Cognitive & Perceptual Function Flashcards
General Assessments : Performance Based ADL Assessments
Performance of Self Care Skills (PASS)
Structured Observation Test of Function (STOP)
This assessments allow to see the pt. functioning vs just using a pen & paper assessment.
General Assessments: Clinical Vision Screen
Should be used with ALL neuro pts.
General Assessments : Perception Test
Such as the MVPT which can be linked with driving
Perception
The integration of sensory impressions into meaningful information.
Recognitions of sounds (i.e. doorbell) also visual & tactile stims.
Motor Planning (Praxis) : Apraxia
Absence of motor planning ability (frontal & parietal lobe dysfunction)
Lack of purposeful, skilled movement that cannot be attributed to weakness, tremor, spasticity, loss of position in space.
Motor Planing Consist of 2 Steps
- Conceptual/ideation
2. Production/planning
Ideational Apraxia : Clinical Manifestations
*Inappropriate tool use
Sequences activity incorrectly
Overall loss of concept of tasks
Uses familiar objects incorrectly (i.e. toothbrush as a hairbrush)
Can’t relate object together (can’t put toothpaste on toothbrush)
**You can see hesitation when pt. is completing a task
Ideational Apraxia : Clinical Manifestations Continued
Multi-step tasks, requiring multiple objects are especially difficult such as morning or bedtime routine
Culturally inappropriate use of objects
Eats with fingers, stirs coffee with finger
Slow task performance
Cant initiate task
Task perseveration
Ideomotor Apraxia
A disorder of the production praxis system. A loss of kinesthetic memory patterns so that purposeful movement cannot be produced or achieved due to defective planning & sequencing of movements even though the idea/purpose of task is understood.
Ideormotor Apraxia : Clinical Manifestations
Awkward or clumsy movements Difficulty crossing midline Trouble with grasping patterns Trouble orienting hand to objects (i.e. fork backwards) Inflexible or static hand positions
Ideomotor Apraxia : Clinical Manifestations Continued
Spatial errors such as moving scissors laterally
Difficulty coordinating 2 or > joints for tasks
Difficulty with timing of movement
Impercise movements
Poor gestural ability (cant replicate waving/blowing a kiss)
Difficulty with completing a task on command but can initiate a task when needed (i.e. they can get a drink when thirsty)
Ideomotor Apraxia : Tx. Ideas
Hand over hand A to start ADL’s
Work on familiar tasks
Pt.s can struggle in a new envt. vs. their home envt.
Use a lot of gestures, mock the task (i.e. mimic what a taking a drink looks like)
Apraxia Prevalence
Of those w/ (L) brain damage 25% have apraxia
Those w/ global aphasia have more apraxia than others.
Strong association btw expressive aphasia & ideomotor apraxia.
Occurs w/ aquired brain injury, CVA, parkinson’s, alzhimers, suprnuclear palsy, & Huntingtons.
Apraxia & ADL Impact
The # of errors made during B & IADL’s is predictive of the severity of the apraxia (dressing & grooming are the best indicators) The pt. moving “slowly” is a warning sign.
Those pt. with ideomotor apraxia have > dependence in toileting, dressing, & bathing compared to age matched controls.
Apraxia & ADL Impact Continued
Apraxia severity is moderately predictive of meal prop competency (always have the pt. make toast, coffee, or wash dishes)
The absence of apraxia is a significant predictor of the ability to return to work
Learning new skills and relearning old skills in those w/ apraxia requires more repetition
Oral Motor Apraxia
Pt.s have difficulty with recripcal conversation and initation of thought
Assessments for Apraxia : STOP Error Types
Content Error: Accuracy with what the pt. needs to do (i.e. handle utensils, materials)
Temporal Error: Time and efficiency with completing steps of the task
Spatial Errors: Over/Under shooting, decreased depth perception & mapping (i.e. next, behind)
Intervention for Apraxia : Compensatory
Compensatory strategies are dependent on the pt.s baseline.
A high baseline would require reps and structure
A low baseline limits the amount of compensation that can be used and these pt.s usually require 1:1 supervision.
Intervention for Apraxia : Interest Checklists
Used to determine what tasks are important to the client.
The intervention focus was error specific and determines by the problems observed during the standardized ADL observations.
Every 2 weeks new tasks were chosen.
Intervention for Initiation Errors
Developing necessary plan of action and selecting objects (Hand over Hand A)
Intervention for Execution Errors
Performing the pan (guiding & talking through task)
Intervention for Control Errors
Direct & correcting errors to ensure desired end result (more spaital errors/provide guiding)
Errorless Learning Background
Preventing mistakes through verbal and physical support vs trial and error.
Used for apraxia and memory impairments.
Trail and error can lead to increased frustration w/ Apraxix pts.
(Errorless learning) The therapist supports the difficult asspects of the task by:
Guiding w/ hand over hand A through difficult parts
Sitting parallel & doing the same action simultaneously.
Demonstrating required action & having client copy it afterword.
Errorless Learning Training Focuses On
The specific difficult steps and critical features of the pereptual deficits of the task.
Examples:
Key details of ADL objects are explores (toothbrush bristles, sleeves on a shirt)
Actions connected with the task details are practiced
Specific motor skills are practiced in other activities & contexts (squeezing paint from a tube is similar to toothpaste)
Hemianopsia
Blindness in 1/2 of the visual field
Sensory loss within the visual field
Commonly lost on the L side
Clinically you can see stiffness in the pts. neck and head due to decreased rotation to the L
Can get better when swelling in the brain decreases however it usually results in residual deficits
Intervention for Hemianopsia
Prisms to shift image to center of retina (referral to a behavioral optomitrist)
Head turning toward L coupled with sensorimotor tasks to reinforce environmental information and stim on the L side
Pair movement with head turning toward L
Visual Discrimination Deficits : Depth Perception
(Stereopsis) 3-D understanding of objects.
Functionally required when putting things away
Visual Discrimination Deficits: Figure Ground
Foreground from background distinction.
Functionally required when sorting laundry: whites towels off of white shirts, sheets.
Intervention : Use contrasting colors
Visual Discrimination Deficits: Spatial Relations
Relationship of objects to each other and self.
Functionally required when putting clothes in drawers.
intervention for Visual Deficits
Task specific training (organize closets, drawers, labeling objects)
Select functional activities with visuospatial demands (wrapping gifts, dressing)
Combine movements with visuospatial demands (standing on moving surface and tossing bean bags)
Combine compensatory stratagies with appropriate sensory cues (contrasting sleeves w/ tactile cues for dressing)
Agnosia
Inability to RECOGNIZE incoming sensory information; sensory reception is intact.
Relatively rare compared to apraxia, inattention an other disorders
Loss of ability to recognize objects, people, sounds and shapes.
Tends to be a SINGLE modality specific within pts.
Visual Agnosia : Object Agnosia
Cant recognize objects in the environment
Visual Agnosia: Prosopagnosia
poor face recognition
