Cortical Function Testing Flashcards
1
Q
Frontal lobes
A
- attention, executive function
- motivation and behavior
- tests for function include working memory (digit span, spell backward)
- judgement, task organization and set generation such as naming lists of things in a certain category
2
Q
Temporal lobes
A
- emotional response (amygdala and its connections to the hypothalamus and frontal lobes)
- memory (hippocampus and limbic connections)
- tests for function are those of memory particularly declarative memory
3
Q
receptive language
A
- wernicke’s area
- poterosuperior temporal gyrus of dominant temporal lobe
4
Q
what is involved with
Expressive langauge
A
- broca’s area
- posterior inferior frontal gyrus of dominant hemisphere
5
Q
Language centers
A
- frontal and temporal lobes
- receptive language
- expressive language
- homologous regions of non-dominant hemispheres are important for non-verbal and emotional aspects of langauge
- tests for written and spoken receptive and expressive language are used to view these language centers
6
Q
Parietal lobes
A
- perception and interpretation of somatosensory information
- non-dominant parietal lobe: visual spatial function
- dominant parietal lobe: important for praxis (formation of the idea of a complex purposeful motor act) while the frontal lobes are responsible for execution of the act
7
Q
What could be found when preforming Clinical tests for
parietal lobe function
A
- tactile agnosia: inability to identify objects by touch
- apraxia: inability to prefrom purposeful motor acts on command
- constructional apraxia: inability to draw objects which require use of visual spatial organization
- elements of gerstmann’s syndrome
8
Q
Gerstmann’s syndrome
A
- acalculia: cannot do math
- finger agnosia
- R/L confusion
- agraphia
- occurs with damage to dominant inferior parietal lobe
9
Q
Occipital lobe
A
- perception of visual information
- inferior temporal visual association cortex: recognition of color and shape, recognition of faces
- projections from occiptial lobe to superior temporal-parietal area: perceiving motion of objects
10
Q
Tests for function
Occipital lobe
Also what can occur with damage to occipital lobe
A
- visual fields
- naming objects
- naming of colors
- recognition of faces
- cortically blind= can just see shadowns due to occiptial lobe lesion
11
Q
Examination of mental status
A
- begins with listening and watching the patient during history talking
- patient must be awake and alert in order to have a window to view cortex
- assessment of level of alertness is actually 1st step in cognitive assessment
12
Q
Definition of
alert/conscious
A
appearance of wakefulness, awareness of the self and environment
13
Q
Definition of
lethargy
A
- mild reduction in alertness
14
Q
Definition of
obtundation
A
- moderate reduction in alertness
- increased response time to stimuli
15
Q
Definition of
Strupor
A
- deep sleep
- patient can be aroused only by vigorous and repetitive stimulation
- returns to deep sleep when not continually stimulated
16
Q
Definition of
Coma
A
- sleep like appearance and behaviorally unresponsive to all external stimuli
- unarousable unresponsiveness, eyes closed
17
Q
What to consider with cortical function testing
A
- age
- education
- socioeconomic and cultureal background
- hearing
- vision
- depression
- pain level
- time of day, stress, fatigue and pain can affect a patients performance on the mental status exam
18
Q
Mini-mentalstate examination
A
- screening of cognitive disorders
- < 10 minutes
- 11 questions/tasks inc. orientiation to time and place, recall of words, attention, calculation, language and visual construction
- level of impairment by score: none=24-30, mild = 18-23, severe = 0-17
19
Q
Orientation and memory testing
A
- asking questions about month, date, day of week and place tests orientation, which involves not only memory but also attention and language
- three-word recall tests recent memory for which the temporal lobe is importnat
20
Q
Attention and working memory testing
A
- digit scan
- spelling backwards and naming months of the year backwards
- test attention and working memory which are frontal lobe functions
21
Q
Judgment/abstract reasoning
A
- what would you do if there was a fire in your house
- these frontal lobe functions can be tested by using problem solving, verbal similarities and proverbs
22
Q
Set generation
A
- this is a test of verbal fluency and the ability to generate a set of items
- which are frontal lobe functions
- most individuals can give 10 or more words in a minute
23
Q
Receptive Language testing
A
- asking the patients to follow commands demonstrataes that they understand the meaning of what they have heard or read
- it is important to test reception of both spoek and written language
- wernicke’s aphasia (fluent aphasia, cant rerally understand but can respond?)
24
Q
Expressive language
A
- note fluency and correctness of content and grammar
- via tasks that require spontaneous speech and writting, naming objects, repetition of sentences and reading comprehension
- pts are aware of language deficit and often frustrated
25
Q
Praxis
A
- patient is asked to perform skilled motor tasks without any nonverbal prompting
- tested skills should involved the face then the limbs
- patient must have normal comprehension and intact voluntary movement
- apraxia is typically seen in lesions of the DOMINANT inferior parietal lobe or premotor or supplementary motor area
26
Q
Gnosis
A
- ability to recognize objects
- perceived by the senses, especially somatosensory sensation
- having the patient (with their eyes closed) identify objects placed in their hand (stereognosis)
- numbers written on their hand (graphesthesia) tests parietal lobe senory perception
27
Q
Dominant parietal lobe function
A
- tests for function include right-left orientation, naming fingers, and calculations
- lesions will result in right-left confusion and difficuly with simple arithmetic
- gertsmann syndrome: may occur (right-left confusion, finger agnosia, agraphia and acalculia)
28
Q
Non-dominant parietal lobe function: test function
A
- visual spatial sensory tasks such as attending to contralateral side of body and space as well as
- constructional tasks such as drawing a face, clock or geometric figures
29
Q
Rey-osterrieth test
A
- assesses spatial perception and visual memory
- observe the drawing for 1 minute then reporduce it
- patients with left parietal lobe damage will draw an appropriate outline but oversimplify the figure
- patient with right parietal lobe damage will draw details but in a disorganized way
30
Q
Visual recognition
A
- recognition of colors and faces tests visual association cortex (inferior occiptotemporal area)
- Achromatopsia (inability to distinguish colors)
- visual agnosia: inability to name or point to a color
- prosopagnosia: inability to identify a familiar face
- result from lesions in this area
31
Q
Cognitive or perceptual impairment: implications for treatment
A
- referral to OT, SP; directly address limitations outside PT scope of practice
- interventios: must anticipate/address impairments
- prognosis/goal setting
- teaching patient vs caregiver (increased supervision may be required)
- written HEP
32
Q
Strategies for modifying treament
A
- reduce confusion: make sure the task is clear
- improve motivation: work on tasks that are relevant
- encourage consistency
- use simple, clearr and concise instructions
- improve attention; minimize irrelevant stimuli in the environment
- begin with simple tasks; increase complexity
- encourage verbal and mental practice
- seek a moderate level of arousal; moderrate the sensory stimulation in the environmen t
- provide increased supervision
- recognize that progress may be slowe when patients have cognitive impairments
33
Q
Strategies for improving communcation in the presence of cognitive-communication disorder
A
- use visual materials/aids to help orient the person to time
- break long complicated tasks into shorter task that are easier to follow
- establish eye contact to initiate and maintain conversation
- when giving verbal directions, use simple sentences and repitition as necessary
- accommodate the persence of visual fields deficits by helping the person find compensatory means for reading and writtin g
- gentle state whne the topic in a conversation changes prematurely
