Cognition & Perception Flashcards
Pt. has no insight or awareness into their injury
Usually resolves in 1st couple of months
Keep doing what they want- Right CVA
Left CVA- will not want to do anything
Real or feigned ignorance of the presence of disease, especially of paralysis.
Anosognosia
aka Body agnosia
Difficulty with body structure and relationship to body part
Inability to correctly identify or orient the parts of one’s body or the body of another.
Somatoagnosia
Typically stroke patient has a hard time
Stroke patient has no clue which is left or right
Can be scrambled from day-to-day
Right-Left Discrimination
Can’t figure out how to use fingers in a useful fashion- fingers are all messed up
Tying shoes, zippers, piano
Neurologic disorder in which a patient is unable to distinguish between stimuli applied to two different fingers without visual clues; to recognize his or her own digits, for example, finger versus, thumb; or to recognize or identify another person’s fingers.
Finger Agnosia
Spatial relation disorder
the ability to separate elements of a visual image on the basis of contrast (e.g., light, dark), to perceive an object (figure) against a background (ground). classic illustration figure-ground perception is the Rubin vase, a simple black and white image which can be seen as two dark faces against a white background
Figure ground discrimination
- o Subtle differences are hard for pt. to separate
o Toothbrush, eye liner, razor- looks all the same- long and skinny- can’t separate those subtle nuances
Form Discrimination
The sense of where one is relative to the environment, or where objects are relative to each other. Relative to visual processing it is the awareness of the orientation of forms, numbers or letters on a page.
Position in Space
Severe condition including lack of awareness of the presence or severity of one’s paralysis- defined as lack of awareness or denial of a paretic extremity as belonging to the person, or lack of insight concerning, or denial of paralysis.
Anosognosia
o Difficulty in understanding and remembering the relationship of one location to another
o Try to get pathways firing again
Topographical disorientation
Anosognosia - Implication for rehabilitation
can complicate rehab since it limits the patient’s ability to recognize the need for, and thus to use compensatory techniques
Anosognosia- Clinical example
Typically the patient maintains that there is nothing wrong and disown the paralyzed limbs and refuse to accept responsibility for them. The patient may claim that the limb has a mind of its own or that it as left at home.
Anosognosia- Lesion area
Unclear- supramarinal gyrus has been proposed
Anosognosia Testing
Identified by talking to the patient. Ask pt. what happened to the limb, whether he/she is paralyzed, how the limb feels, and why it cannot move. Pt with this disorder will deny the paralysis, say it is of no concern and fabricate reasons why the limb does not move as it should
anosognosia treatment
Often resolves spontaneously in the 1st 3 months following a stroke however until the condition resolves it seriously hampers rehab. If condition persists for long term it is extremely difficult to compensate for. Safety is of great importance in treatment and discharge planning because pt. does not acknowledge their disability and refuses to be careful
Patients display difficulty following instructions that
require distinguishing body parts and may be unable to imitate movements of the therapist. pt. reports limb feeling unduly heavy. lack of proprioception may underlie or compound this disorder
Somatognosia
Pt. may have difficulty performing transfer activities because he/she does not perceive the meaning of the terms related to body parts.
Somatognosia- clinical example
Somatognosia- clinical example
Pt. may have difficulty performing transfer activities because he/she does not perceive the meaning of the terms related to body parts. Additionally pt. with body scheme disorder will have difficulty dressing and hard time participating in exercises requiring movement of body parts in relation to other body parts. e.g. bring arm across chest and touch shoulder.
Somatoagnosia - Lesion area
Often the dominant parietal lobe thus primarily seen in right hemiplegia.
Somatoagnosia- Testing
Have pt. point to body parts named by the therapist on his/her self, on the therapist and on a picture or puzzle of a human figure. e.g. show me your face, chin, arm etc. words right & left should not be used, may lead to inaccurate diagnosis in pt. with right-left discrimination. Therapist could have pt. imitate movements and answer relationship questions about body parts e.g. knee is below head etc.
Right-Left Discrimination
The inability to identify the right and left sides of one’s own body or that of the examiner. Including the inability to execute movements in response to verbal commands that includes the terms left and right. Typically stroke patient has a hard time -Can be scrambled from day-to-day
Somatoagnosia - treatment
Use remedial approach, therapists should aim for pt. to associate sensory input with an adaptive motor response. Facilitate body awareness by sensory stimulation of the body part affected. e.g. ask pt. to rub body part with rough cloth as it is being named.
