Right Hemisphere Syndrome: Treatment Susan T. Jackson October 1, 2010

Treatment of Deficits in Attention Arousal and Vigilance tasks Computerized RT tasks; could vary the inter- stimulus interval to tax vigilance Sustained attention tasks RT tasks of varying lengths, sorting items, doing addition problems; may have worse performance as inter-stimulus interval increases

Treatment of Deficits in Attention Selective attention tasks Letter cancellations tasks, computer task that involves identifying when a particular stimulus occurs given the presence of foils, identify a particular word in a series of words, Stroop tasks ct, alternating attention tasks (switch task demands part way through task); watch for neglect (place stimuli in R hemispace, arrange stimuli vertically); ct Divided attention tasks Dual tasks such as counting out loud while completing a cancellation task, say the alphabet out loud while connecting dots, attend to more than one type of info within a task (identify particular letters and numbers in a cancellation task)

Treatment of Neglect Compensatory Strategies for Neglect Verbal cues Visual and tactile cues Anchors Restructuring the environment Right-sided placement Left-sided placement (more of a facilitation technique)

Treatment of Neglect Facilitating Recovery from Neglect Medical treatments Pharmacological treatment (dopamine receptor agonists) Vestibular stimulation (irrigate R ear w/warm water or L ear w/cold water – temporary effect, not sure why it works: nystagmus effect?)

Treatment of Neglect Facilitating Recovery from Neglect Behavioral treatments Left limb stimulation (voluntary movements of L hand in L hemispace, do prior to neglect tasks) Leftward search tasks I: Stimulating Unconscious Perception (meaningful stimuli, stimuli within a border, contiguous stimuli, interactive stimuli) Leftward search tasks II: Stimulating automatic leftward movements of attention (paper and pencil cancellation tasks – borders, less crowded array, dissimilar targets and foils, stimuli arranged in rows rather than randomly; computerized scanning tasks – manipulate placement of stimuli within four quadrants and inter-stimulus interval; warning stimulus )

Treatment of Neglect Facilitating Recovery from Neglect Behavioral treatments Leftward search tasks III: Stimulating voluntary shifts of attention (the Mackisack- Myers Edgeness task – may do prior to discourse tasks, right-left alternating tasks) Reading and Writing – it’s thought that many of the leftward search tasks will indirectly help with reading and writing; irregular left margin reading task; graph paper for writing (helps with spacing, margins)

Treatment of Prosodic Deficits Compensation Strategies Explaining prosody to patients and families Helping patients compensate Facilitating Recovery of Function Production of emotional prosody Production of emphatic stress

Treatment of Affective Communication Deficits Nonverbal Affective Communication Comprehension of nonverbal emotional expression Production of nonverbal emotional expression Verbal Affective Communication Addressed previously (the ones related to prosodic impairments) or in the next section (the ones related to discourse deficits)

Treatment of Discourse Deficits: Narrative and Conversational Discourse Macrostructure and Other Inferences Tasks Picture/story interpretation Guided inference generation: Compensatory strategy for inference deficits Picture titles/story headlines Story continuations Comprehension of individual inferences

Treatment of Discourse Deficits: Narrative and Conversational Discourse Integration Tasks Sentence/picture arrangement Puzzle and object arrangements Fragmented object identification Recognizing commonalities Increasing Informative Content Divergent questions I: Increasing informative content Divergent questions II: Increasing efficiency Recognizing the dimensions of informative content Concept generation Increasing specificity: Pronoun reference task

Treatment of Discourse Deficits: Managing Alternate Meanings Activation Tasks Word associations Homographs Resolving lexical ambiguities Inference revision Suppression Tasks Homographs Semantic relations Sentence interpretation I Sentence interpretation II: Providing context Sentence interpretation III: Explaining Alternatives Guided sentence interpretation IV

Tx of Social Disconnection Deficits (Pragmatic Deficits) Conversational conventions I Conversational conventions II Theory of mind tasks