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.
Right-left discrimination clinical examples
Pt. cannot tell the therapist which is right arm and which is left. Right shoe cannot be discerned from the left and pt. is unable to follow instructions using the concept of right-left . Pt. cannot distinguish the therapists right from left
Right-left discrimination - Lesion area
Parietal lobe of either hemisphere. There is a close relationship between aphasia (L side H damage)& deficits in this disorder.
Right-left discrimination - Testing
Ask pt. to point to body part on command e.g. right ear, left foot etc. 6 responses should be elicited on pt. own body on that of the therapist and on a model or picture of the human body. To rule our somatoagnosia the pt. should be first tested without using the words right and left.
The inability to identify the fingers of one’s own hands or of the hands of the examiner
Finger Agnosia
Right-left discrimination - Treatment
If using a compensatory approach, when giving instructions to pt. words like right and left should be avoided. Point or provide cues instead using distinguishing features of the limb may be more effective. Mark right side of all common objects such as shoes and clothing with red tape or seam binding
Finger agnosia- Clinical examples
Difficulty in naming the fingers on command, identifying which finger was touched, and, by some definitions. mimicking finger movements. Deficit usually occurs bilaterally and more common in the middle 3 fingers. FA correlates highly with poor dexterity in tasks that require movement of individual fingers in relation to each other e.g. buttoning, tying laces and typing
Finger agnosia- Lesion area
Either parietal lobe. Often in angular gyrus region of L hemisphere. Often in conjunction with aphasic disorder or general mental impairments. Bilateral finger agnosia with Right-Left discrimination known as agraphia.
Finger agnosia- Testing
ask pt. to move or point to his/her finger when named by the therapist to determine if FA is present. Between 5-10 commands is adequate. start naming with eyes open then progress to eyes closed. use patient’ fingers, therapist fingers models etc.
Figure ground discrimination
Inability to visually distinguish a figure from the background in which it is embedded. Interferes with the pt. ability to locate important objects not prominent in a visual array. Pt. has difficulty ignoring irrelevant visual stimuli and cannot select the appropriate cue to which to respond. may lead to distractibility resulting in shortened attention span, frustration and decreased independent and safe functioning.
Finger agnosia- Treatment
Little evidence for treatment- when using remedial approach paient’s discriminative tactile system are stimulated (touch/ pressure). Rough cloth used to rub the dorsal 7 ventral surface of affected part.
Depth and distance perception
Pouring water into class
o Stairs- can be very challenging for pt.
o Can’t pick up small undulations in grass
Vertical Disorientation
This is different from pusher
o Common in both right and left CVA
o Pt. will lean to one side for no reason – not weakness
Visual Agnosia
The person has normal eye function- but when looking at object, they have a hard time understanding what it is and can’t name it. If they hold it and feel it, they can name it (hairbrush, no idea what it is, but once they
hold they know it’s a brush)
Auditory agnosia
Can still hear, but if a sound has another sound they can’t identify it
Example: loud startling bark could sound like a lightning bolt
These people will have other communication issues
Categorizing to a finite level
Astereognosis
If things are in their hand, they can’t determine what it is
Apraxia-
2 big ones: Ideomotor apraxia & Ideational apraxia
Ideomotor apraxia
a.
Breakdown between concept and performance
i. They can do the task but can’t do it when asked- they have ability
ii. If they voluntary do it, they can do it- but can’t get the concept if you ask and can’t perform
iii. Will have potential to perseverate
1. Motor perseveration (continually brush teeth)
a. Can’t hit the button to stop
2. Verbal perseveration (yes, yes, yes, yes)
b. Sometimes you can trick them into doing it
Constructional apraxia
Inability to put parts together to make a whole- the correct way
Dressing apraxia
a. Pants as shirt
b. Underwear on outside
Non equilibrium coordination test
Something outside of balance- pick some UE and LE and use them for eval on patient o Look at pursuit- smoothness o Undershoot/Overshoot o Does she go right to it o Ataxic o Mass grasp o Finger tip o Dysdiadochokinesia o LE Alternating foot tap Heel to shin • If they have strength issues, they may not have the wild movement- may have motor or coordination impairment • Does the pt. even have strength to do it
Equilibrium coordination test (balance)- maintaining COM over BOS
COM
BOS
COM- center of mass
Men belly button
Women is a little lower
Amputation
BOS- base of support
Feet- get closer as you age and take smaller steps
Butt- When sitting, more butt on surface = more stable
Hands and knees- In quadruped
Sitting: 90/90/90
Chair and feet is base of support - If you scoot forward or backwards have same 90° angle, it’s still the same BOS
Cone of stability
• This is different with everybody
• Looking to see how far you can learn forward/backward/side-to-side and still maintain balance
• After a fall, a person’s cone of stability become smaller
o They start to become retropulsion/retropulsive
Surgery, injury, braces (halo) can affect BOS
o If I start to fall- 3 strategies to correct a fall:
1. Ankle joint
2. Hip
3. Take a step
o Use this on a balance patient
We try to make the pt. fall so they can work on
T
balance
Work until they are at brink of falling
Strengthening muscles in LE and strengthen the neurological system so if they do begin to fall, the firing rate occurs faster
Unstable surface
Carpet
Bosu
Foam
Person better be good at single leg stance because when you take a step the hind leg is in a single leg
T
stance
Pt. is scared- learning to not fear it
o Assistive device
Moves COM and BOS
See what works for patient
Quad-cane won’t do much for BOS- same area expanded as single point
Crutches base of support is now an ellipse- not good
RW- steps need to be inside walker
• With retropulsive person, you may move walker more forward
Rollator- give these to cardio patient
High order cognition- Executive Function
- Volition
- Planning- I want to do something so I play movement
- Purposive action- Action that actually has purpose- not randomly moving
Plan that movement for something - Effective performance
Pt. knocks over water
Pt. squeeze Styrofoam too tight
Cognitive attention deficits- SAD
Sustained attention
Selective attention
Alternating attention
Divided attention
Cognitive memory impairments- ILS
Immediate recall
Short term recall
Long term memory
Higher order cognition- VPPP
Volition
Planning
Purposive action
Effective performance
Perception- body scheme/ body image Impairments
FARS U
Finger agnosia Anosognosia Righ- Left discrimination Somatoagnosia Unilateral neglect
Perception- Spatial relation impairments (complex perception)
Figure ground discrimination Form discrimination Spacial relations Position in space Topographical disorientation Depth distance Perception Vertical disorientation
Agnosia
Visual object agnosia
Auditory agnosia
Tactile agnosia
Apraxia
Ideomotor
Ideational
Buccofacial
