Cognitive, Sensory, and Perception Flashcards
what are the 5 primary categories of tests for cognitive status?
- consciousness
- orientation
- attention/concentration
- memory
- executive function
what are the levels of consciousness?
- alert/fully conscious
- lethargy = general slowing of cognitive and motor processes
- obtundation = dulled/blunted sensitivity, difficult to arouse
- stupor = semi-conscious state, aroused only w/deep pressure pain
- coma
what is the gold-standard test for levels of consciousness?
Glascow Coma Scale (GCS)
what are the 3 areas of consciousness measured in the GCS?
- eye opening
- motor response
- verbal response
*graded 3-15 (<8 = severe; 9-12 moderate; 13-15 mild)
What are the 3-4 primary areas of examination for orientation?
- Person
- Place
- Time
- Situation
what are the 4 different aspects of attention/concentration?
- sustained attention
- selective attention
- divided attention
- alternating attention
what is sustained attention?
How can we test it?
ability to sustain and focus attention over a duration of time
tested via the Cancellation Test
what is the Cancellation test?
a method of testing sustained attention
instruct pt to inspect an image and circle all of the ______ in the image. Will take a lot of time and require a lot of attention
what is selective attention?
How can we test it?
ability to screen and process relevant sensory info about the task and environment while screening out irrelevant info
Test = Stroop Test
what is the Stroop Test?
used to test selective attention
look at a letter outloud and say the color of the word rather than the word itself
what is divided attention?
How can we test it?
ability to perform 2 tasks simultaneously
Walkie-Talkie Test
what is alternating attention?
How can we test it?
attention flexibility
shifting your attention back and forth between 2 different things
What is memory?
the capacity to store knowledge, experiences, and perceptions for recall and recognition
what are the 2 types of memory?
Declarative (Explict)
Non-declarative (Procedural/Implict)
what is declarative memory?
conscious recollection of facts and events
what is non-declarative memory?
recall movements/movement schema without conscious recollections
what is another 3 part classification of memory?
- immediate recall
- “repeat after me” (seconds to minutes)
- short-term memory
- recent or working memory (minutes to hours/days)
- long-term memory
- remote memory (months to years)
What is executive function?
capacity to engage successfully in independent, purposeful, self-directed behavior
what are the different aspects of executive function?
- volition/planning
- problem solving/reasoning
- insight/awareness
- poor judgement
- social pragmatics
- inappropriate behaviors
- self-regulation/purposeful action
- initiate, maintain, switch, and stop tasks
what is difference between sensation and perception?
sensation = raw data
perception = interpretation of data
what are 2 critera for sensation to occur?
adequate arousal and selective attention
adequate stimulus level to activate sensory receptor
*entire pathway must work!
Give a working definition of perception
capacity to transform info from the senses and use it to interact appropriately with the environment
selective, integrative, dynamic process that includes problem solving and memory
what type of sensations are carried in the spinothalamic tract?
- pain
- temperature
- crude touch
what types of receptors are utilized in the spinothalamic tract?
- free nerve endings
- cutaneous receptors in the skin
what are the afferent fiber characteristics in the spinothalamic tract?
small, thin, slow conducting
no myelination
where is the spinothalamic tract heading?
what are it’s major connections?
- lower brainstem
- thalamus
- limbic system
- diffuse cortical areas
what types of sensations are carried by the dorsal column/medial lemniscus tract?
- discriminative touch (tactile location)
- proprioception
- kinesthesia
- vibration
- 2-point discrimination
what types of receptors are utilized in the dorsal column/medial lemniscus tract?
- muscle spindle
- GTOs
- joint receptors
- some cutaneous receptors in the skin
what are the afferent fiber types of the dorsal column/medial lemniscus tract?
large, thick, rapidly conducting
well myelinated
where is the dorsal column/medial lemniscus tract headed?
sensory cortex
what types of sensations are carried in the spinocerebellar tract?
“unconscious”
proprioception and kinesthesia
what types of receptors are utilized in the spinocerebellar tracts?
- muscle spindles
- GTOs
- joint receptors
- some cutaneous receptors in the skin
what are the afferent fiber types of the spinocerebellar tract?
fast, direct, heavily myelinated
where is the spinocerebellar tract headed?
cerebellum
What are the 4 major subcategories/components of the perceptual exam?
- Body scheme and body image impairments
- spatial relationships
- agnosias
- apraxia
what is the difference between body scheme and body image?
body image = visual/mental image of one’s body
body scheme = postural model of body (body awareness)
Name a major impairment to body scheme/image
Unilateral Neglect
what is unilateral neglect?
failure to orient toward, respond to, or report stimuli on the contralateral side to the lesion
*despite normal sensory, visual and motor systems
Unilateral neglect occurs mostly with ________ lesions
R tempoparietal junction
posterior parietal
(**R side most often)
what are the 2 classification systems for unilateral neglect?
- Modality
- Distribution
what are the 3 types of modality neglect?
- sensory
- motor
- representational
What is sensory neglect?
brain loses ability to maintain awareness of a specific sense as it comes in (can be visual, auditory, or tactile)
the sensation is fine but the perception is off
what is motor neglect?
“output neglect”
failure to generate a movement response to a specific stimuli even if the pt. is aware of the stimuli
ex: ball is thrown at you, you only raise 1 arm to catch it even though both arms have 5/5 strength
what is representational neglect?
loss of internally generated images
ex: pt asked to recall and draw a clock. They draw a clock with all the numbers on 1 side of a circle
What are the two subcategories of distribution neglect?
- Personal
- Spatial
what is personal neglect?
individual lacks awares of entire contralateral side of their body
what is spatial neglect?
failure to acknowledge stimuli of the contralateral side of space
can be peripersonal (within reaching space)
extrapersonal (in far space)
Other than unilateral neglect. What are 4 other types of body scheme/body image impairments?
- somatoagnosia
- R-L discrimination
- vertical disorientation/midline disorientation
- Pusher syndrome
what is somatoagnosia?
an impairment of body scheme
Lack of awareness of relationship of body parts
(how your shoulder relates to your elbow, difficult to differentiate from proprioception)
what portion of the brain is primarily/most often affected with somatoagnosia?
usually lesion to dominant parietal lobe
what is R-L discrimination?
decreased R/L differentiation with body parts and following directions
what portion of the brain is primarily/usually affected with R/L discrimination?
lesion to either parietal lobe
what is vertical disorientation/midline disorientation?
cannot ID when their body is in the middle
what is Pusher Syndrome?
a subtype of vertical/midline disorientation
characterized by leaning and active pushing towards hemiplegic side w/o compensation for instability and with resistance to passive correction towards midline
what portion of the brain is primarily affected with pusher syndrome?
lesion to R hemisphere centered in area of posterolateral thalamus
tends to be more common when L hemiplegia is present alongside L spatial and sensory neglect
list the various spatial relationships impairments
- Figure ground
- spatial relations disorder
- position in space disorder
- topographical disorientation
- depth and distance perception
what is Figure ground?
the inability to distinguish a figure from the background in which it is embedded
ex: pick a screwdriver out of a toolbox full of tools
what is spatial relations disorder?
the inability to percieve relationships of one object in space to another object, or to one’s self
what primarily causes spatial relations disorder?
lesion in the R inferior parietal lobe
what is position in space disorder?
decreased ability to perceive and interpret spatial concepts
can’t distinguis between opposite directional/spatial concepts
ex: confused up and down
what is topographical disorientation?
difficulty perceiving relationships from one location to another in the environment
what is depth and distance perception?
inaccurate judgement of directions, distance, and depth
more broad than spatial relationship disorders, and deals with environmental cues (like difficulty negotiating a curb)
what is the primary cause of depth and distance perception issues?
lesion of R or bilateral visual assocaition cortex
what does the general term agnosias mean?
decreased ability to recognize stimuli despite intact sensory function.
most commonly associated with damage to temporal lobe
what are the different types of agnosias?
- Sensory
- visual
- auditory
- tactile (asterognosis)
- Body scheme
- anosognosia
- somatagonsia
what is visual agnosia?
inability to recognize familiar objects despite normal eye function
what type of lesion normally causes visual agnosia?
occipital and temporal lobe (R or L)
what is auditory agnosia?
inability to recognize non-speech sounds and discriminate between them
what type of lesion normally causes auditory agnosia?
left temporal lobe
what is tactile agnosia (astereognosis)?
inabilty to recongize objects when handling them, despite normal tactile sensation
what types of lesions normally causes tactile agnosia?
parietal/temporal/occipital association areas (R or L)
what is anosognosia?
a severe condition in which an individual does not acknowledge, denies, or lacks awareness of presence/severity of one’s deficits
define apraxia
impairment of voluntary, skilled, well-learned movement
w/o deficits in motor function, sensory function, or coordination
what are the 2 types of apraxia?
ideomotor
ideational
what is ideomotor apraxia?
breakdown between concept (idea) and performance (motor execution)
what is ideational apraxia?
failure in the conceptualization of the task
what type of lesion normally causes apraxia?
left frontal or parietal lobes
