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Section 3
Left and Right-Hemisphere Stroke

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In the last section, we discussed six suggestions for getting up when you’re feeling down.

In this section, we will discuss differences between right-brain and left-brain injury as a result of stroke.  In addition, we will discuss the time orientation strategies technique at the end of the section.

Clearly, the symptoms and challenges a stroke victim will face are the result of the particular locations of the injury to the brain tissue.  Since the right and left hemispheres in the brain tend to dominate different kinds of functions, it is possible to make some basic generalization about specific consequences based on the hemisphere in which the stroke occurs.

♦ Common Consequences of Stroke
Regardless of the location of the injury, a common consequence of stroke is weakness or paralysis on the opposite side of the body.  Another common consequence is a cut or deficit in the field of vision on the side of the body opposite the injury.  Part of the visual field may be perceived as blank, or there may be tunnel vision, blurring, or tunnel vision.

♦ Consequences of Left-Brain Injury
Clients who have suffered a stroke located in the left side of the brain are highly likely to display some degree of aphasia.  A client with a left-side injury may face more challenges in the ability to speak than in the ability to comprehend what is said.  Difficulties in speaking may include trouble pronouncing words, continuous repetition of words or phrases, trouble recalling names or nouns, and difficulty naming objects even though the use of the objects is understood. 

Emotional consequences of left side stroke injury may include feelings of despair or hopelessness, and these clients may cry easily or become angry easily.  I have also observed a tendency towards slow, cautious, anxious behavior in clients with left side injury.

♦ Consequences of Right-Brain Injury
Clients who have suffered an injury to the right side of the brain may have difficulty recognizing faces.  Speech may be slurred or lack inflection, and it may be difficult for the client to make himself or herself understood.  In addition, I have observed that clients who have suffered a stroke on the right side may have difficulty with reading and understanding the meaning of what they have read.  A client’s listening ability may also be disrupted, characterized by conversations that tend to be self centered, since the ability for give and take in conversations is impaired. 

Four Potential Consequences of Right Side Injury

In terms of attention and awareness, clients with right side injury may have a shortened attention span.  I have also observed challenges in abstracting or organizing information.  A tendency that I have found problematic in terms of relationships with caregivers is a difficulty perceiving personal errors, or a lack of awareness of personal limitations including a denial of problems. 

Finally, in terms of emotional consequences, right side injury may result in several emotional challenges, including inappropriate or impulsive behavior or laughter, flat affect or emotionality, outbursts of swearing, making inappropriate disclosures, and a difficulty interpreting ir discerning the emotional responses of others.

Arlene, age 72, had suffered a minor stroke on the right side which had left her with some physical impairment on her left side.  Arlene stated, "For the most part, living with my daughter has been going well.  But it frustrates Laura that I’m always running out of time.  The other day I wanted her to take me shopping.  I didn’t realize that while I was getting ready 3 hours went by!"

♦ Time Orientation Technique, 5 Steps

Step # 1 - Recording Time
I discussed the time orientation technique with Arlene to help her and her daughter identify strategies that would help Arlene stay in touch with time.  I stated, "A first strategy that can be useful is for you and Laura to record together how much time it takes you to accomplish daily activities, like dressing, bathing, or eating. 

"The idea not to do so as a test of your abilities, but as a way to gather information and add quality to your day.  With this information, you can then estimate the time you need for your daily routines without ever feeling rushed.  This can also help you maintain more independence in creating and managing your own schedule."

Step # 2 - Structured Schedule
A second strategy I recommended to Charlene was to use a structured schedule to help orient herself to the time of day.  I stated, "Even if you have difficulty with the concept of time, if you connect the things you do, like dressing or eating dinner, with time, it will help you develop a structure to your day.  Such structure has a built-in responsibility and accountability, so you may find that you give yourself more chances to feel good about yourself when you own your own  time."

Step # 3 - Calendars & Reminders
In addition to recording the time daily activities take and using structured schedules, I encouraged Arlene to use calendars and daily reminders.  I stated, "A monthly calendar to remind you of coming events and appointments, and crossing off the days in the evenings can help orient you to the passing of days.  A daily reminder or calendar can be useful to help you keep track of daily schedules, activities, and medication times.  In addition, you may discuss with Laura a specific handy location for family notes and reminders."

Step # 4 - Use Digital Watches and Clocks
Arlene stated, "One of my biggest challenges is my old clock.  My late husband bought it for me when we were married, but sometimes I have trouble figuring out what the hands mean.  I love that clock, but even when I remember to look at it sometimes it doesn’t help!" 

I stated to Arlene, "A fourth strategy for time orientation can be to use digital watches and clocks.  If having the analog clock around is comforting, by all means keep it.  But digital clocks can be easier to interpret, and you might consider keeping a digital clock next to the analog one, since you are already used to looking in that direction.  You may also consider using a digital alarm clock to help orient you to medication times or other tasks you wish to remember."

Step # 5 - Set Realistic Goals
A fifth and final strategy for time orientation is to help the client and his or her family set realistic goals when focusing on time.  I stated to Arlene, "using these other strategies can help you better prioritize those tasks that are truly important, and apportion time accordingly.   The goal is to help yourself keep a positive attitude towards time, not see time as something to compete with."

Think of your Arlene.  Would the time orientation strategies help him or her improve his or her ability to function effectively and create feelings of positivity and self-reliance?

In this section, we have discussed differences between right-brain and left-brain injury as a result of stroke.  In addition, we have discussed the time orientation strategies technique.

Peer-Reviewed Journal Article References:
Adams, A. G., Henry, J. D., von Hippel, W., Laakso, E-L., Molenberghs, P., Robinson, G. A., & Schweitzer, D. (2021). A comprehensive assessment of poststroke social cognitive function. Neuropsychology, 35(5), 556–567.

Kim, E.-J., Lee, B., Jo, M.-K., Jung, K., You, H., Lee, B. H., Cho, H.-J., Sung, S.-M., Jung, D. S., Heilman, K. M., & Na, D. L. (2013). Directional and spatial motor intentional disorders in patients with right versus left hemisphere strokes. Neuropsychology, 27(4), 428–437.

Kusch, M., Gillessen, S., Saliger, J., Karbe, H., Binder, E., Fink, G. R., Vossel, S., & Weiss, P. H. (2018). Reduced awareness for apraxic deficits in left hemisphere stroke. Neuropsychology, 32(4), 509–515.

Machner, B., Könemund, I., von der Gablentz, J., Bays, P. M., & Sprenger, A. (2019). "The ipsilesional attention bias in right-hemisphere stroke patients as revealed by a realistic visual search task: Neuroanatomical correlates and functional relevance": Correction to Machner et al. (2018). Neuropsychology, 33(4), 595.

QUESTION 3
What are the five parts of the time orientation strategies technique? To select and enter your answer go to Test.

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