RHD Therapy

Question 1

Things to know about treating individuals with RHD

Answer 1

• Implusive behavior:

— nonverbal or verbal signals so wait a few seconds before responding

• Denial and Indifference:

— Often times, patients with RHD are unaware of their deficits.

• Videotaping sessions to give immediate feedback to the patient increases awareness.

Question 2

Therapy Strategies

Answer 2

• Left Neglect
• Attention
• Orientation
• Holistic, Gestalt-like stimuli
• Temporal ordrer- Sequencing
• Prosody
• Pragmatics
• Inferencing
• Emotions and Expressions
• Prosopagnosia
• Memory
• Figurative Language
• Visual Perception
• Reading and Writing

Question 3

Left Neglect Treatment with RHD

Answer 3

• Goal is to get patient to attend to left side of visual field and reinforce behavior
• Approach individual from left side and begin speaking, make contact if they don’t move toward you
• Place items on left side
• Include the left hand in therapy tasks

Question 4

Attention

Answer 4

• Sustained- The state of focusing on one stimulus to the exclusion of all other competing stimuli
• Selective -The ability to focus on the important/relevant stimuli in the presence of distracting stimuli
• Sustained- use puzzles, simple math problems, series of yes/no questions and other simple tasks
• Selective- Could have patient tap finger when clinician says a target number when a series of numbers are read aloud
• Frequently draw attention to treatment stimuli

Question 5

Orientation

Answer 5

• Involves frequent and systematic repetition of basic information about the patient, the events leading to hospitalization, and temporal and spatial facts relating to the current time, place, date, and time.
• Therapy relies on environmental prompts in living space, verbal orientation, information delivered by caregivers, and orientation drills

Question 6

Holistic, Gestalt-like stimuli

Answer 6

• Target main ideas vs. smaller details (cards, pictures, and short stories)
• Puzzle /object arrangements
• Recognizing commonalities and categories

Question 7

Temporal Order-Sequencing

Answer 7

• Work on activities that require sequencing
• Review schedule of events for the day
• Use sequencing cards/ worksheets

Question 8

Prosody

Answer 8

• Provide model sentence with emotional prosody
• Use cards identifying the target emotion and picture of facial expression
• Eventually make phone calls or go into natural settings for treatment to practice appropriate prosdy and pragmatics

Question 9

Pragmatics

Answer 9

• Give verbal cues to maintain eye contact
• Topic maintenance- simple to complex
• Turn taking with role playing
• It’s your turn- regulate smooth turn taking
• Show videos of conversations with people using appropriate and inappropriate pragmatic behaviors
• Train family members to prompt patient to attend to conversational partners on the left side

Question 10

Inferencing

Answer 10

• Treatment should focus on evaluating contextual cues, determining which ones are relevant and which aren’t, and integrating multiple cues to arrive at one most plausible interpretation
• Simple to complex
• Reading/auditory comprehension

—- patient reads or listens to story and makes inferences

—- must state contextual clues, identify words that lead to the inference

• Matching cardgame of situations and emotions

Question 11

Emotions & Expressions

Answer 11

• Label emotions

- Descriptions of vocal characteristics to convey emotions

Question 12

Prosopagnosia

Answer 12

• Focus on unique qualities of loved ones, other then their face (hair, height, clothing, perfume, voice ) that will help to identify that person
• VSD of patient’s loved ones and voices

Question 13

Memory

Answer 13

• Test STM while working on inferencing of short paragraph read aloud to them
• Make them recall their reading strategies

Question 14

Figurative Language

Answer 14

• Practice metaphors and idioms w/literal and figurative meanings
• Use of metaphors and idioms that are age-appropriate and relevant to the patient’s everyday life
• Have patient draw correct depiction of metaphor or idiom.

Question 15

Visual Perception

Answer 15

• Customize to patients age and interests

- On computer, dots appear on screen so patient must visually scan in all directions to find the next number

Question 16

Reading & Writing

Answer 16

• Draw thick and colorful line on left margin of paper
• Keep a finger on the left side of the page
• Point to the beginning of each line
• Frequent verbal prompts to pay attention to the left side of the body