Denial of illness, lack of awareness

Problems recognising and identifying objects which are highly similar - typically this is manifested in a difficulty recognising individual faces

poor ability to copy or manipulate 2 & 3D images or objects

poor organisation of features of drawings - these may not be related well to each other

style of work is impulsive

attempts at self-correction are inaccurate

Difficulty following maps and giving directions - impaired ability to respresent external space mentally

Geographical disorientation i.e. Being unable to determine where they are relative to landmarks or objects - unable to use visual cues to construct representation of location

Unilateral neglect (damage to R parietal region)

Affects reading as miss LH side of the page

Similarly writing affected – half words are produced

Drawings may miss one half 

attentional control - focussing, maintaining, shifting attention

hypoarousal, - difficulties with vigilance, paying attention to important stimuli

sustaining attention and operating selective attention

Word finding and word fluency problems

Body part naming problems

Problems with comprehension of complex material

Difficulties with oral sentence reading

Writing difficulties

visual errors in naming and have problems with naming categories and collective nouns

understanding metaphors and interpreting implicit and implied meaning

 Inability to be sensitive to the communicative situation and emotional tone, difficulty using and reading the emotion in facial expression

 Difficulties with humour

'overall theme or core concept conveyed in discource or visual events'

RHD patients appear to have impaired ability to recognise, use and integrate significant contextual features to identify the core theme or make inferences 

Cannot produce normal pitch and stress, leading to patients not being able to express feeling or distinguish between question and interrogative 

Impaired processing of prosody may affect comprehension and/or production

Observe in both quiet and normal settings

With groups or 1:1

How they cope with distraction

Can they maintain communication with more than one person in the conversation

Questions: do you have any difficulties? tell me what happened, personal history, what have you done today, what do you think will happen in a few weeks?

Assess the responses for evidence of insight, memory  problems, ability to maintain narrative discourse, orientation

Picture description

Identify any areas requiring formal Ax

RH Language battery - Bryan 1995

RICE - Burns 1996

RH Communication Battery - Gardener and Brownell 1986

Discource Comprehension Assessment - Brookshire and Nicolas 1993

Could use conversation analysis

Improving awareness of problems (anosognosia)

Improving awareness of alternative lexical meanings

Councelling

Supporting and training conversation partners

Joint goal planning with other professionals

Work on understanding humour and sarcasm

Training in understanding and producing prosody

Discource training

Provide a consistent routine every day 

Use calendars, clocks, and notepads to remind the person of important information 

Decrease distractions when communicating 

Stand to the person's right side and place objects to the person's right if they are experiencing left side neglect 

Break down instructions to small steps and repeat directions as needed 

Ask questions and use reminders to keep the individual on topic 

Avoid sarcasm, metaphors, etc. when speaking to the individual 

Provide appropriate supervision to ensure the person's safety