FUNCTIONS IN WHICH THE RIGHT HEMISPHERE PLAYS A MAIN ROLE
1.Attention and orientation
2.Motor permanence (determination in continuing a certain motor activity until it reaches its goal)
3. Construction
4. Topographic orientation
5. Musical talent and perception
6. Non-verbal memory
Functions shared with the other hemisphere:
• Comprehension
• Prosody
• Praxis
Contribution of the Right Hemisphere to Language Functions
Comprehension, as a function that is nourished and developed as a result of encountering many stimuli, is a function with a broader organization in the brain than speaking, reading and writing. In this organization, the right hemisphere plays a special role in understanding non-verbal sounds (melodes, animal sounds, etc.). Thus, it complements the comprehension function.
It is possible that this mechanism plays a role in the recovery periods of patients with aphasia. In fact, this may be the underlying reason why the comprehension of patients with severe aphasia, whose left hemisphere is almost completely affected by very large lesions, improves noticeably after a few months, although it was initially at "no" level. The right hemisphere's emotional and musical involvement also contributes to language. In this way, emotional tones in speech can be understood. The fact that left hemisphere patients can sing despite the presence of aphasia, but in right hemisphere patients, speech becomes dull and emotionless even though the language is preserved, proves the emotional and melodic function of the right hemisphere.
RIGHT HEMISPHERE LESION (RHL)
Selectivity in perception allows attention to be drawn to the most important point. It has been found that the perception selectivity skills of some people with SHL (especially with frontal lesion) are worse than those of people with left HL. People with SHL have difficulty concentrating their attention on several objects or events at the same time. It has been observed that these people are much slower and make mistakes than people with left HL. Attention disorder due to SHL will also affect the person's visual and auditory skills.
EVALUATION
There are many tests on the market that can be applied on this subject. “Right Brain Damage Mini Inventory” is a standardized test. “Ha� � The Hemisphere Language Battery” consists of the sum of specific subtests based on literature researched in the 1980s. Although the “Clinical Evaluation of Right Hemisphere Dysfunction” (RICE) is the most expensive evaluation tool, it is not a standardized test. Clinicians can use these tests together with Informal tests as explained below.
* First Encounter
Taping the mutual conversation
Having a picture narrated
Reading: sentences, paragraph
* Evaluation of non-verbal disorders
Marking the middle of the line
Marking the target symbol
Drawing: spontaneous, copy
Testing for Anosognosia
Reading: sentences, paragraphs
Writing: spontaneous, copy
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* Assessment of Attention
Testing awareness
Selectivity tests in perception
Testing the ability to do two things at the same time
* Assessment of Non-Language Disorders
Interpretation of story and picture
Speech production and perception
Alternative meaning generalization
Understanding and production of prosody
FIRST MEETING WITH THE PATIENT
Establishing trust between the patient and the clinician is especially important. Because patients with SHL may deny some or all of their problem, this will also affect their participation in therapy. The first meeting with the patient is appropriate to tell the patient and family that the disorders experienced can be reduced. Taped speech is a good way to evaluate communication impairment. The conversation should include open-ended questions to evaluate the patient's orientation, perception, and short-term memory of recent events. The patient is simply asked where he is and why he is there. Other questions may be about daily activities, future plans, and specific problems the patient is experiencing. Generally, the interview lasts 2-3 minutes. should continue and an evaluation appropriate to the subject should be made. The patient is then asked to describe a picture. The aim is to evaluate the patient's inference skills, visual attention and expression style. The picture is complex involving several events There must be a picture. The picture “boy stealing cookies” is a suitable picture for this situation. Finally, the clinician asks the patient to read a few sentences out loud. The aim is to test whether the patient will neglect the left side. Sentences should be placed in the center of the patient's field of vision. Like pictures, written materials can be used to demonstrate existing problems to patients who are unaware of their own problem. First meeting; It provides us with important information in terms of conversation, picture telling and reading, but a broader evaluation needs to be made for non-verbal and supra-linguistic skills.
Assessment of Non-Verbal Skills
TESTING NEGLIGENCE
There are many tests on the market regarding this subject. Although standardized tests are more valuable, it is not very difficult to determine the presence of “neglect.” The steps to be taken are explained below. And these procedures do not take much time.
* Marking the middle of the line: Draw a line 6-10 inches (10-15cm.) long in the middle of the patient's field of vision. Ask the patient to mark the exact middle of the line. The average deviation from the center should be calculated as a result of at least 3 attempts.
* Marking the target symbol: A page with complex symbols is placed in front of the patient. These symbols are scattered all over the page. The patient is asked to mark a symbol designated as a target on the entire page.
* Free drawing: The patient is asked to draw pictures such as flowers or people. The symmetry between right and left in the patient's drawing and the difference in detail between the right and left sides of the drawing are important.
* Drawing by copying: The patient is asked to draw simple geometric shapes by looking. The difference in detail between the right and left of the drawing is important.
* Anosognosia: The patient is asked to show his left arm and leg. If the patient fails, this indicates the presence of anasognosia.
* Reading: The patient is asked to read out loud the words, sentences and paragraphs placed in the middle of the field of vision. Long sentences, words and paragraphs are also used to determine whether there is "neglect". It is functional.
* Writing: The patient is asked to write a sentence he hears without looking at it and to write a sentence in front of him by looking at it. Not writing a letter or word on the left (e.g. writing i's or t's instead of it's) indicates the presence of "omission".
Evaluation of Attention
• Testing awareness requires the patient to respond auditorily and visually. Scoring is done depending on whether the patient's answers are clear and timely.
• Selectivity in perception can be measured with the help of many published tests (e.g. Stroop), and the clinician can also prepare his own test.
• Attention can also be evaluated by checking whether the patient can do two tasks at the same time.
Evaluation of Disorders Other than Language
1) Determining different salient features and the relationship between them.
– Stimuli: Some pictures require certain interpretations and conclusions to be made based on several events and the relationships between events. The patient cannot be expected to reach such conclusions in pictures that do not contain simple, related events. Patients with SHL may have difficulty with complex images due to their visual-spatial problems. But on the other hand, complex pictures also provide the patient with many visual cues. However, simple paintings do not contain such visual diversity. Therefore, the picture given to the patient should not be just visually complex. The important thing is that there are pictures in which connections can be made between events and certain inferences can be made.
– Method: Place the picture in the middle of the patient's field of vision. Ask the patient what is in the picture. If the patient has visual neglect, give a clue by pointing to the left side from time to time.
– Scoring: It is done according to the ability to establish the relationship between the events and the inferences and interpretations made regarding this. One method is to determine the noun phrases that have function and meaning for the people and objects in the picture. For example, in the picture titled "New Year's Morning", "tree" and "packages" are noun phrases, while "Christmas tree" and "gifts" are inference. Calculate the ratio of inferences to noun phrases plans. The patient's comments and stories provide the clinician with a lot of information. First of all, it is evaluated whether the patient can distinguish between relevant and irrelevant events. Afterwards, it is evaluated whether the patient can make a conclusion about the noun phrases.
2) Production of speech
– Stimuli: The patient's (1) You may be asked to list the events, (2) tell what you do in daily life, (3) make comments about the events in the picture and/or the story given or read.
– Method: The picture is in full view of the patient. put it in the middle. If necessary, help the patient follow the events in the story by viewing them vertically in order to eliminate the risk of "neglect". Make sure that the patient sees the left side of the picture.
– Scoring: It is expected that the patient will have problems in terms of macrolinguistics despite his microlinguistic level. Microlinguistic functions include the phonological and syntactic appearance of individual words and sentences, which are language-specific and independent of context. Macrolinguistic functions, on the other hand, include context-dependent cognitive processes aimed at combining linguistic and non-linguistic information regarding the conceptual, semantic and pragmatics of speech. Analysis of context information is done by comparing relevant and non-related information.
3) Perception of what is spoken:
– Stimuli: The patient is asked to answer questions about a narrative. Questions measure the ability to recall the main points and details in what is said.
4) Ability to generalize alternative meanings:
– Meanings of words: Patients are asked about the different meanings of words that have more than one meaning. Ex. “Eagle” is both a bird and the symbol of the USA.
– Sentences: Titles are appropriate because they usually contain two meanings. The first meaning is the meaning related to the story, and the second is the meaning it gives on its own.
– Phraseological language: The patient is asked to tell the story containing idioms or indirect expressions. Ex: hitting rock bottom. It is not recommended to ask the patient what the idioms mean, because this is quite difficult.
