Chico, Patrick McCaffrey, Ph.D.

Chapter 14. Right Hemisphere Involvement: Evaluation

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.


Commercially Available Instruments

Several standardized tests have been developed for use with RHD patients. One such test is the 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. The 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.


Clinical Procedures (Myers and Mackisack, 1990)

A clinician can easily devise tasks to be used in the evaluation of RHD patients.

  1. If the patient seems to have some of the specific language problems usually seen in aphasia, give them an aphasia battery like the BDAE.
  2. Assess the patient's orientation, insight, and memory for recent events using open-ended questions.
  3. 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.
  4. 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).
  5. Evaluate 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.
  6. Assess 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.
  7. 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.

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

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