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RHD- typically results from stroke or TBI…
RHD- typically results from stroke
or TBI
What’s affected
Cognitive-Communication Disorder (CCD)
This is the main communication issue after RHD.
Pragmatics – e.g. difficulty understanding jokes, sarcasm, indirect requests.
Discourse – disorganised storytelling, lack of coherence.
Prosody – flat tone or trouble interpreting emotional intonation.
Attention – may drift off mid-conversation.
Awareness – poor insight into their own communication issues (anosognosia).
➡️ Example: They might respond to “Do you have the time?” with “Yes” instead of giving the time.
Left Neglect
➡️ Implication: They might ignore the left side of a conversation partner’s face or miss written text on the left-hand side of a worksheet.
Affects reading/writing, not just vision — e.g. omitting words on the left side of a page.
Common in RHD due to damage to the right parietal lobe.
Theory of mind
Trouble interpreting others’ emotions, intentions, or perspectives.
Impacts social use of language
Mini Inventory of Right Brain Injury–2 (MIRBI-2)
RICE-R (Right Hemisphere Communication Battery)
Discourse analysis
Pragmatic observation during conversation
Neglect tests – e.g., line bisection, cancellation tasks
Functional tasks – e.g., using calendars, phone calls, writing message
Summary
Speech pathologists treat RHD by addressing discourse, inference, pragmatics, prosody, and cognition using structured therapy and education. It’s less about language form (like aphasia) and more about social communication and integration of meaning :
Anosognosia
Lack of awareness of deficits. They may insist they’re fine despite obvious difficultie
Intervention strategies**
Metacognitive training – to build insight and self-monitoring
Compensatory strategies – checklists, repetition
Pragmatic language training
Prosody drills
Visual scanning training – for neglect
Communication partner training
Educate family/carer
Comprehension diff
attention deficits
impaired prosody
discourse comprehsnion
Interpreting abstract language
understanding humour, sarcasm
diff with inferencing & pragmatics
Executive function
impairments
Difficulty with planning, problem-solving, reasoning, and organisation.
This affects functional communication and following therapy tasks.
Assessments