Perceptual Dysfunction Flashcards

Question

Somatagnosia Summarized

Answer 1

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

Answer 2

-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”

Answer 3

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

Answer 4

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

Answer 5

Figure-ground discrimination Form discrimination Spatial relations Position in space Topographical disorientation Depth and distance perception

Answer 6

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)

Answer 7

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

Answer 8

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

Answer 9

*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

Answer 10

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

Answer 11

-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

Answer 12

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

Answer 13

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

Answer 14

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

Answer 15

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

Answer 16

-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

Answer 17

-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

Answer 18

-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

Answer 19

-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

Answer 20

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

Answer 21

Agnosia: the inability to recognize or make sense of incoming information despite intact sensory capacities Visual object agnosia Auditory agnosia Tactile agnosia

Answer 22

-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

Answer 23

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

Answer 24

-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

Answer 25

-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

Answer 26

-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

Answer 27

Communicate and collaborate with an Occupational Therapist to enhance assessment and intervention strategies utilized. Occupational Therapists are specially trained to treat perceptual deficits.