Since the pyramidal pathway crosses the medulla, one side of the brain affects the motor function on the opposite side of the body. Right hemisphere stroke causes left side paralysis and possibly left-sided neglect. Assess the patient's response to stimuli on the left-handed side. Use visual and tactile stimuli to increase reintegration of the affected side.
Right hemisphere stroke affects spatial-perceptual orientation. Damage to the parietal lobe may cause the patient to deny their disabilities or their own body parts. The patient may neglect all sensory inputs on the left side of the body. Additional deficits include the inability to judge distances, to recognize an object, and to move in a learned sequence. Poor proprioception may increase the patient's risk of accident and injury. Assess the patient for altered proprioception, since the patient may be unaware of their deficits.
Damage to the right hemisphere impairs the patient's concept of time. The patient may be disoriented to person, place, and time. Frequently re-orientating the patient may help improve their concept of time.
Prosopagnosia refers to the patient's inability to recognize faces. Encourage the patient's loved ones to continue communication efforts to maintain relationships.
Right hemisphere stroke may result in decreased awareness and poor judgment. The patient may benefit from rearranging the environment to compensate for visual deficits and decrease the risk of injury.
Right hemisphere stroke tends to cause rushed movements and impulsive behavior. Create a safe environment and monitor the patient's activity to prevent injury.
Damage to the right hemisphere may cause changes in personality. The patient may experience emotional lability and present with constant smiling, euphoria, confabulation, or crying. Inform the patient's loved ones that not all personality changes are permanent.
After experiencing a right hemisphere stroke, the patient may have tonal hearing loss. Right brain damage may affect the patient's ability to distinguish tonal variations. Maintain a normal volume and tone while speaking with the patient.
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