Perception and cognition

Question 1

Define perception

Answer 1

The processing that transforms sensory information into meaningful representations.

Question 2

Define cognition

Answer 2

All the mental processes that allow us to recognise, learn, remember and attend to changing information in the environment.

It is the act of knowing or thinking. It includes the ability to choose, understand, remember and use informati

Question 3

What is the incidence of cognitive problems in CVA, TBI and MS

Answer 3

• 50 – 60% in people with MS
• 80% of stroke survivors experience acute cognitive impairment, which persists long term in 38–73% of cases
• Cognitive deficits associated with mild TBI resolve fully within three to six months in about 80–85% of patients
• 65% of moderate to severe TBI patients report long-term problems with cognitive functioning

Question 4

State the types of perception disorders

Answer 4

Agnosia
Neglect
Apraxia

Question 5

Define agnosia

Answer 5

Failure of recognition
• Visual agnosia - inability to recognise objects; cannot find the name for them (links with receptive dysphasia)
• Auditory agnosia - inability to recognise sounds (voices of others)
• Astereognosis - inability to recognise objects without looking at them

Question 6

Define neglect

Answer 6

Visuospatial Neglect (Hemi inattention) is the failure to report, respond to or orient to stimuli in the space contralateral to the site of the brain lesion (hemiplegic side)
• Often patient is unaware
• May be confused with visual field defect

Question 7

Define apraxia and dyspraxia

Answer 7

Disorder of movement not characterized by problems with tone /co-ordination, but by an inability to combine simple movements into a sequence to achieve a goal

2 types: ideomotor and ideational (more severe)

Question 8

Define ideomotor apraxia

Answer 8

• Disorder in the planning, timing and spatial organisation of purposeful movement.
• Cannot do movements to command but may be able to do things automatically
• Can imitate movements
• Associated with L parietal lesions but bilateral effects

Question 9

Define ideational apraxia

Answer 9

• Disorder in the performance of purposeful movement due to loss of the concept of movement
• Can perform isolated movements but will do them out of context, e.g. attempt to write with finger tip rather than pen
• May be able to describe what they want to do
• Unable to copy movement
• Associated with diffuse damage eg: anoxia

Question 10

Give brief overview of left hemisphere in terms of perception and cognition

Answer 10

Dominant hence why most people are R handed
Processing of focal information: e.g. language: reading, writing & speech
Sequencing of action
Literal analysis of emotional input
Lesions may result in: Problems with language, Apraxia

Question 11

Give brief overview of right hemisphere in terms of perception and cognition

Answer 11

Non - dominant
Processing of global information, e.g. visual & spatial info.
Recognition of objects / body parts
Spatial awareness
Analysis of emotional tone stimuli
Lesions may result in visual perception problem

Question 12

Give brief overview of occipital lobe in terms of perception and cognition

Answer 12

Receives input from ascending spinal pathways and senses
Involved with processing sensory input
Lesions may result in deficits in visuospatial perception

Question 13

Give brief overview of frontal lobe in terms of perception and cognition

Answer 13

Receives input from posterior cortex and lower brain centres
Involved with output processing for speech, movement & behaviour
Lesions may result in motor, planning or behavioural problems

Question 14

State types of cognitive disorders as a result of brain injury

Answer 14

Attention and concentration
Processing and understanding 
Language and communication
Learning and remembering new information
Planning and organization
Reasoning, problem-solving and judgment
Inappropriate, embarrassing or impulsive behaviour

Question 15

Where does damage occur for attention and concentration disorders

Answer 15

Frontal lobe and brainstem damage

Question 16

Where does damage occur for processing and understanding disorders

Answer 16

Frontal lobe damage

Question 17

Where does damage occur for language and communication disorders

Answer 17

Frontal (expressive dysphasia) and temporal lobes (receptive dysphasia)

Question 18

Where does damage occur for Learning and remembering new information disorders

Answer 18

Frontal lobe and cerebellum damage

Question 19

Where does damage occur for reasoning, problem-solving and judgement disorders

Answer 19

Frontal lobe damage

Question 20

Where does damage occur for inappropriate, embarrassing or impulsive behaviour disorders

Answer 20

Frontal lobe damage

Question 21

Potential strategies for attention and concentration deficits

Answer 21

1. Decrease the distractions. For example, work in a quiet room.
2. Focus on one task at a time.
3. Begin practicing attention skills on simple, yet practical activities (such as reading a paragraph or adding numbers) in a quiet room. Gradually make the tasks harder (read a short story or balance a checkbook) or work in a more noisy environment.
4. Take breaks when you get tired
5. Use of brain training apps - Luminosity, Peak, Elevate, BrainHQ

Question 22

Potential strategies for processing and understanding deficits, i.e. Taking longer to grasp information, answer questions or follow a command

Answer 22

1. Place your full attention on what you are trying to understand.
2. Decrease distractions.
3. Allow more time to think about the information before moving on.
4. Re-read information as needed. Take notes and summarize in your own words.
5. If needed, ask people to repeat themselves, to say something in a different way, or to speak slower. Repeat what you just heard to make sure you understood it correctly.

Question 23

Potential strategies for language and communication deficits, i.e. Difficulty thinking of the correct word and communicating what they want

Answer 23

• Use kind words and a gentle tone of voice.
• When talking with the patient, ask every so often if he or she understands what you are saying, or ask the person a question to determine if he or she understood what you said.
• Do not speak too fast or say too much at once.
• Develop a signal (like raising a finger) that will let the patient know when he or she has gotten off topic or allow you to know if they do not understand what you are saying.
• Limit conversations to one person at a time.

Question 24

Potential strategies for learning and remembering new information deficits, i.e. Struggling with memory of daily events

Answer 24

• Put together a structured routine of daily tasks and activities.
• Be organized and have a set location for keeping things.
• Learn to use memory aids such as memory notebooks, calendars, daily schedules, daily task lists, computer reminder programs and cue cards.
• Devote time and attention to review and practice new information often.
• Be well rested and try to reduce anxiety as much as possible.
• Speak with your doctor about how medications may affect your memory

Question 25

Potential strategies for planning and organising deficits, i.e Difficulty planning the day

Answer 25

• Make a list of things that need to be done and when. List them in order of what should be done first.
• Break down activities into smaller steps.
• When figuring out what steps you need to do first to complete an activity, think of the end goal and work backwards.

Question 26

Potential strategies for reasoning, problem-solving and judgement deficits

Answer 26

• A speech therapist or psychologist experienced in cognitive rehabilitation can teach an organized approach for daily problem-solving.
• Work through a step-by-step problem-solving strategy in writing: define the problem; brainstorm possible solutions; list the pros and cons of each solution; pick a solution to try; evaluate the success of the solution; and try another solution if the first one doesn’t work.

Question 27

Potential strategies for inappropriate, embarrassing or impulsive behaviour deficits, i.e. Saying hurtful insensitive things or lack of social awareness

Answer 27

• Think ahead about situations that might bring about poor judgment.
• Give realistic, supportive feedback as you observe inappropriate behaviour.
• Provide clear expectations for desirable behaviour before events.
• Plan and rehearse social interactions so they will be predictable and consistent.
• Establish verbal and non-verbal cues to signal the person to “stop and think.” For example, you could hold up your hand to signal “stop,” shake your head “no,” or say a special word you have both agreed on. Practice this ahead of time.
• If undesired behaviour occurs, stop whatever activity you are doing. For example, if you are at the mall, return home immediately

Question 28

State types of amnesia

Answer 28

• Post traumatic amnesia: Period of confusion following brain injury, no memory of events immediately preceding trauma and/or memory post injury missing or confused
• Retrograde amnesia: no memory of events preceding episode
• Anterograde amnesia: inability to incorporate new information

Question 29

OMs for cognition specifically for CVA

Answer 29

• Montreal Cognitive Assessment (MoCA)
• Mini Mental State Examination (MMSE) met all psychometric and clinical utility criteria for any levels of cognitive impairment for CVA

Question 30

Cognition OMs for any impairment

Answer 30

Addenbrooke’s Cognitive Examination Revised (ACE-R), Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and Cognistat.

Question 31

What is sensory information

Answer 31

1. Visual
2. Auditory
3. Touch
4. Taste
5. Smell

Question 32

Visual spatial neglect is most common in what area of the brain?

Answer 32

Most common in R parietal lesions ie. sensory deficits

Very common post-stroke