Right hemisphere syndrome is in the eye of the beholder

Abstract

Background: Specific information about prevalence and patterns of deficits associated with right hemisphere brain damage (RHD) is incomplete. A recent large-scale study of inpatients in a United States rehabilitation centre (Lehman Blake, Duffy, Myers & Tompkins, 2002) provided initial estimates of deficit prevalence and co-occurrence. The data obtained were based on information from multiple medical disciplines, and may not adequately reflect the typical caseload seen by US speech-language pathologists (SLP). Differences in how professionals view RHD may influence whether patients are appropriately referred for services. Aims: The first aim was to evaluate whether prevalence and patterns of deficits differ when diagnoses are made by SLPs versus other disciplines. The second aim was to examine whether the presence of certain deficits is associated with referrals to SLP. Methods and Procedures: A retrospective chart review was conducted examining medical records for 122 adults with RHD in an inpatient rehabilitation unit. Diagnoses were obtained from speech-language pathology versus a group of other medical professionals, including neurology/physiatry, neuropsychology, and occupational therapy. Frequencies and cluster analyses were computed for both groups of diagnosticians to examine differences between groups. Relationships between performance on a screening measure of mental status and cognitive/communicative diagnoses were examined to determine if there were obvious connections between specific disorders and referrals to SLP. Outcomes and Results: Diagnoses of pragmatic and communicative deficits were made more often by SLPs, while the other professionals more often diagnosed deficits in attention, visuoperception, and learning/memory. Moderate-strong correlations between diagnoses from the two groups were obtained only for deficits of attention, linguistics, and neglect. Referral to SLP was not related to performance on a general mental status screening test. Patients who presented with neglect, aprosodia, or deficits in interpersonal interactions were more likely to be referred to SLP than when these deficits were absent. Conclusions: This study raises the question of how to ensure appropriate referrals to SLP when referring professionals may not always identify the communicative disorders exhibited by individuals with RHD. A descriptive definition of right hemisphere syndrome and a consistent set of terminology would facilitate communication about right hemisphere deficits within and across disciplines. A broader scope of referrals to SLP would increase the number of patients who receive appropriate care for their cognitive and communicative deficits.