1. ignore
Neglect refers to unresponsiveness or disorientation to meaningful stimuli on the opposite side of brain injury, which is not caused by the dysfunction of the right hemisphere caused by basic sensory and motor defects. The degree of serious neglect is much higher than that of left hemisphere injury. Most neglected patients have parietal lobe injury. However, neglect may also be caused by damage to the temporal lobe and thalamus of the frontal cingulate gyrus, including stroke, tumor, brain injury, demyelination or any disease that may damage the right hemisphere. The neuropsychological explanations of neglect include attention disorder, sports concept exploration disorder and spatial representation (perception) disorder. Neglect can occur in visual, auditory, tactile and olfactory modes, alone or in combination. It has been proved that these patients are incoherent or neglected when looking at things on the left: drawing lines, filling clocks on maps, taking food from plates, and paying attention to people in the room. Patients' hearing problems on the left side can be manifested as ignoring telephone ringing, people's conversation ringing and horn ringing. The communication disorder on the left side includes left-hand dyslexia, which is called neglect alexia or spatial alexia. This writing disorder is called spatial alexia.
2. Disease agnosia and facial agnosia
Patients with dysfunction of the right hemisphere usually show agnosia and face blindness. Patients usually show perceptual defects, especially paralysis of one limb. This symptom is mostly caused by the injury of the right parietal lobe. Patients usually deny the existence of the affected limb or think that the affected limb is not their own. This symptom is usually related to novel neglect or disorientation. Face blindness means that you can't recognize your face, even your own. Patients usually identify others according to other characteristics such as voice, gait, weight and figure or clothing. This symptom is usually due to the right hemisphere.
3. Novel
Patients with right hemisphere dysfunction usually have little or no obstacles in listening comprehension and reading comprehension or oral and written expression, while adult aphasia patients have them. Patients with dysfunction in the right hemisphere may show irrelevant language. In other words, the patient's response has nothing to do with the corresponding stimulus or there is a fictional phenomenon. Patients with right hemisphere dysfunction show an increase in language volume or are more likely to deviate from the speech center than patients with left hemisphere dysfunction. Through behavior observation, fiction can be divided into spontaneous and exciting. Spontaneous fiction usually appears without obvious stimulation. It is usually strange or untrue. Exciting fiction usually appears as a response to a question, and it is often related to some real things. For example, a patient with dysfunction in the right hemisphere answered the therapist's question about whether to finish his homework: the patient said that he couldn't do his homework all weekend because of toothache, and he needed to see a doctor. He thought the therapist was a dentist. He also said the soles of his feet hurt. He came to see a therapist because his toothache therapist talked with the patient's family and found that the patient's teeth were fine and he had not seen a dentist. The toothache had been gone for a long time.
communication disorders
1. Patients with language disorders in the right hemisphere have obstacles in logical reasoning, abstract words, story arrangement, oral dialogue understanding and pragmatic ability.
(1) logical reasoning
A large number of studies have found that patients with right hemisphere dysfunction have defects in reasoning, and some patients have difficulty in understanding metaphorical words, especially those with right hemisphere dysfunction, and there are obvious obstacles in logical reasoning of pictures, such as working memory and reasoning needs. Patients with right hemisphere dysfunction have more difficulty in understanding work than patients with left hemisphere dysfunction. Patients with dysfunction in the right hemisphere have relatively poor understanding of humor, which further shows that they have difficulties in conversational reasoning. However, some studies have confirmed that there may be no significant difference between patients with right hemisphere dysfunction and patients with left brain injury in understanding familiar languages and normal peers.
(2) Abstract words and concrete words
Patients with right hemisphere dysfunction will make mistakes in the application of abstract words or specific words to varying degrees.
(3) Story arrangement
Patients with right hemisphere dysfunction have more difficulties in story arrangement than patients with left brain injury and normal subjects.
(4) Understanding of narrative oral dialogue
When asked about the main meaning rather than the details of the narrative, patients with right hemisphere dysfunction have more correct responses, so the understanding of narrative information is more obviously affected than the understanding of the main content. In addition, the correct rate of answering metaphorical information is lower than that of answering narrative information.
(5) Pragmatic competence
Many studies have shown that patients with right hemisphere dysfunction have difficulties in pragmatic competence. Take a pragmatic obstacle as an example. The question is "Tell me what every good citizen should do". A patient with dysfunction in the right hemisphere reacted like this: "Sleep, get up and go to the toilet." His answer excited him and kept laughing for the next few minutes, very happy.
2. Speech ability
(1) rhythm
Rhythm is a part of part of speech, including tone, stress, speech speed, rhythm, melody, volume, interval between words and interval and pause in conversation, which can convey language and emotional information (such as happiness, sadness, anger, shock and sigh or neutrality). The language effect of prosody also includes the listener's understanding of the language and the emotional information expressed by the speaker.
(2) Understanding and expression of emotional language
Patients with right hemisphere dysfunction have obstacles in understanding and expressing emotional language, and the weakening of attention to external environment (facial expression, gesture language, posture and rhythm) will hinder the understanding of external language information. From these clues of external language information, we can infer emotional information. Some scholars have found that the emotional poverty of schizophrenic patients is very similar to that of patients with right hemisphere dysfunction. Perceptual problems such as spatial judgment and feature integration may lead to the decline of patients' ability to recognize facial expressions. The test of understanding emotion or emotional rhythm is to let the interviewee listen to some emotional sentences and then judge the speaker's attitude.
(3) Understanding and expression of linguistic information
Patients with right brain injury may also have obstacles in understanding and expressing prosodic language information. The understanding of prosodic linguistics is to let the subjects listen to the prosodic features of sentences: different forms of sentences (interjections of interrogative sentences) distinguish different meanings of words by emphasizing stress (for example, "green house" and "green house" emphasize pronunciation); Language stress symbols are used to distinguish the meaning of sentences (for example, "Xiao Wang wants a red bike" and "Xiao Wang wants a red bike"). Prosodic comprehension disorder may be related to perceptual disorder and attention disorder. In a word, the research on prosodic comprehension disorder in patients with right hemisphere dysfunction is not very clear. Is this problem due to language and emotion? At present, it is uncertain that the disorder of cognition (perception and attention) is caused by prosodic damage in language expression, which may only be related to the dysfunction of the right hemisphere. In the process of speech production, prosodic damage may be related to brain damage in different parts (such as frontal lobe, frontal lobe and subcortical area) and motor speech disorders (such as dysarthria and apraxia). The language forms of prosody related to cognitive and emotional disorders (such as depression) are usually described as dull, indifferent, lacking in expression and emotion, almost without autonomous rhythm, computer-like and robot-like, monotonous, and lacking of special language (such as ridicule or irony) to convey at a changing volume.
(4) communication skills and reasoning obstacles
The language disorder presented by patients with right hemisphere dysfunction is mainly reasoning disorder, which can be regarded as a response to sensory data. Input data is not only perceived, but also interpreted. Reasoning mainly depends on the following processes: paying attention to clues, selecting relevant clues, integrating relevant clues, and linking the obtained clues with past experience. Potential reasoning obstacles lead to the following obstacles: producing informative content (for example, patients with right brain injury may speak a lot, but many of them are empty language); Integration of conversation information (for example, patients with right hemisphere dysfunction may forget the main points they heard or what they said next); Ambiguous language (for example, patients with dysfunction in the right hemisphere have difficulty in understanding rhetorical devices, such as metaphors, idioms and proverbs, language with ironic sense of humor, or the potential meaning of a sentence, etc. ); Understand or express feelings; Understand or produce rhythm.