Lecture 8- Tests and Measures Flashcards
What is cognition?
- The process that enables us to think
- Includes the ability to pay attention, remember, and learn
What are the 5 main subcategories of our cognitive function?
- Consciousness
- Orientation
- Attention/Concentration
- Memory
- Executive Function
Why is cognition the first thing we test for?
Cognition affects all the rest of our exams we perform.
What are the 5 levels of consciousness and how they present?
- Full consciousness
- Lethargy- general slowing of cognitive and motor function
- Obtundation- dulled or blunted sensitivity, difficult to arouse
- Stupor- state of semi-consciousness, only arouses with intense stimulation
- Coma- unconsciousness
Does physical therapy play a role in every stage of consciousness?
Yes
When we have a disorder of consciousness, what goes wrong?
Interuption of the ascending reticular activating systems which functions to arouse and awake the brain and control sleep/wake cycles
What part of the brain is important in maintaining consciousness?
reticular formation
What is the scale used to measure level of consciousness?
Glasgow Coma Scale (GCS)
What are the 3 areas of consciousness Glasgow Coma Scale measures?
- eye opening
- motor response
- verbal response
What is the grading scale of the Glasgow Coma Scale?
- <8 = severe
- 9-12 = moderate
- 13-15 = mild
When testing for orientation, what are the 4 main questions that are asked?
- Person (name, age, birthplace)
- Place (where are you, what is the name of this place)
- Time (what day, month, year, season)
- Situation (what happened, why are you here)
Can you give the patient credit if you give them ques for the 4 subcategories of orientation?
No, but note it
What is attention and concentration?
The capacity of our brain to process info from the environment and appropriately direct thoughts and actions towards a stimuli or circumstance.
What are the 4 types of attention?
- Sustained
- Selective
- Divided
- Alternating
What is sustained attention?
What is the test used to assess this?
- focused attention over a duration of time
- Cancellation Test (page with a bunch of objects and ask patient to circle all birds)
What is selective attention?
What is the test used to assess this?
- ability to process relevant sensory info about the task while screening out irrelevant info
- Stroop Test (say the color of the word and not the word itself)
What is divided attention?
What is the test used to assess this?
- ability to perform 2 tasks simultaneously
- Walkie-Talkie Test (can you walk and talk without either degenerating)
What is alternating attention?
-attention flexibility (shift back and forth between tasks)
What is memory?
the capacity to store knowledge, experiences, and perceptions for recall and recognition
What are the 2 categories of memory?
- declarative (explicit)
- non-declarative (procedural, implicit)
What is declarative memory?
conscious recollection of facts and events
What is non-declarative memory?
recall of movements/ movement schema without conscious recollections
What are the 3 types of memory in regards to time and their time frame?
- Immediate Recall (seconds to minutes)
- Short-Term Memory (minutes to hours/days)
- Long-Term Memory (months to years)
Immediate, Short, and Long term memory can be both ________ or ____________________.
declarative, non-declarative
What is executive function?
capacity to engage successfully in independent, purposeful, self-directed behavior
What are the 5 sub-categories of executive function?
- Volition/Planning
- Problem solving/reasoning
- Insight/Awareness
- Social Pragmatics
- Self-Regulation/Purposeful Action
What is volition/planning?
goal planning and task initiation
What is problem solving/reasoning?
abstract thinking, flexibility
What is insight/awareness?
poor judgement, appropriate behaviors
What is social pragmatics?
inappropriate behavior
What is self-regulation/purposeful action?
initiate, maintain, switch, and stop tasks
SENSATION AN PERCEPTION
SENSATION AND PERCEPTION
What is the difference between sensation and perception?
- sensation- raw data (tactile, auditory, visual)
- perception- interpretation of data
For sensation, we need adequate _______ and selective __________. We need an adequate stimulus level to activate sensory receptors.
-arousal, attention
Perception is the capacity to transform ________ information and use it to interact appropriately to the environment.
sensory (touch, hearing, vision, smell, taste)
Perception is a selective, integrative, dynamic process involving both ________ and ________.
- problem solving
- memory
What are the 9 somatosensation exam components of a neuro exam?
- Light touch
- Tactile location (discriminatory touch)
- Pain
- Bilateral touch (sensory extinction)
- Proprioception
- Kinesthesia
- Stereognosis
- Two-point discrimination
- Vibration
What are the 4 main components of a perceptual exam?
- Body scheme and Body Image Impairments
- Spatial Relationships
- Agnosias
- Apraxia
Perceptual deficits in general tend to be associated with ________ injuries and tend to be more common with injury to our ______ side.
- parietal
- right
What is body image?
visual and mental image of ones body
What is body scheme?
- postural model of the body (body awareness)
- includes relationship of body parts to each other and their relationship of the body to the environment (body awareness)
One of the most common impairments related to our body scheme/image is ________.
unilateral neglect
What is unilateral neglect?
failure to orient toward, respond to, or report stimuli on the side contralateral to the lesion despite normal sensory, motor, and visual symptoms
Unilateral neglect mostly occurs with ___________, ___________ lesions
R temporoparietal junction, posterior parietal
Why do we usually see unilateral neglect on the R side of the brain?
- The right side of our brain provides perception to both visual sides while the left only provides visual perception to the right side.
- From this, we can deduce that if we lose the left visual perception, the right can still perceive the right side.
- If we lose the right, however, there is nothing to make up for the left side that is lost.
What are the 2 classifications used for unilateral neglect?
- Modality
- Distribution
For modality, what are the 3 types of neglect we can see?
- sensory
- motor
- representational
What are the 3 senses that are effected with sensory neglect?
- auditory
- visual
- tactile
What is an example of sensory neglect?
- patient only draws half a house
- patient cant hear family member on left side, even though hearing is fine
What is an example of motor neglect?
ball thrown at someone and they only lift one arm to catch it even if they have full strength in both arms
What is an example of representational neglect?
patient internally knows what a clock looks like, but draws all 12 numbers on one side of the clock
What is the difference between personal neglect and spatial neglect?
Personal Neglect
-lack of exploration or awareness of contralateral side of BODY
Spatial Neglect
-failure to acknowledge stimuli of the contralateral side of space
-can be divided into peripersonal and extrapersonal spatial neglect
What is the difference between peripersonal and extrapersonal spatial neglect?
- Peripersonal- spatial neglect within reaching space
- Extrapersonal- spatial neglect in far space
What is somatoagnosia and where is it more common?
- impairment of body scheme, lack of awareness of relationship of body parts
- lesion usually in dominant parietal lobe
What is right-left discrimination and where is it common?
- decreased R/L differentiation with body parts and with following directions
- lesion in either parietal lobe
What is vertical disorientation/midline disorientation?
Patient cannot identify when body is in the middle
What syndrome is associated with vertical disorientation/midline disorientation?
Pusher Syndrome
Pusher syndrome is a lesion in the ____ hemisphere centered in area of posterolateral ________.
- right
- thalamus
Pusher syndrome is characterized by leaning and ___________ toward hemiplegic side _________ compensation for instability and with resistance to ________ correction towards midline
- active pushing
- without
- passive
What is Figure Ground?
inability to distinguish a figure from the background in which it is embedded
What is Spatial Relations Disorder?
Where is the lesion in this disorder?
- inability to perceive relationship of one object in space to another object or to one’s self (distance between)
- lesion in right inferior parietal lobe
What is position in space disorder?
- decreased ability to perceive and interpret spatial concepts
- more specific to directional concepts (up, down, left, right)
What is topographical disorientation?
difficulty perceiving relationships from one location to another in the environment
What is depth and distance perception?
- inaccurate judgement of direction, distance, and depth
- different than spatial relations disorder by looking at more broad environmental cues (such as difficulty negotiating a curb and picking leg up high enough to clear stairs)
What is agnosia?
- decreased ability to recognize stimuli despite intact sensory function
- most commonly associated with damage to temporal lobe
What are the 3 types of agnosias?
- visual
- auditory
- tactile
What is an example of visual agnosia?
-inability to recognize familiar objects despite normal eye function
What is an example of auditory agnosia?
inability to distuingish between doorbell or phone ringing
What is an example of tactile agnosia?
inability to recognize objects when handling them
What is anosognosia?
- severe condition
- denial or lack of awareness of presence or severity of one’s deficits
- may deny ownership of limbs
- significantly limits rehab potential
-can spontaneously resolve in first 2-3 months
What is apraxia?
Where is the lesion?
- impairment of voluntary, skilled, well-learned movement
- left frontal or parietal lobes
What are the two types of apraxia?
- ideomotor
- ideational
What is ideomotor apraxia?
- breakdown between concept (idea) and performance (motor execution)
- lose the ability to carry out tasks on command (can do it on own though)
- more common with multiple step commands
What is ideational apraxia?
- failure in the conceptualization of the task
- cant do task on command or own their own
- have no idea what to do with objects