Left Hemiplegia

Question 1

What is perception and what does it allow?

Answer 1

perception is how we attach meaning to sensation and allows us to recognize objects

Question 2

What is the difference between serial processing and parallel processing?

Answer 2

Serial processing comes from info from a single sensation from a single type of receptor (e.g proprioception)

Parallel processing is different types of sensory info being processed at the same time and results in perception

Question 3

What does motor processing begin with?

Answer 3

an internal representation of the desired movement (sensory processing)

Question 4

What gives rise to perceptions and helps focus attention in extra-personal pace?

Answer 4

Posterior parietal lobe, which integrates somatic sensory input with other sensory modalities

Question 5

What is agnosia?

What happens if people have this deficit?

Answer 5

Loss of ability to identify things through touch or vision

lose the ability to interpret or have meaning of things

Question 6

What is Figure Ground?

What happens if people have a deficit in this?

Answer 6

Property of perception in which there is a tendency to see parts of a visual field as solid, well-defined objects standing out against a less distinct background

have difficulty visually differentiating objects from the surroundings

Question 7

What is Apraxia?

What happens if people have this deficit?

Answer 7

a disorder of the nervous system, characterized by an inability to perform purposeful movements, but not accompanied by a loss of sensory function or paralysis

difficulty coordinating highly skilled tasks with multiple steps. They may have difficulty recognizing the purpose of tools or gestures

Question 8

What is neglect?

Answer 8

somatic sensations are intact but lose conscious awareness of the spatial aspects of all sensory input from the left side of the body and left external space

Question 9

What is denial?

Answer 9

severe neglect where the patient deny a leg or an arm belongs to them, they also are unaware of anything being wrong with them

Question 10

Deficit in what brain area will cause conditions such as aparaxia and agnosia?

Answer 10

Left posterior parietal lobe

Question 11

What is stereognosis?

Answer 11

ability to utilize somatosensory info (proprioception and touch) to identify objects

Question 12

What is astereognosis?

How common is astereognosis?

Answer 12

an inability to recognize the form of objects through somatosensation

34-64% of people post-stroke have proprioception loss and 31-89% stereognosis loss

Question 13

What interventions can help with astereognosis?

Answer 13

• Practice differentiating different objects through tactile cues
• Practice shaping hand for different objects

Question 14

A lesion to what area would cause loss of figure ground organization?

Answer 14

Left posterior parietal cortex

Question 15

What interventions can help for figure ground issues? Is this usually an area treated by PTs?

Answer 15

Instruct the person to identify important aspects from visual environment

Generally more of an OT area of practice

Question 16

What are the 3 types of apraxia?

Answer 16

• deficits in sequencing action steps (i. e make a sandwich)- accessing the motor plan is a problem
• conceptual errors-knowledge of tool purpose and gestures-not understanding tool or gesture use
• Spatial-temporal organization errors during movement- may have wrong movements in motor plan, or problems with orientation, speed or grip

Question 17

How common is apraxia?

Answer 17

25-46% of people with left hemisphere stroke have apraxia

Question 18

What should be recorded and evaluated when doing a task analysis for a pt you suspect has apraxia?

Answer 18

• ability to sequence (making coffee or wrapping a gift)
• use of ab object (using matches or a stapler)
• interpret and perform gestures (waving or thumbs up)

Question 19

What intervention are appropriate for apraxia patients?

Answer 19

• errorless guidance of movement with many reps is specific to the task with limited generalization to other tasks
• teaching similar movements under different contextual situations can address problems of generalization
• strategy training may be most effective for overall treatment
• use of verbal cues improves apraxia when cures are faded, must use meaningful activities

Question 20

Damage to what area of the brain can cause neglect?

Answer 20

Right posterior parietal cortex

Question 21

What deficits can arise from damage to the right posterior parietal lobe?

Answer 21

Neglect Syndrome (memory, sensory, or spatial neglect)

Disturbance in Direct Attention (post. parietal cortex and frontal cortex-shifting attention from one sensory input to another)

Question 22

What is an extinction test? What are typical and atypical responses?

Answer 22

Exam that tests attention by using light touch unilaterally and then bilaterally

Typical Response- person identifies both single touch and bilateral touch

Atypical Response-identifies deficits in attention=the person recognizes single touches on either side, but when both sides are touched-one side is ignored

Question 23

What intervention can help address or reduce neglect?

Answer 23

Sustain attention-use auditory cues (like a knock) and saying “attend” when the person is not attending to that side. slowly transition to have the individual perform self-cueing

Provide Proprioception Input-sitting r standing with body rotation to the left in sitting (head straight)-there is a stretch in the left SCM; the stretch provides a proprioceptive cue to attend to the left side

Prisms-prisms glasses move the left visual field to the right by 10 deg, then direct the individual to point to objects

Patching-patch right eye for 3 months to reduce left neglect

Mirror Therapy-initially place the mirror on the right side of the individual, such that they can visualize the left side, then instruct the individual to reach for objects in the left hemi-field, slowly move the mirror to the left

Sensory Stimulation- Sensory input to left side during tasks, either electrical stim or proprioception

Question 24

A lesion to the posterior lateral thalamus can cause what syndrome?

Answer 24

Pusher Syndrome

Question 25

What is involved with Pusher Syndrome?

Answer 25

Visual and vestibular systems ONLY

Question 26

What is mismatch? What causes mismatch?

Answer 26

Visual vertical or perception of tilted body orientation relative to vertical based on visual and vestibular inputs

caused by error in information processing of info from the body and is NOT from the vestibular gravireceptors

Question 27

Which direction will patient lean to with Pusher Syndrome?

Answer 27

toward the affected side

Question 28

How do you classify a patient with pusher syndrome?

Answer 28

severe tilt with fall
severe tilt without fall
mild tilt without fall

Question 29

True or False: An individual can only be classified as pusher syndrome if they use the uninvolved limbs to the side to “push” toward the paretic side

Answer 29

True

Question 30

What interventions help address pusher syndrome?

Answer 30

Teach patient to recognize that they are not upright

Use visual cues of the environment to recognize upright

Learn the movements that are associated with the upright position

Maintain upright while doing other tasks

Question 31

True or False: Prognosis for post-stroke patients with Pusher’s Syndrome is poor due to the high risk fall

Answer 31

False, outcomes are about the same as those without pusher’s syndrome but it will take roughly 3 and a half weeks longer for rehabilitation stays