Right Hemisphere Damage

RHD results in a collection of symptoms that vary in severity and in domains affected, depending on the site and extent of injury to the underlying neural substrate. For a detailed discussion of signs and symptoms associated with RHD, see, for example, Blake (2018). Below are examples of symptoms grouped by domain. Individuals may not present with all symptoms.

Language

RHD does not typically affect word retrieval, syntax, and/or repetition, as seen in aphasia. However, if the left hemisphere language centers are also damaged (e.g., in TBI), RHD symptoms can co-occur with classic aphasia symptoms. Occasionally, RHD may result in the classic aphasia subtypes [PDF] in individuals with crossed hemispheric dominance.

Language deficits typically affected by RHD include the following:

  • Discourse comprehension deficits marked by
    • difficulty understanding abstract language, figurative language, lexical ambiguities, or information that can be interpreted in multiple ways (Lundgren & Brownell, 2016);
    • difficulty making inferences and understanding the global meanings of discourse such as topic, gist, and big picture (Tompkins, Scharp, Meigh, & Fassbinder, 2008; Tompkins, Fassbinder, Blake, Baumgaertner & Jayaram, 2004);
    • difficulty understanding jokes, irony, and sarcasm; and
    • difficulty understanding others’ emotions.
  • Discourse production deficits marked by
    • verbosity;
    • egocentric, tangential comments and digressions from the topic;
    • focus on irrelevant details;
    • disorganized thoughts; and
    • impulsive, poorly organized responses (see Minga, 2016, for a review).
  • Pragmatic communication deficits, including reduced eye contact, poor turn taking, and decreased conversation initiation.
  • Semantic processing deficits, particularly at higher levels of functioning such as understanding the metaphorical meaning of words (e.g., “a sea of grief” and “roller coaster of emotions”).
  • Aprosodia—reduction or absence of normal variations in pitch, loudness, intonation, and rhythm of speech to express meaning or emotion.
  • Flat affect—severely reduced emotional expressiveness; individual may speak in a monotonous voice (aprosodia) and have diminished facial expressions.

Other Cognitive Impairments

Cognitive impairments are not exclusive to RHD. For example, memory deficits are often associated with any injury to the brain, including stroke and TBI.

Cognitive deficits typically associated with RHD that can affect communication include

  • reduced sustained attention;
  • reduced selective attention (easily distracted);
  • reduced attention to detail;
  • unilateral visual neglect—typically, the left side (Kwasnica, 2002; Salvato, Sedd, & Bottini, 2014);
  • decreased or no awareness of deficits (anosognosia);
  • reduced reasoning and judgment;
  • difficulty with sequencing and problem solving;
  • impaired executive functioning skills;
  • reduced inhibition; and
  • reduced recognition of facial expression.

Other Deficits

Other deficits that may be associated with RHD include

  • emotional disorders such as emotional lability (e.g., crying or inappropriate laughing), difficulty interpreting and conveying emotions, and reduced empathy;
  • dysphagia;
  • dysarthria; and
  • hemiparesis/hemiplegia.

See ASHA’s Practice Portal Pages on Adult Dysphagia and Dysarthria in Adults.

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