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Neuro muscular > Perceptual Dysfunction > Flashcards

Perceptual Dysfunction Flashcards

1
Q

what is perception?

A

-The integration of information that is psychologically meaningful

The ability to select stimuli that require attention and action

Integration with prior information
Facilitates interpretation

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2
Q

Why is discussing perception important?

A

Perceptual and cognitive deficits can lead to poor rehabilitation progress for patients, even despite motor skill return

Perception is important for learning

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3
Q

A Perceptual Screen is observed for

A

Often co-occurs with other system screens

Observe for:
-Inattention to therapist during subjective interview
-Inattention to half of body
-Decreased response to verbal cues

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4
Q

what is an Examination of Perceptual Deficits

A

Formal testing is indicated when there is a functional loss unexplained by motor or sensory impairments or deficits in comprehension

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5
Q

what is the purpose of the Perceptual Deficits

A

Determine which perceptual abilities are intact vs. which are impaired
Appropriately guide intervention

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6
Q

What are factors that influence perceptual deficits

A

-Psychological and emotional status
-A patient’s ability to detect relevant cues from the environment

-The presence of anxiety
-Receptive and expressive communication skills
-Depression
-Fatigue

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7
Q

How do I sequence this part of the exam? Perception, Sensation, or vision

A

(1)Perform sensory examination FIRST
-Visual screening

(2)Perform a cognitive screen
(3)Screen hearing
(4)Consult with family about usual vs. unusual behaviors

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8
Q

what is Perception?

A

-Cannot be viewed as independent of sensation
-More complex

-deficits do not lie with sensory ability itself, but rather the interpretation of sensation and the follow-up response

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9
Q

what is sensation

A

Awareness of stimuli through the organs of special sense, the peripheral cutaneous sensory system, or internal receptors

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10
Q

Perceptual Deficit/Visual Neglect consist of what

A

Inattention or neglect of visual stimuli presented on the involved side

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11
Q

what is visual field impairment?

A

Example: hemianopsia

The patient is aware of the deficit

The patient may compensate
spontaneously

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12
Q

what is One of the most common forms of sensory loss in those with hemiplegia

A

visual impairment

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13
Q

what are common visual impairments?

A

poor eyesight, diploplia, homonymous hemianopsia, and damage to the visual cortex or retina

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14
Q

what is a visual screening should include?

A

-Visual acuity
-Oculomotor control (smooth pursuits, “H-test”)
-Visual field testing

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15
Q

With Perceptual Deficits , what disorders you may see?

A

I: Body scheme: the relationship of the body parts to each other and the relationship of the body to the environment

I: Body image/body awareness: visual and mental image of one’s body that includes feelings about one’s body

II: Spatial relations: impairments that have in common a difficulty in perceiving the relationship between self and two or more objects in the environment

III: Agnosias: inability to recognize incoming information despite intact sensory capacities

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16
Q

what are the 5 body scheme and body impairments

A

Unilateral neglect
Anosognosia
Somatagnosia
Right-left discrimination
Finger agnosia

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17
Q

what is Unilateral Neglect/Unilateral Spatial Neglect

A

Lack of awareness of part of the body or the external environment which is not due to sensory loss

Observe for limited use of the more involved extremity

Limited reaction to sensory stimuli (visual, auditory, or somatosensory)

Be observant of spontaneous movements or specific responses to inquiries of movement on the involved side

Impairments may be an inability to attend to an object or the environment as a whole

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18
Q

what are examples of Neglected space

A

Neglect of personal space (pertains to the body)
Ex: failing to wash the left side of the body

Neglect of peripersonal space (area within arm distance from the body)
Ex: failing to use objects on the contralesional side of their plate

Neglect of extrapersonal space (the area of space beyond arm length)
Ex: failing to negotiate obstacles, doorways, etc.

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19
Q

What does neglect look like clinically?

A

Ignoring dressing the left half of the body
Ex: the patient may not put on the left sleeve or pant leg

Forgetting to shave the left half of the face

Neglecting to put on makeup on the left half of the face

Neglecting to eat from the left half of the plate

Bumping into objects on the left side

Propelling a wheelchair and veering to the right

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20
Q

Neglect summarized

A

Despite no sensory loss, individuals lack an ability to register and integrate stimuli from one side of the body and the environment or hemispace

Lesion area: inferior-posterior regions of the right parietal lobe

Testing: Behavioural Inattention Test (BIT) and observations of ADLs

Treatment strategies: remedial approach vs. compensatory approach

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21
Q

what are Interventions to Address Hemianopsia & Unilateral Neglect

A

-Strategies that encourage awareness and use of the environment on the hemiparetic side and use of the hemiparetic extremities

-Active visual scanning through turning the head and axial trunk rotation

-Visual, verbal or motor cues to direct the patient’s attention

-Encouraging active voluntary movements of the neglected limbs while encouraging the patient to look at his or her limbs

-Functional activities that encourage bilateral interaction

-Optimizing visual, tactile and proprioceptive stimuli on the more dominant side

22
Q

What is anosognosia and

A

Defined as a lack of awareness, or denial, of a paretic extremity as belonging to the person

OR a lack of insight concerning, or denial of, paralysis or disability

This limits the patient’s ability to recognize the need for compensatory techniques

Clinical Examples:
-Maintains that ”nothing is wrong” or disowns their more involved limbs

-May refuse to accept responsibility for their more involved limbs

-May utilize words such as “my arm has a mind of its own”

23
Q

summary of Anosognosia

A

Lack of awareness or denial of a paretic extremity

Lesion area: unclear, proposal of the supramarginal gyrus

Testing: subjective interviewing and asking questions such as: “what happened to your arm/leg”

Treatment strategies: prioritize safety

24
Q

what is Somatagnosia

A

Impairment of body scheme

Lack of awareness of the body structure and the relationship of body parts to oneself or others

Also known as body agnosia

Patients often have difficulty following instructions

Extremities are often reported as ”heavy”

A lack of proprioception may compound this disorder

Clinical Examples:

Difficulty with transfers, dressing and with exercises requiring body parts moving in relation to others

25
Q

Somatagnosia Summarized

A

Lack of awareness of the body structure and the relationship of body parts to oneself or to others

Lesion area: dominant parietal lobe; often seen with right hemiplegia

Testing: the patient is asked to point to body parts named by the therapist on themselves, the therapist, and on a picture or puzzle of a human figure; the patient is asked to imitate movements

Treatment strategies: remedial approach to facilitate body awareness

Ex: rubbing a body part or verbal identification of a body part

26
Q

what is Right-Left Discrimination

A

-An inability to identify the right and left sides of one’s own body or that of the examiner

-A patient will have a difficult time verbally responding to commands that include the terms right and left

-A patient will have a difficult time imitating movements

Clinical Examples:
-The patient is unable to tell his or her left arm from right
-Incorrect shoe placement
-Difficulty with gait cues such as “turn right around the corner”

27
Q

Right-Left Discrimination Summarized

A

Difficulty with identifying left vs. right

Lesion area: parietal lobe of either hemisphere

Testing: the patient is asked to point to body parts on command

6 responses should be elicited
To rule out: test first without the terms “left” and “right”
Treatment strategies: compensatory approach
Avoid left and right
Pointing or providing other distinguishing cues

28
Q

Finger Agnosia Summarized

A

An inability to identify the fingers of one’s hand or that of the examiner’s

Lesion area: the parietal lobe at the region of the angular gyrus of the left hemisphere

Testing: a portion of Sauguet’s test that includes items such as the therapist’s touching the patient’s hand, vice versa, recognition on a picture, and with imitation

Treatment strategies: limited evidence, but a remedial approach can be attempted

29
Q

what are Spatial Relations Syndrome Impairments

A

Figure-ground discrimination

Form discrimination

Spatial relations

Position in space

Topographical disorientation

Depth and distance perception

30
Q

what is Figure-Ground Discrimination

A

An inability to distinguish a figure from the background in which it is embedded

Functional relevance: difficulty ignoring irrelevant visual stimuli, increased distractibility, shortened attention span, frustration, and reduced safety

Clinical Examples:
The patient cannot locate items within a drawer, locate buttons on a shirt, or have difficulty with stair negotiation (specifically descending)

31
Q

Figure-Ground Discrimination is

A

Lesion area: parieto-occipital lesions of the right hemisphere

Testing: The Ayres Figure-Ground Test

Functional Based Test:
-Place a towel on a white sheet
-Locate the sleeve, buttons, and collar of a white shirt

Treatment strategies: remedial and compensatory

32
Q

what is Spatial Relations Disorder/Spatial Disorientation

A

Inability to perceive the relation of one object in space to another object, or to oneself

-Spatial relation skills are required to manage most ADLs
Difficulties could result in impaired dressing, crossing midline, etc.

Clinical Examples:
-Difficulty with setting the table
-Difficulty reading a clock
-Difficulty with preparing for a transfer

33
Q

Spatial Relations is also

A

*Lesion Area: inferior parietal lobe or parieto-occipital junction on the right

*Testing: Rivermead Perceptual Assessment Battery (RPAB) and the Arnadottir OT- ADL Neurobehavioural Evaluation (A-ONE)

Treatment strategies:

Remedial Approach: providing instructions to the patient to position himself or herself in relation to the therapist or another object; setup a maze; incorporation of midline crossing activities

34
Q

what is position in space

A

An inability to perceive and to interpret spatial concepts such as up, down, over, under, etc.

Clinical examples:
When asked “place your feet “on” the footrests” a patient may not know what to do

Lesion area: nondominant parietal lobe

Testing:
Utilize a shoe and shoebox and ask the patient to place the shoe in different positions in relation to the shoebox OR you can present a relationship and ask the patient to describe

Have the patient copy the therapist’s manipulations with an identical set of objects to the patient

35
Q

position in space is also

A

-Figure-ground difficulty, apraxia and incoordination, and a lack of comprehension should be ruled out

Treatment strategies:
-Retraining approach: 3 or 4 identical objects are placed in the same orientation with an additional object placed in a different orientation

–The patient is asked to identify the odd one and place it in the same orientation

36
Q

what is Topographical Disorientation

A

Difficulty in understanding and remembering the relationship of one location to another
Clinical Examples:
Difficulty with describing home layout
Difficulty getting to and from the therapy gym despite exposure
Lesion area: right retrosplenial cortex, bilateral parietal lesions, L parietal lesions
Testing: the patient is asked to draw or describe a familiar route
Rule out memory problems

37
Q

how do you treat Topographical Disorientation

A

Remedial Approach: practice going from one place to another

-Simple to more complex
-Verbal instructions should be used

Compensatory Approach:
-Frequent routes can be marked with colored dots (progression can occur with greater distance placed between dots)
-Safety considerations such as not leaving home independently

38
Q

what is Depth and Distance Perception

A

A patient with this disorder will experience inaccurate judgement of direction, distance, and depth

Clinical Examples:
-A patient may miss a chair when returning to sit
-A patient may continue pouring water despite a full glass

Lesion areas: posterior right hemisphere in the superior visual association cortices

Testing:
-Object grasp on a table or in the air
-Fill a glass of water

39
Q

what are treatment strategies for Depth and Distance Perception

A

Assist the patient in becoming aware of the deficit

Provide education on uneven terrain and stair negotiation

Remedial Approach:
-Place feet on designated spot during gait training
-Touch foot to a pile to re-establish sense of depth and distance

Compensatory Approach:
-Utilize UE support to sit squarely within a chair

40
Q

what is Vertical Disorientation

A

-Distorted perception of what is vertical

-Clinical Example: a person has a distorted view of the world

-Lesion area: nondominant parietal lobe

-Testing:
*The therapist holds a cane and then turns it sideways to a horizontal position and the patient is asked to return the cane back to the original position

Treatment strategies:
-Enhance awareness and cue tactile input to assist

41
Q

What is pushers syndrome

A

-Also known as ipsilateral pushing or contraversive pushing

-Defined as “motor behavior characterized by active pushing with the stronger extremities toward the hemiparetic side with a lateral postural imbalance”

-Results in a loss of balance towards the hemiparetic side

-Area affected: posterolateral thalamus

-Results in altered perception of the body’s orientation in relation to gravity

There is a misperception of subjective postural vertical

42
Q

what are functional implications of pushers syndrome

A

-Sitting within a wheelchair often results in a thrust push over the wheelchair arm

-Transfers are often less successful to the less involved side

-Standing often results in instability on the hemiparetic limb resulting in increased fall risk

-During walking, common impairments include difficulty with weight transfer towards the less involved LE, potential scissoring of the more involved LE, and difficulty with unilateral AD training

43
Q

examination criteria for pushers syndrome

A

-Spontaneous body posture with tilting toward the more paretic side

-An increase in pushing force by the less involved extremities as evidenced by increased abduction and extension

-Resistance to passive correction of the posture

44
Q

what are some things you should know about pushers syndrome

A

Individuals with pusher’s syndrome will actively and strongly resist any attempt at passive correction to midline

The brain can compensate with therapeutic training

Therapeutic management goals include:
-Re-orienting patients to true vertical

-Managing the environment to optimize these visual cues

45
Q

what is Agnosia impariments?

A

Agnosia: the inability to recognize or make sense of incoming information despite intact sensory capacities

Visual object agnosia
Auditory agnosia
Tactile agnosia

46
Q

what is visual object agnosia

A

-An inability to recognize familiar objects despite normal function of the eyes and optic tracts

Clinical Examples:
-Difficulty recognizing people, possessions, and common objects

-Examples include: simultanagnosia, prosopagnosia, color agnosia

-Lesion area: occipito-temporo-parietal association areas of either hemisphere

-Testing: place several common objects in front of a patient with instruction to name, point or demonstrate use of each object

-Aphasia and apraxia can make this deficit difficult to recognize

47
Q

what are strategies and treatment for visual object agnosia

A

Remedial Approach:
-Practice drills to discriminate between faces of importance to the patient, discriminate between colors and common objects

Compensatory Approach:
-Encourage use of intact sensory modalities to distinguish people and objects

48
Q

what is auditory agnosia

A

-An inability to recognize non-speech sounds or to discriminate between them

Clinical Examples:
-Inability to distinguish the ring of a doorbell and that of a telephone

-Inability to distinguish between the bark of a dog and thunder

-Lesion area: dominant temporal lobe
-Testing: often performed by a SLP
- Treatment strategies:

-Drill the patient on sounds, but reduced effectiveness overall

49
Q

what is tactile agnosia

A

-The inability to recognize forms by handling them although tactile, proprioceptive, and thermal sensations may be intact

Clinical Examples:
-Inability to recognize a familiar object when it is handed to the patient

-Lesion area: parieto-temporooccipital lobe (posterior association areas) of either hemisphere

-Testing: object identification in the hand without visual cues

Treatment strategies:
-Remedial Approach: instruct feeling objects placed within the hand followed by immediate visual feedback

-Compensatory Approach: visual compensation

50
Q

How do we mitigate these impairments?

A

-Use verbal cues to enhance success

-Minimize clutter and activity within the treatment environment

-Practice in a closed environment with limited distractions
-Provide adequate lighting

-Provide clear boundaries and reference points

51
Q

Collaboration is Key

A

Communicate and collaborate with an Occupational Therapist to enhance assessment and intervention strategies utilized.

Occupational Therapists are specially trained to treat perceptual deficits.

Neuro muscular (12 decks)

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