Cortical Function Testing

Question 1

Frontal lobes

Answer 1

• 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

Question 2

Temporal lobes

Answer 2

• 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

Question 3

receptive language

Answer 3

• wernicke’s area
• poterosuperior temporal gyrus of dominant temporal lobe

Question 4

what is involved with

Expressive langauge

Answer 4

• broca’s area
• posterior inferior frontal gyrus of dominant hemisphere

Question 5

Language centers

Answer 5

• 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

Question 6

Parietal lobes

Answer 6

• 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

Question 7

What could be found when preforming Clinical tests for

parietal lobe function

Answer 7

• 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

Question 8

Gerstmann’s syndrome

Answer 8

• acalculia: cannot do math
• finger agnosia
• R/L confusion
• agraphia
• occurs with damage to dominant inferior parietal lobe

Question 9

Occipital lobe

Answer 9

• 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

Question 10

Tests for function

Occipital lobe

Also what can occur with damage to occipital lobe

Answer 10

• visual fields
• naming objects
• naming of colors
• recognition of faces
• cortically blind= can just see shadowns due to occiptial lobe lesion

Question 11

Examination of mental status

Answer 11

• 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

Question 12

Definition of

alert/conscious

Answer 12

appearance of wakefulness, awareness of the self and environment

Question 13

Definition of

lethargy

Answer 13

• mild reduction in alertness

Question 14

Definition of

obtundation

Answer 14

• moderate reduction in alertness
• increased response time to stimuli

Question 15

Definition of

Strupor

Answer 15

• deep sleep
• patient can be aroused only by vigorous and repetitive stimulation
• returns to deep sleep when not continually stimulated

Question 16

Definition of

Coma

Answer 16

• sleep like appearance and behaviorally unresponsive to all external stimuli
• unarousable unresponsiveness, eyes closed

Question 17

What to consider with cortical function testing

Answer 17

• 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

Question 18

Mini-mentalstate examination

Answer 18

• 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

Question 19

Orientation and memory testing

Answer 19

• 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

Question 20

Attention and working memory testing

Answer 20

• digit scan
• spelling backwards and naming months of the year backwards
• test attention and working memory which are frontal lobe functions

Question 21

Judgment/abstract reasoning

Answer 21

• 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

Question 22

Set generation

Answer 22

• 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

Question 23

Receptive Language testing

Answer 23

• 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?)

Question 24

Expressive language

Answer 24

• 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

Question 25

Praxis

Answer 25

• 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

Question 26

Gnosis

Answer 26

• 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

Question 27

Dominant parietal lobe function

Answer 27

• 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)

Question 28

Non-dominant parietal lobe function: test function

Answer 28

• 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

Question 29

Rey-osterrieth test

Answer 29

• 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

Question 30

Visual recognition

Answer 30

• 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

Question 31

Cognitive or perceptual impairment: implications for treatment

Answer 31

• 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

Question 32

Strategies for modifying treament

Answer 32

1. reduce confusion: make sure the task is clear
2. improve motivation: work on tasks that are relevant
3. encourage consistency
4. use simple, clearr and concise instructions
5. improve attention; minimize irrelevant stimuli in the environment
6. begin with simple tasks; increase complexity
7. encourage verbal and mental practice
8. seek a moderate level of arousal; moderrate the sensory stimulation in the environmen t
9. provide increased supervision
10. recognize that progress may be slowe when patients have cognitive impairments

Question 33

Strategies for improving communcation in the presence of cognitive-communication disorder

Answer 33

• 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