Right hemisphere brain damage (RHD) is damage to the right side of the brain. The brain is made up of two sides or hemispheres. Each hemisphere is responsible for different body functions and skills. In most people, the left side of the brain contains the person’s language functions. The right side contributes to a number of functions, such as attention, memory, reasoning, and problem solving (all of which contribute to effective communication). Damage to the right hemisphere of the brain may lead to disruption of these cognitive processes, resulting in unique cognitive and communication problems. In many cases, the person with right brain damage is not aware of the problems that he or she is experiencing (anosognosia).
Signs and Symptoms
Cognitive-communication problems that can occur from RHD include difficulty with the following:
- Attention: Difficulty concentrating on a task or focusing on what is said or seen.
- Perception: Visual perception deficits causing a person to have difficulty perceiving and processing any information on the left visual field (left-sided neglect). For example, individuals with RHD may have difficulty with reading words on the left side of a page, eating food on the left side of their plate, or acknowledging the left side of their body.
- Reasoning and problem solving: Difficulty identifying that there is a problem (e.g., ran out of medication) and generating solutions (e.g., call the pharmacy).
- Memory: Difficulty recalling previously learned information and learning new information.
- Social communication (pragmatics): Difficulty interpreting abstract language such as metaphors, making inferences, and understanding jokes; and problems understanding nonverbal cues and following the rules of communication (e.g., saying inappropriate things, not using facial expressions, talking at the wrong time).
- Organization: Difficulty with systematically arranging information and planning, which is often reflected in communication difficulties, such as trouble telling a story with events in the right order, giving directions, or maintaining a topic during conversation.
- Insight: Difficulty recognizing problems and their impact on daily functioning.
- Orientation: Difficulty recalling the date, time, or place. The individual may also be disoriented to self, meaning that he/she cannot correctly recall personal information, such as birth date, age, or family names.
The causes of right hemisphere brain damage include stroke, tumors, infection, and traumatic brain injury (TBI).
Diagnosis of Cognitive Communication Deficits
A speech-language pathologist (SLP) will complete a variety of formal and informal evaluation procedures. Specifically, the person’s language (comprehension and expression) and cognitive processes (attention, memory, reasoning, problem solving) will be examined. The nature and severity of the cognitive-communication problem will depend on the extent of damage to the brain.
A person with right hemisphere brain damage should see an SLP, a professional trained to work with people with communication disorders, in addition to his or her doctor. The SLP will work with the person and develop a treatment plan designed to improve his or her cognitive-communication abilities.
Tips for Communication
- Ask questions and use reminders to keep the individual on topic.
- Avoid sarcasm, metaphors, etc., when speaking to the individual.
- Provide a consistent routine every day.
- Break down instructions into small steps and repeat directions as needed.
- Decrease distractions when communicating.
- Provide appropriate supervision to ensure the person’s safety.
- Stand to the person’s right side and place objects to the person’s right if he or she is experiencing left-side neglect.
- Use calendars, clocks, and notepads to remind the person of important information.