Agnosia And Apraxia

Question 1

agnosia/apraxia

what is it

Answer 1

altered perception occurs, difficulty making sense of information coming in

Question 2

perception

what is it an ability of

what does it require

Answer 2

• ability to interpret sensory input or to process visual, somesthetic, auditory input
• requires cortical association areas interacting with primary sensory cortex

Question 3

Cortical Association Areas (4)

Answer 3

1. prefrontal cortex
2. temporal lobe
3. occipital lobe
4. parietal lobe

Question 4

Prefrontal cortex

5 things it does

Answer 4

1. goal directed behavior
2. understanding outcomes of behavior
3. determining goal achievement
4. Short Term Memory
5. Emotional Responsiveness

Question 5

Temporal Lobe

5 things it does

Answer 5

1. memory processing: make sense of the memory
2. auditory association–makes sense of sounds (area 22, superior temporal gyrus)
3. Language comprehension–makes sense of spoken language and written language (Wernickes area)
4. Visual Task Memory: make sense of visual input
5. Visual Recognition: complex patterns

Question 6

Occipital Lobe (3)

Answer 6

1. visual association area : make sense of visual input
2. identify visual input (area 18)
3. how to use visual input (area 19)

Question 7

Parietal lobe (4)

Answer 7

makes sense of sensory input

1. somatosensory association area: i am holding a key
2. interface sensory and motor cortices
3. process spatial aspects of environment
4. right hemisphere: body image, tactile discrimination

Question 8

Parieto Temporal Spatial Occipital Junction

what it does
what a lesion will do

Answer 8

overlapping association area, a polymodal sensory area

ability to make multimodal sense of LANGUAGE as simultaneously written and spoken

there is a dense overlapping association cortex that allows us to make sense of association

lesions result in AGNOSIA or APRAXIA

Question 9

AGNOSIA

1. what causes it
2. what is it

Answer 9

“lack of knowledge”

1. lesion in association cortex causes inability to interpret sensory input
2. agnosia is an acquired condition characterized by an inability to recognize stimuli when transduction, transmission, and perception of stimuli are intact
   - -lack of perceptual ability to recognize stimuli (ie stereognosia, graphesthesia)

–cannot interpret, perceive or recognize

–occurs in the presence of normal sensation

–can be agnostic for a specific modality (more common: visual, auditory, tactile) or a subcatogory (facial)

–can touch, feel, and describe it, but cannot recognize or make sense of it

Question 10

Is sensation intact in agnosia

Answer 10

yes

–can touch, feel, and describe it, but cannot recognize or make sense of it

Question 11

Body Image

1. what is it, how is it formed
2. is it acquired
3. what lobe
4. what happens if difficulties here

Answer 11

1) body acquired mental image about the body formed by synthesis of sensory stimuli
2) acquired through memory of previous body position, movements, relationship to objects
3) nondominant parietal lobe
4) difficulties here result in intact movement skills but difficulty performing functional tasks due to inability to recognize the “meaning” of the task

Question 12

body image issue

how does it affect movement

Answer 12

difficulties here result in intact movement skills but difficulty performing functional tasks due to inability to recognize the “meaning” of the task

Question 13

Body Image Agnosis (2)

Answer 13

1. somatopagnosia: loss of ability to identify body as a whole or recognize relationship of body parts (not mine)
2. hemisomatotopagnosia: impaired ability to recognize 1/2 of body –can feel and use it, but do not recognize it (not mine)

Question 14

somatopagnosia:

Answer 14

loss of ability to identify body as a whole or recognize relationship of body parts (not mine)

Question 15

hemisomatotopagnosia:

Answer 15

impaired ability to recognize 1/2 of body –can feel and use it, but do not recognize it (not mine)

Question 16

Unilateral Neglect (2)

Answer 16

1. Hemispatial Neglect: a spatial neglect and do not pay attention to that part of the body.
   –impaired attention to 1/2 of body
   –NOT agnosia
   –complete lack of sensation or awareness of 1/2 of body but not a denial, an IGNORAL
   –unaware that the hand is hanging off the w/C
   do a clock test
2. Hemisensory Neglect: loss of sensation of hemi side, they can see it, may be able to use it, but do not feel it

Question 17

Hemispatial Neglect:

what is it

is it agnosia

what test can we do

Answer 17

a spatial neglect and do not pay attention to that part of the body.

• -impaired attention to 1/2 of body
• -complete lack of sensation or awareness of 1/2 of body but not a denial, an IGNORAL
• -unaware that the hand is hanging off the w/C

–NOT agnosia (can be cued to see it and would know it is their own body) [like when on autopilot]

do a clock test

Question 18

Hemisensory Neglect:

Answer 18

loss of sensation of hemi side, they can see it, may be able to use it, but do not feel it

Question 19

hononymous hemianopsia

Answer 19

loss of 1/2 of visual feild

cannot see that side

it is a visual feild cut

in L sided hononymous hemianopsia, one can only see the right visual field

injury to R brain will effect L visual feild

Question 20

side note: tranndelenburg

Answer 20

When standing on the right leg, if the left hip drops, it’s a positive right Trendelenburg sign (the contralateral side drops because the ipsilateral hip abductors do not stabilize the pelvis to prevent the droop).

Question 21

finger agnosia

Answer 21

inability to recognize one owns finger from those of the examiner

Question 22

tactile agnosia

what is it

what causes it

how to test

Answer 22

inability to recognize object by touch in the presence of intact cutaneous and proprioceptive hand sensation

• -inability to synthesize tactile and proprioceptive information (texture, size, weight)
• -difficulty with using scissors, putting on gloves, R and L discrimination

caused by lesion in the CONTRALATERAL PARIETAL LOBE

test with graphesthesia or stereognosis

Question 23

Visual Agnosia

what is it

what makes us suspect it

common characteristic

Answer 23

inability to interpret visual stimuli despite intact visual sensory apparatus

individual can perceive a visual stimuli, describe its specific characteristics, but is not able to “recognize” its function, structure, or purpose

suspect if :
RO visual acuity
EOM
Visual Fields

CIRCUMLOCATION: talk around it, cannot determine it is a pen, can describe it, do not know what it is for, ask if they know what it is and if they can demonstrate a use for it

Question 24

CIRCUMLOCATION:

Answer 24

in visual agnosia

talk around it, cannot determine it is a pen, can describe it, do not know what it is for, ask if they know what it is and if they can demonstrate a use for it

Question 25

Visual Object Agnosia what is it how to test it what causes it

Answer 25

inability to name or demonstrate use of a familiar object test by giving pt familiar object and asking them to demonstrate its use indicates lesion in the visual association cortex of the occipital lobe

Question 26

visual spatial agnosia what is it examples what causes it how is it tested

Answer 26

inability to perceive spatial relationships between objects or between the object and self - unable to follow familiar paths - unable to orient objects in space - impaired ability to judge distance - poor depth perception ie sit down and miss chair make the bed with everything in the wronge place RIGHT PARIETAL LOBE ``` Tests: figure ground design extraction test ask person to touch body parts design copying ```

Question 27

Prosopagnosia what is it what causes it how is it tested

Answer 27

facial agnosia inability to recognize familiar faces, either famous people or close relationships bilateral medial TEMPORAL-OCCIPITAL LOBE famous people test

Question 28

How to test visual-spatial agnosia

Answer 28

figure ground 1. design extraction test: find design in the design and perceive 2 identical objects in different positions 2. separating objects from two identical ones 3. ask person to touch body parts ie left shoulder and right eye etc. 4. design copying: draw a design and they have to copy it

Question 29

Apraxia what is it what causes it

Answer 29

praxis = movement organization loss of movement organization not caused by incoordination, sensory loss, or failure to follow simple commands in absence of sensory, motor or language problem PREMOTOR LESION

Question 30

What is lost in apraxia, what isnt lost in apraxia

Answer 30

praxis = movement organization loss of movement organization not caused by incoordination, sensory loss, or failure to follow simple commands in absence of sensory, motor or language problem

Question 31

Types of Apraxia (3)

Answer 31

1. ideational 2. ideomotor 3. special apraxia

Question 32

Ideational Apraxia - -what is it - -what can they not do/what is preserved? - -give an example - -what causes it

Answer 32

- cannot form the concept of an action - inability to form a plan or idea for a specific movement -ability to DESCRIBE ACTION is preserved see inability to complete a typical multistep command ie pick up a pen, write name, put paper into envelope -->spatial and temporal errors (cannot do multistep command)--incorrect sequencing or may not be able to figure out how to put the paper into the envelope see diffuse bilateral brain damage AD dominant lobe lesions movement looks smooth, NOT like cerebellar overshoot

Question 33

Ideomotor Apraxia what is it what can work what causes it

Answer 33

- inability to follow commands - spontaneous movement is intact and can do the movement on their own -gestural commands may do better than spoken commands DOMINANT PARIETAL LOBE LESION [we also see movement to command impaired in PD but different cause]

Question 34

constructural apraxia what is it what can work what causes it

Answer 34

--unable to use visual information to complete a motor task - inability to draw or construct a simple figure (lego) - copying may be ok (draw) - OCCIPITAL LOBE LESION

Question 35

dressing apraxia

Answer 35

specific form of apraxia with difficulty sequencing motor actions needed for dressing

Question 36

``` IMPAIRMENTS BY LOBE Temporal Lobe (4) ```

Answer 36

1) memory loss [hippocampus] 2) auditory processing 3) language: WERNICKE's APHASIA 4) visual : UPPER QUADRANTANOPSIA

Question 37

``` IMPAIRMENTS BY LOBE Frontal Lobe (6) ```

Answer 37

1) apathy (lose will) 2) disinhibition (any urge is acted on) 3) preservation (task, ideal movement, speech repeated over and over) 4) loss of executive function (pay attention to disinhibition) 5) BROCA's APHASIA 6) contralateral hemiplegia

Question 38

``` IMPAIRMENTS BY LOBE Parietal Lobe (5) ```

Answer 38

1. mental status: calculation, perceptual/spatial orientation 2. apraxias 3. neglect 4. VISUAL: homonymous hemianopsia 5. sensory: hemisensory deficit

Question 39

``` IMPAIRMENTS BY LOBE Occipital Lobe (4) ```

Answer 39

1. visuospatial deficits 2. central blindness 3. visual hallucinations 4. Hemianopsia (lose 1/2 of visual field)

Question 40

Note to self: determine difference in visual in parietal and temporal and occipital

Answer 40

Note to self: determine difference in visual in parietal and temporal and occipital