Chapter 13 Cognitive-perceptual approaches: eval and intervention Flashcards
Definition of perception
The integration/interpretation of sensory impressions recieved from the environment into psychologically meaningful information
Def of Cognition
The ability of the brain to process, store, retrieve, and manipulate information. It involves the skills of understanding and knowing, the ability to judge and make decisions, and an overall environmental awareness
Etiology of Cognitive-Perceptual deficits
Occur as a result of multiple pathologies including CVA, TBI, Neoplasms, acquired diseases, psychiatric disorders, and/or developmental disabilities.
Impaired alertness or arousal
Person displays decreased response to environmental stimuli
- Intervention - Increae environmental stimuli, use gross motor activities, increase sensory stimuli
Astereognosis (tactile agnosia)
- The inabiltiy to recognize objects, forms, shapes, and sizes by touch alone
- A failure of tactiel recognition although sensory testing (tactile and proprioceptive) is intact.
Impaired attention
- An inability to attend to or focus on specific stimuli
- May result in distraction by irrelevant stimuli
- includes difficulty with sustained attention and selective attention in addition to dividing and alternating attention between 2 tasks
Ideational apraxia
- a breakdown in the knowledge of what is to be done or how to perform
- a lack of knowledge regarding object use
- the neuronal model about the concept of hot to perform is lost although the sensorimotor system may be intact
- Intervention - Provide step by step instructions. use hand over hand guiding techniques, provide opportunities for motor planning and motor execution
Motor apraxia/ ideomotor apraxia
- Loss of access to kinesthetic memory so that purposeful movment cannot be achieved because of ineffective motor planning although sensation, movement, and coordination are intact
- Intervention - utilize genral verbal cues as opposed to specific. decrease manipulation demands. provide hand over hand guiding techniques. Provide opportunities for motor planning and motor execution.
Long term memory loss
- lack of storage, consolidation and retention of information that has passed throught working memory. Includes the inability to retrieve the info.
- intervention - rehearsal strategies. “chunk” information, tilize memory aids (alarms, timers, etc) utilize “temporal tags” focusing on when the event to be remembered occured.
Short term memory loss
- Lack of registration and temporary story of information recieved by various sensory modalitities.
- includes loss of working memory
- intervention - rehearsal strategies. “chunk” information, tilize memory aids (alarms, timers, etc) utilize “temporal tags” focusing on when the event to be remembered occured.
Impaired organization/sequencing
- Inability to organize thoughts with activity steps properly sequenced
- Intervention - Use external cues (written directions, daily planners). grade tasks that are increasingly comples in terms of number of steps required.
right-left indiscrimination
- Inability to discrimintae between the right and left sides of the body or to apply the concepts of right and left to the environment.
body scheme disorders
- loss of awareness of body parts, as well as the relationship of the body parts to eachother and objects
- includes body neglect and asomatoagnosia
- Intervention - Provide bilateral activities, guide the affected side throught the activitiy, increase sensory stimulation to the affected side
Spatial relations impairement
- difficulty relating objects to eachother or to the self secondary to a loss of spatial concepts (up/down, front/back, under/over, etc)
- Intervention - utilize activities that challenge underlying spatial skills. utilize tasks that require discrimination of right/left
asomatognosia
a body scheme disorder that results in diminished awareness of ody structure, and a failure to recognize body parts as one’s own.
Intervention - Provide bilateral activities, guide the affected side throught the activitiy, increase sensory stimulation to the affected side
Topographical disorientation
- difficulty finding one’s way in space secondary to memeory dysfuntion or an inability to interpret sensory stimuli
Unilateral spatial neglect
- Inattention to , or neglect of, stimuli presented in the extrapersonal space contralateral to the lesion.
- may occur independently of visual deficits
- Intervention - Provide gradded scanning activities, grade activities from simple to complex. use anchoring technique to compensate. utilize manipulative tasks in conjuntion with scannign activities. use external cues (colroed markers, written directions)
Unilateral body neglect
- Failure to respond to or report unilateral stimulus presented to the body side contralateral to the lesion.
- intervention - provide bilateral ativities, guide the affected side thfought the activity. Increase sensoy stimulatin to the afffected side.
figure/ground dysfunction
- an inability to distinguish foreground from background
Anosognosia
- an unawareness of motor deficit
- may be related to a lack of insight regarding disabilities
perseveration
- the continuation or repetition of a motor act or task
acalculia
- the acquired inability to perform calculations
alexia
- the acquired inabiliyt to read
agraphia
The acquired inability to write
Impaired problem solving
the inability to manipulate a fund of knowledge and apply this information to new or unfamiliar situations
disorientation
lack of knowledge of person, place, and time
anomia
loss of the abiliyt to name objects or retieve names of people
Broca’s aphasia
loss of expressive language indicated by a loss of speech production
Wernicke’s aphasia
adeficit in auditory comprehension that affect semantic speech performance, manifested in paraphsia or nonsensical syllables
Global aphasia
The symptoms of global aphasia are those of severe broca’s aphasia and wernicke’s aphasia combined. Almost total reuction of all aspects of spoken and written language, in expression as well as comprehension
Agnosia
A loss of ability tot recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor eis there any significant memory loss.
executive dysfuntion or dysexecutive syndrom
Impairments related to multiple specific functions; such as decision makeing, problem solving, planning task switching, modifying behaivor in the light of new information, self-correction, generating strategies, formulating goals, and sequencing complex actions.
Visual foundations skills
(must be evaluated to differentiate perceptual dysfunction adn visual systems deficits)
- Visual acuity
- Visual fields
- Oculomotor function
- Scanning
- Visual acutiy - the claritiy of visuon both near and far
- Visual fields - the available vision to the right, left, superior, and inferior. Example (homonymous hemianopsia - left temporal field and right nasal field ar affected)
- Oculomotor function - control of eye movements
- Scanning - ability to systematically observe and locate items in teh environment.
Cognitive/Perceptual evaluation during routine task performance
- Impaired alertness or arousal
- Motor/ideomotor apraxia
- Ideational apraxia
- perseveration
- spatial neglect
- body neglect
- sequencing
- spatial relations dysfunction
- imparied attention
- an observation of a person’s performace during rutounte tasks can provide multiple opportunities to screeen for cognitive-perceptual deficits
- impaired alertness or arousal - requires sensory cues to maintain arousal such as loud voice, tactile stimulation, vestibular input, appears lethargic falls asleep during ADL performance
- Motor/ ideomotor apraxia - appears clumsy, difficulties crossing midline, difficulties with manipulation activities (coins, awkward grasp pattern with phone, difficutlty with bilateral activities)
- Ideational apraxia - uses objects incorrectly (hairbrush as toothbrush, cannot sequence the steps of task of meal prep, does not engage in task
- perseveration - repeats the same motor act, difficulty terminating an activity. repetition of task (dress and undress repeatedly)
- Spatial neglect - cannot find food on left side of plate, only responding to one side of the environment
- Body neglect - does not dress left side of body, shaves only one side of face. does not incorporate the involved limbs into activities
- sequencing and organization - steps of task are not in logical order (putting shoes on before socks) or steps ommited for washing dishes
- spatial relations dysfunction - difficulty with dressing (unable to orient shirt to the body)undershooting or overshooting when reaching for glasses, spilling when pouring, difficulty aligning body when transfering
- Impaired attention - not being able to attend to long conversations, instructions, lessons, tv shows, impaired attentional switching.
Behavioral inattention test
- Utilized with adults presenting with unilateral neglect
- examines the presence of neglect and its impact on functional task performance
- includes 9 activity based subtests (picture scanning, menu reading, map navigation, address and sentence copying, card sorting, article reading, telephone dialing, coing sorting, telling/setting time
Mini-mental state examination (MMSE)
- brief 30 pt questionnaire test used to screen for cognitive impairment. Commonly used to screen for dementia.
Cognitive/Perceptual Intervention
Remedial/restorative/ transfer of trainign approach
- deficit specific
- Focus on restoration or components to increase skills
- targets cause of symptoms
- assumes improvements in performance components will result in increased skill
- assumes the cerebral cortex is malleable and can reorganize
- utilizes table top and computer activities such as memory drills, blockdesigns, as treatment modalities.
Cognitive/Perceptual Intervention
Compensatory/ Adaptive Functioanl approach
- Involves repetitive practice of functional tasks
- emphasizes modification
- activity choice driven by tasks the person needs, or wants to perform.
- treats symptoms not cause
- Utilizes technique sof environmental adaptaiton and compensatory strategies
- treatment is task specific
- utilizes functioan tasks (BADL, IADL, work, and leisure tasks) that the individual desires, or is required to perform at discharge as the basis of treatment
Cognitive/Perceptual Intervention
Information processing approach
- Provides information on how the individual appraches the task
- investigates how performance changes with cueing
- standardized cues are given to determine their effect on performance.
- cues or feedback are utilized to draw attention to relevant feature of the task
- investigative questions are used to provide insight to the underlying deficits
Cognitive/Perceptual Intervention
Dynamic interactional approach
- emphasizes transfer of information from one situation to the next
- varyign treatment environments, and practice of targeteed strategy with varied tasks and situations
- utilizes self awareness of strenths and deeficits as basis of learning and generalization of learning
- transfer of learnign must be taught form one situation to the next and does not occur outomatically
- transfer of learning occurs througth graded series of tasks that decrease in similarity
- the person’s processing abilities and self-monitoring techniques are used to faciltiate learning for different tasks or environments.
- The therapists utilizes awarenes questioning (how do you know this is right?) to help the individual detect errors, estimate task difficulty and predict outcomes
Cognitive/Perceptual Intervention
neurofunctional approach
- Used for individuals with acquired neurological impairments
- focuses on retraining real world skills rather than cognitive-perceptual processes
- Treatment is focused on training specific functional skills in true contexts
