A Guide to Right Hemisphere Brain Damage

Leaving food on half their plate… Drawing only half an object… Starting writing from the middle of the page… Insisting they waved their left hand when they actually didn’t… If you’ve observed any of these behaviors, you’ve seen some of the amazing, yet problematic neurological symptoms of right hemisphere brain damage caused by stroke or traumatic brain injury.

Right Side Brain Damage Provides Only Half The Picture

Our brains are divided into 2 halves – the right side (or hemisphere) and the left side – connected in the middle by the corpus callosum. The functions of each are distinctly different so that when one side is damaged by stroke or brain injury, only the functions that are controlled by that injured side are impacted.

With right hemisphere brain damage (known as RHBD or RHD), a person may have trouble with things like attention, perception, and memory, as well as loss of mobility and control on the left side of the body, since each hemisphere controls functions on the opposite side of the body.

The other problem making this even more difficult is that often, a person with RHBD is not even aware of their problems, and may deny they exist at all.

By increasing awareness of the potential effects of right side brain injury, our goal is to help caregivers and families of individuals with RHBD recognize, understand, and cope more effectively with the challenges their loved ones are facing.

What Is Controlled By The Right Side Of The Brain?

In general, the right side of our brain is in charge of visual awareness, imagination, emotions, spatial abilities, face recognition, music awareness, 3D forms, interpreting social cues, and left-hand control. It performs some math, but only rough estimations and comparisons.

The brain’s right side also helps comprehend visual imagery and make sense of what we see. It plays a role in language, particularly in interpreting context and a person’s tone, staying on topic in a conversation and organizing thoughts and ideas.

How Does RHBD Impact Daily Life?

Injury to the right side of the brain may result in cognitive and communication problems. Difficulties with memory, attention and components of executive function are most common, including planning, organizing and self-awareness in the following areas:

• Attention — Difficulty concentrating on a task or focusing on what is said or seen.
• Visual & Spatial Perception — Processing information in the left visual field, resulting in trouble judging location and objects in their surroundings. This is called Left Neglect.
• Reasoning & Problem Solving — Difficulty identifying that there is a problem and generating solutions.
• Memory — Difficulty recalling previously learned information and learning new information.
• Social Communication — Difficulty interpreting abstract language such as metaphors, making predictive inferences, understanding jokes, and nonverbal cues. Affect, or emotional expressiveness, is often flat and reduced. There may be difficulty filtering comments during conversations.
• Organization — Difficulty arranging information and planning, reflected in communication difficulties such as telling a story 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.
• Musicality — Trouble picking up on certain sounds, which could result in miscommunication or inability to appreciate the musicality of speech and tone.
• Speech — Voices can sound monotone or unnatural.
• Emotional Indifference — Acting as if nothing serious – physical or mental – needs to be addressed, when this may not be the case.
• Loss of Mobility & Control of The Left Side of the Body — Damage to the right side of the brain can result in a loss of functionality or weakness (called hemiparesis) in the left side of the body. 

RHBD Is Complicated By Associated Neurological Self-Awareness Issues

Perhaps the most difficult challenges facing survivors of stroke or brain injury with right side damage is that they are often unaware they are missing half of the picture. They may be unaware of things on the left side, plus, may deny the need to get help for their condition.

Right side brain damage may result in the following cognitive challenges:

•  Hemispatial (or Unilateral) Left Neglect — Refers to difficulty seeing or processing awareness of anything on the left side, including inability to respond to people or objects on the left, or being unaware there is a problem on the left. For example, they may forget that they are able to move their left arm or leg. Or they may fail to eat food from the left side of their plate, or fail to comb the hair on the left side of their head. This may have serious consequences for safety.
• Denial Syndrome or Anosognosia — Considered a sub-feature of Hemispatial Neglect, it is a complex neurological condition (rather than a psychological one) that occurs when specific brain regions are damaged by a stroke, rendering a survivor unable to move one part of their body, but because a closely related region of the brain is still intact, it tells them that their bodies are responding normally. The result is that survivors may believe that they are carrying out their physical functions in a normal fashion despite their actual inability to do so. This can lead to refusal to undergo rehabilitation.

How Is Right Hemisphere Brain Damage Treated?

Like other damage resulting from brain injury or stroke, RHBD is treatable. In rehab, Speech-Language Pathologists, Occupational Therapists, and Physical Therapists, using evidence-based practice, work with survivors in one-on-one therapy to improve skills and limit the consequences of right side brain damage.

Science tells us that the most important element in rehabilitation is carefully directed, focused, repetitive practice, so expect this kind of therapy to form the basis of most rehab programs. In addition, clinicians may treat left-neglect by focusing on conscious awareness and using contextual cues that can remove ambiguity.

The goal of therapy programs is always to help survivors regain lost skills and become more independent.

Tips For Caring For Someone With RHBD

At home, caregivers can take specific steps to help loved ones deal with limitations of right hemisphere brain damage, and also help improve awareness of their recovering side. And caregivers should take steps to avoid caregiver stress in the process. Here’s how:

• Keep The Environment Safe — Keep all items that have the potential to be dangerous (like cleaning chemicals or sharp objects) in a secured or out-of-the-way place.
• Decrease Environmental Clutter & Distractions — Too much visual or auditory stimulation in the environment may be confusing.
• Help Them With Routines & Planning — Try to have a routine every day so your loved one knows what to expect. Use calendars, clocks, and notepads to remind them of important information. Break down directions into small steps and repeat as needed.
• Use a Caring Approach — Recovering from stroke or brain injury can be frustrating for the survivor. Avoid sarcasm or scolding, even if your patience is thin. For example, if they haven’t seen the fork to their left, gently remind them by saying “look to the left,” “here is your fork” or drawing their hand to the fork, rather than saying something which may come across as condescending, such as “What did you forget?”
• Be Sensitive To The Survivor’s Visual & Sensory Difficulties — Talk to the rehabilitation team about how to best support the survivor’s needs. For some individuals, it may be appropriate to place critical items the person needs to their right side if they have trouble seeing or sensing things on their left side.
• Help Increase Awareness Of The Left Side — Hold their hand, touch their arm, or stand on their left side during a conversation to help them become more aware. Placing non-critical items like the TV remote or a glass of water on the neglected side may encourage them to look and reach for objects on that side. Talk to the rehabilitation team about how best to support the survivor’s needs so that the neglected side is incorporated into daily tasks, but is not too frustrating for the survivor.
• Encourage Scanning — Have your loved one fully scan (turn their head or move eyes from side to side to see) their surroundings to adjust for any loss in field of vision. For pen-and-paper tasks, using your finger to guide the eye gaze or highlighting the left margin of a page can be helpful visual reminders to scan. Place a comfortable chair next to the bed on the left (the neglected) side, encouraging them to look in your direction as you speak.

As much as we know today, researchers still feel there is a need for significantly more treatment research for cognitive and communication disorders associated with RHBD, and are therefore continuously studying the effects of right side brain injuries. If you are a survivor or a caregiver, be sure to stay up-to-date on research developments in the field, so that your recovery can benefit from the very latest information.

References:

• Blake, Margaret Lehman (2017), The Right Hemisphere and Disorders of Cognition and Communication: Theory and Clinical Practice, San Diego, Plural Publishing, Inc.
• Blake, Margaret Lehman, Perspectives on Treatment for Communication Deficits Associated With Right Hemisphere Brain Damage, American Journal of Speech-Language Pathology, November 2007, Vol. 16, 331-342. doi:10.1044/1058-0360(2007/037).
• American Speech-Language-Hearing Association. (2015). Right hemisphere brain damage.
• Federmeier, Wlotko, and Meyer, What’s “right” in language comprehension: ERPs reveal right hemisphere language capabilities, Lang Linguist Compass, 2008 Jan 1; 2(1): 1–17.
• Request our Left-Brain – Right-Brain Guide for Your Patients.