Cognitive and Perceptual Dysfunction, CH 29 p 1149 Flashcards
Localized CVA vs. Generlaized TBA
Patient with an initial CVA is thought to have focal or localized damage to discrete areas of the brain resulting in discrete cognitive or perceptual problems
TBA patients are presumed to have generalized brain damage resulting in attention, ,memory, learning problems
What we are trying to get at with both groups is their true residual abilities
Patient with an initial CVA is thought to have focal or localized damage to discrete areas of the brain resulting in discrete cognitive or perceptual problems
3 steps to the process model.
selects, intergrates, and interperts
Cognitive process includes (KUAJD)
Knowing Understanding Awareness Judgment Decision making
PERCEPTION , ACTION , THINKING, MEMORY
Cognitive processes are generally defined as,
Give examples of higher functions like reading, and writing
Abilities that enable us to think, including concentrate, pay attention, remember, & learn
Executive functions- capacity to plan, manipulate information, initiate & terminate activates, recognize errors, problem solve, think abstractly (HIGHER ORDER COGNITIVE FUCNTIONS/ METACOGNITIVE FUCNTIONS
What is a preception then what is sensation (more just sensory)
Is the integration of sensory impressions into information that is psychologically meaningful
Ability to select stimuli that require attention/action
Integrate with other info
Interpret info
Sensation is the appreciation of stimuli through organs, peripheral cutaneous sensory system
Charateristics of cognitive decfecit like oh now where did I put my shoes. How do I walk down the stairs I forgot :/
Inability to do simple tasks independently or safely,
Difficulty in imitating or completing a task
Difficulty switching from task to task
Diminished capacity to locate visually or to identify objects that seem obviously necessary for task completion
Unable to follow simple one stage instructions
Repeated mistakes
Longer time to complete activates or done impulsively
Hesitate, appear distracted, frustrated, exhibit poor planning
Frequently inattentive of one side of their body
THEORETICAL FRAMEWORKS
1. Transfer to training
Practice of one task with particular perceptual requirements will enhance the performance of other tasks with similar perceptual demands (focus is the process)
Neistadt 1995, learning capacity is key to a patient’s ability to generalize
Sensory intergrative Apporach
Ayres, explain relationship between neural functioning & the behavior of children with sensor motor or learning problems
Neurobehavioral literature
Integration of sensorimotor functions
Development of tactile, proprioceptive, vestibular proceeds in a developmental sequence in the normal child within the context of goal-directed, meaningful activity
(like trying to balance on a skateboard)
Treatment modalites used in the sensory approach
Rubbing Icing Resistance Weight bearing Spinning
What are splinter skills?
In young children avoid Compensatory or Splinter skills, (acquired in a manner incapable of being integrated with already present skills)
Neurofunctional Approach
Giles and Wilson 1992 based on learning theory
In direct contrast to the retraining approach
Practice in true context
Retrain real world skills
Neurodevelopmental Approach
NDT
Perception is facilitated during normal infant neuromotor development by kinethetic, proprioceptive, tactile, & vestibular feedback received through normal movement experiences
Sensations are used as a progression from early physiological flexion to movement against gravity for sitting, crawling, kneeling, standing, & initial walking
Provides a sense of midline orientation, two side awareness & full body awareness
PERCEPTION is imperative to handling techniques that provide sensory inputs & the FB accompanying correct movement during retraining
Rehabilitative /Compensatory Functional Approach
Most widely used for perceptual dysfunction
Adults with brain trauma will have difficulty generalizing learning from non similar tasks
Require direct repetitive practice of tasks
Address the functional problems
Therapy is a learning process that takes into consideration individual strengths & limitations
Composed of two complementary components
Compensation, change in patient’s approach
Adaptation, alterations in human and physical environment
Compensation,how to deal with it
Cognitive awareness of deficiencies
Teach circumvention by using intact sensations & perceptual skills
Attend to Cues/successful habits
Use simple directions
Establish and carry out routine
Do each activity in a consistent manner
Employ repetition as needed
Cognitive Rehabilitation and the Quadraphonic Approach
Focuses on training individuals with BI to structure & organize information
Memory, language disorders, perceptual dysfunction under one umbrella
Information processing, problem solving, awareness, judgment, decision making
What four things are incoporated in the cognitive approach
Use of multiple learning environements
Task analysis
Training on ability awareness, task difficulty, self assessment
Relate new info to previously learned ones
Abreu’s model- quadraphonic approach: Fig. 29.1,2 p 1155/56 Works on both the Micro level like memory, attention, postural control etc. Then on the macro level like more job like tasks to match the patients enviorment
Assessment of Cognitive & Perceptual Problems what can influence an assessment
Task analysis Determine which Cognitive & Perceptual abilities are intact & which are limited What can influence an assessment? Psychological, emotional status Level of relevant cue detection Anxiety over capabilities Reduced receptive & expressive communication Depression Fatigue Medications Premorbid status Must conduct sensory assessment prior to cognitive or perceptual testing
How do we distinguish between Sensory & Cognitive/Perceptual Problems?
Deep (proprioceptive) sensations (kinesthesia, position sense, vibration)
Superficial sensations (pain, temp, light touch, pressure)
Combined cortical sensations (stereognosis, tactile localization 2 point discrim, barognosis, graphesthesia, recognition of texture)
Hearing
visual
Visual disturbances
Hemiplegia, poor eyesight, diplopia (double vision), homonymous hemianopsia (visual field deficit), damage to visual cortex, retinal damage
Review figure 29-4 pg 1158
Visual field deficits and associated lesions sites
Remember:
result is a loss of incoming information from half of the visual surround contralateral to the side of the lesion
If you loss left half of visual field occurs with left hemiplegia
Loss of right visual field accompanies right hemiplegia
Tests for presesnce of hemianopsia
Figure 29.7 p 1160
gaze tracking task in sitting
2 types of eye movements
Visual fixation, near far object focus
Ocular pursuits, following moving objects & visual scan abilities
What is cortical blindness? total or partial loss of vision in a normal-appearing eye caused by damage to the brain’s occipital cortex.
Who performs better right or left hemi with regard to visual perceptual issues? dont know
Things to remember
Performance may vary daily
Number of short sessions on successive days is preferred
Perceptual testing along with ADL self care
Standardized cognitive and perceptual tests
Table 29.1 p 1162
Intervention what can we do
categorized the 5 major approaches for cognitive and perceptual rehab into either,
Remedial approaches, focus on deficits & retraining specific perceptual components of behavior for the recovery or reorganization of deficient CNS functioning, bottom up approach, “Neurotherapeutic approaches”,
SI, COGNITIVE,RETRAINING APPROACHES
Adaptive/Compensatory Approach, direct training of functional deficiencies, limit generalizability, top down approach, may foster learned non use/splinter skill development
NEUROFUNCTIONAL, REHABILITATIVE
Education, FB- Knowledge of Results & Performance
Review Table 29-2 pg 1163
Common assumptions of adaptive and remedial approaches
Who uses the “top down” vs “bottom up” approach
Review Table 29-2 pg 1163
Common assumptions of adaptive and remedial approaches
Who uses the “top down” vs “bottom up” approach
Lab focusing on integrating cognitive and perceptual impairments Table 29.3 p 1165
Attention deficits Memory disorders Executive function impairments Body image disorders Spatial relation disorders Agnosias Apraxia
