CVA Impairments pt. 2: altered consciousness, cognition, perception Flashcards
why is the level of consciousness of the pt important
- participation of the pt
how do we measure level of consciousness
- Glasgow coma scale
- eye opening, motor response, verbal response
glasgow coma scale is a good predictor of what
- overall prognosis
- mortality rate
cognitive impairments with orientation
- intellectual dysfunction but can reflect difficulties with attention, memory
- increase cues, redirect encouragement
- multiple cortical regions involved
cognitive impairments with attention
- prefrontal cortex, reticular formation
- most common deficit
- difficulty processing and assimilating new info and techniques, motor learning and dual task
- balance impairment, falls
cognitive impairments with memory
- ST: prefrontal cortex, limbic
- LT: hippocampus, temporal lobe
- difficulty with carry over of newly learned or retained tasks
- long term memory typically remains intact
cognitive impairments with executive fxn
- prefrontal cortex
- inappropriate interactions, poor self-monitoring and self-correcting
- impulsive, inflexible thinking, decreased insight, impaired organization, sequencing and planning abilities, impaired judgement
lesions where it can produce emotional changes
- frontal lobe
- hypothalamus
- limbic system
apathy
shallow affect, blunted emotional response - flat emotions
euphoria
exaggerated feelings of well-being - easily frustrated
pseudobulbar affect
- state of emotional lability due to neurological insult
- inferior frontal and inferior parietal lobe damage (R or L)
- emotional outbursts of uncontrolled or exaggerated laughing or crying
- inconsistent with actual mood
depression
- left frontal and right parietal lesions
- secondary of impact of injury
behavioral considerations from a right hemisphere lesion
- difficulty perceiving emotions
- difficulty with expression of negative emotions
- irritability, confusion
- impulsive, quick with movement*
- poor judgement
- rigidity of thought
- absent of poor insight, awareness of impairments, may completely deny disability
- high safety risk –> impulsive –> fall risk`
behavioral considerations from a left hemisphere lesion
- difficulty with expression of positive emotions
- slow, anxious, cautious
- disorganized and distracted when attempting to complete a task
- compulsive behavior
- typically very aware of impairments and extent of disability; more realistic
- extra coaxing to participate
- high safety risk –> fear of falling –> fall risk
perception
integration of sensory impression into info that is psychologically meaningful
perceptual considerations for right hemisphere lesion
- body scheme impairments: unilateral neglect, pushers syndrome, anosognosia, somatagnosia, R-L discrimination
- spatial relationships: hand-eye coordination, figure ground discrimination, position in space, depth and distance, topographical disorientation
- agnosia
perceptual considerations for left hemisphere lesion
- apraxia: ideational or ideomotor
vertical disorientation/midline disorientation
what is “up” is impaired
lateropulsion
midline is off laterally
retropulsion
midline is off posteriorly
pushers syndrome
- lean in direction of involved side - or away from lesion
- lesion: R hemisphere centered in area of posterolateral thalamus
features of pusher’s syndrome
- contralateral tilts posture with severe imbalance, but head is able to orient to vertical with cues
- push strongly towards paretic side
- resistance to external corrections
pusher’s syndrome and right CVA
- 50-65% of cases
- commonly seen with left hemiplegia
- high association with left spatial and sensory neglect
pusher’s syndrome and left CVA
- commonly seen with right hemiplegia
- aphasia
pusher’s syndrome does what to recovery
significantly hinder and or delay it
