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Neuromuscular Exam and Rehab Exam 2 > Perceptual Dysfunction > Flashcards

Perceptual Dysfunction Flashcards

1
Q

What does Perception have the ability to do?

A

It has the ability to select stimuli that requires attention and action

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2
Q

What is Perception?

A

The integration of information that is psychologically meaningful

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3
Q

What does perception integration with?

A

Prior Information

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4
Q

What does perception facilitate?

A

Interpretation

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5
Q

Perceptual and Cognitive Deficits can lead to what?

A

They can lead to poor rehabilitation progress for patients, even despite motor skill return

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6
Q

Why is perception important?

A

For learning

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7
Q

What is a Perceptual Screen?

A

Often co-occurs with other system screens

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8
Q

What is observed during a Perceptual Screen?

A

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

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9
Q

What is 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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10
Q

What are the purposes of examination of Perceptual Deficits?

A
  • Determine which perceptual abilities are intact vs which are impaired
  • Appropriately guide intervention
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11
Q

What are the factors that influence the exam?

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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12
Q

How should one sequence this part of the exam?

A
  • Perform sensory examination BEST: visual screening
  • Perform a cognitive screen
  • Screen hearing
  • Consult with family about usual vs unusual behaviors
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13
Q

What can perception NOT be viewed as?

A

Cannot be viewed as independent of sensation

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14
Q

Is perception more complex?

A

YES

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15
Q

Where do deficits not lie in perception?

A

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

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16
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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17
Q

What is Perceptual Deficit/Visual Neglect?

A

Inattention or neglect of visual stimuli presented on the involved side

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18
Q

What is visual field impairment?

A
  • The patient is aware of the deficit
  • The patient may compensate spontaneously
  • Example: Hemianopsia
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19
Q

What is the most common forms of sensory loss in those with hemiplegia?

A

Visual Impairment

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20
Q

What are some common impairments that are included with visual impairments?

A

Poor eyesight, Diplopia, Homonymous Hemianopsia, and damage to the visual cortex or retina

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21
Q

What should a visual screening include?

A
  • Visual acuity
  • Oculomotor control (smooth pursuits, “H- test”)
  • Visual field testing
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22
Q

What are some Body Scheme Perceptual Deficits?

A

The relationship of the body parts to each other and the relationship of the body to the environments

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23
Q

What are some Body Image/Body Awareness Perceptual Deficits?

A

Visual and mental image of one’s body that includes feelings about one’s body

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24
Q

What are some Spatial Relations Perceptual Deficits?

A

Impairments that have in common a difficulty in perceiving the relationship between self and two or more objects in the environment

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25
Q

What are some Agnosia’s Perceptual Deficits?

A

Inability to recognize incoming information despite intact sensory capacities

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26
Q

Which lobe do lesion happen that typically produce perceptual deficits?

A

Right Parietal Lobe

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27
Q

What are some impairments for Body scheme/Body image?

A
  • Unilateral neglect
  • Anosognoisa
  • Somatagnosia
  • Right Left Discrimination
  • Finger Agnosia
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28
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

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29
Q

What is Observed with Unilateral Neglect/Unilateral Spatial Neglect patients?

A

Limited use of the more involved extremity

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30
Q

What is Limited with Unilateral Neglect/Unilateral Spatial Neglect patients?

A

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

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31
Q

What is should be observed with Unilateral Neglect/Unilateral Spatial Neglect patients?

A

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

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32
Q

What some impairments with Unilateral Neglect/Unilateral Spatial Neglect patients?

A

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

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33
Q

What is Neglect of personal space?

A

Pertains to the body (ex. failing to wash the left side of the body)

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34
Q

What is Neglect of Peripersonal Space?

A

Area within arm distance from the body (ex. failing to use objects on the contralateral side of their plate)

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35
Q

What is Neglect of Extrapersonal Space?

A

The area of space beyond arm length (ex. failing to negotiate obstacles, doorways)

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36
Q

What are some examples of how patient with neglect would clinically present?

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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37
Q

Where the Lesions for patient that have Neglect?

A

Inferior-Posterior regions of the right parietal lobe

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38
Q

What kind of tests can be done with patient that have Neglect?

A

Behavioral Inattention Test (BIT) and Observations of ADLs

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39
Q

What are some treatment strategies that can be used with patients that have Neglect?

A

Remedial approach vs compensatory approach

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40
Q

What is Neglect?

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

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41
Q

What can promote turning the head and axial trunk rotation?

A

Active Visual Screening

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42
Q

What type of cues help direct a patient’s attention?

A

Visual, Verbal and Motor Cues

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43
Q

What can be encouraging with a Hemiparetic patient?

A

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

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44
Q

What type of encouragement should functional activities do?

A

Encourages bilateral interaction

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45
Q

What should be optimized on the dominant side?

A

Optimizing visual, tactile and proprioceptive stimuli

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46
Q

What is Anosognosia?

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

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47
Q

What are some limits with patients who suffer from Anosognosia?

A

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

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48
Q

What are some clinical examples of Anosognosia?

A
  • Maintains that “nothing is wrong” or disowns their involved side
  • May refuse to accept responsibility for their more involved side
  • May utilize words such as “my arm has a mind of its own”
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49
Q

Where are the Lesions with patients who suffer from Anosognosia?

A

Unclear, proposal of the supramarginal gyrus

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50
Q

What are some tests for patients who suffer from Anosognosia?

A

Subjective interviewing and asking questions such as “ what happened to your arm/leg”

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51
Q

What are some treatment strategies for patients who suffer from Anosognosia?

A

Prioritize safety

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52
Q

What is Somatagnosia?

A

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

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53
Q

What is Somatagnosia also known as?

A

Body Agnosia

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54
Q

What do patient have difficulty with when suffering from Somatagnosia?

A

Patients often have difficulty following instructions

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55
Q

What are extremities often reported as for Somatagnosia?

A

HEAVY

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56
Q

The lack of _____ may compound this disorder?

A

Proprioception

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57
Q

What is a clinical example of Somatagnosia?

A

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

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58
Q

Where is the lesion for patient who suffer from Somatagnosia?

A

Dominant parietal lobe; often seen with right hemiplegia

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59
Q

What are some tests for patient who suffer from Somatagnosia?

A

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

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60
Q

What are some treatment strategies for patient who suffer from Somatagnosia?

A

Remedial approach to facilitate body awareness (ex. rubbing a body part or verbal identification of a body part)

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61
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

62
Q

A patient suffering from Right-Left Discrimination will have a difficult time with what?

A

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

63
Q

A patient suffering from Right-Left Discrimination will have a difficult time with what type of movements?

A

A patient will have a difficult time imitating movements

64
Q

What are clinical examples of Right-Left Discrimination?

A
  • The patient is unstable to tell his or her left arm from right
  • Incorrect shoe placement
  • Difficulty with gait cues such as “turn right around the corner”
65
Q

Where is the lesion with patients suffering from Right-Left Discrimination?

A

Parietal Lobe of either hemisphere

66
Q

What are some tests with patients suffering from Right-Left Discrimination?

A

The patient is asked to point to body parts on commands
- 6 responses should be elicited
- To rule out: test first without the terms “left” and “right”

67
Q

What are some treatment strategies with patients suffering from Right-Left Discrimination?

A

Compensatory Approach
- Avoid left and right
- Pointing or providing other distinguishing cues

68
Q

What is Finger Agnosia?

A

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

69
Q

Where are lesions with patient suffering from Finger Agnosia?

A

The parietal lobe at the region of the angular gyrus of the left hemisphere

70
Q

What some tests for a patient suffering from Finger Agnosia?

A

A portion of sauguets test that includes items such as the therapist’s touching the patients hand, vice versa, recognition on a picture, and with imitation

71
Q

What are some treatment strategies for a patient suffering from Finger Agnosia?

A

Limited evidence, but a remedial approach can be attempted

72
Q

What are some impairments for Spatial Relations Syndrome?

A
  • Figure Ground Discrimination
  • Form Discrimination
  • Spatial Relations
  • Position in Space
  • Topographical Disorientation
  • Depth and Distance Perception
73
Q

What is Figure Ground Discrimination?

A

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

74
Q

What is Functional Relevance for Figure Ground Discrimination?

A

Difficulty ignoring irrelevant visual stimuli, increased distractibility, shortened attention span, frustration and reduced safety

75
Q

What are clinical examples of Figure Ground Discrimination?

A

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

76
Q

Where are the lesions for patient suffering from Figure Ground Discrimination?

A

Parieto-Occipital lesion of the right hemisphere

77
Q

What are some tests for patient suffering from Figure Ground Discrimination?

A

The Ayres Figure Ground Test

78
Q

What are Functional Based Tests for patient suffering from Figure Ground Discrimination?

A

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

79
Q

What are some treatment strategies for patient suffering from Figure Ground Discrimination?

A

Remedial and Compensatory

80
Q

What is Form Discrimination?

A

Impairment of discrimination in the inability to perceive or attend to subtle differences in form and shape

81
Q

What are some clinical examples of Form Discrimination?

A

Confusing pen with a toothbrush, a vase with a water pitcher, and/ or a cane with a crutch

82
Q

Where is the lesion for a patient suffering from Form Discrimination?

A

Parieto-temporooccipital region in the non-dominant lobe

83
Q

What are some tests for a patient suffering from Form Discrimination?

A

The patient is asked to identify several items similar in shape and different in size

84
Q

What are some treatment strategies for a patient suffering from Form Discrimination?

A

Remedial and Compensatory

85
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

86
Q

Why should Spatial Relation Skills be acquired?

A

Spatial relation skills are required to manage most ADL’s

87
Q

If a patient doesn’t have Spatial Relation skills what difficulties can occur?

A

Difficulties could result in impaired dressing, crossing midline, etc

88
Q

What are some clinical examples of Spatial Relations Disorder/Spatial Disorientation?

A
  • Difficulty with setting the table
  • Difficulty reading a clock
  • Difficulty with preparing for a transfer
89
Q

Where is the lesion located for patient who suffer from Spatial Relation Disorder?

A

Inferior Parietal Lobe or Parieto-Occipital Junction on the right

90
Q

What are some tests for patient who suffer from Spatial Relation Disorder?

A

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

91
Q

What are some treatment strategies for patient who suffer from Spatial relation Disorder?

A

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

92
Q

What is Position in Space?

A

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

93
Q

What are some clinical examples in Position in Space?

A

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

94
Q

Where is the lesion located for patients who suffer from position in space?

A

Non-dominant Parietal Lobe

95
Q

What are some tests for patients who suffer from Position in Space?

A
  • 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 manipulations with an identical set of objects to the patient
96
Q

What should be RULED OUT for patients how suffer from Position in Space?

A

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

97
Q

What are some treatment strategies for patients who suffer from Position in Space?

A
  • 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
98
Q

What is Topographical Disorientation?

A

Difficulty in understanding and remembering the relationship of one location to another

99
Q

What are some clinical examples of Topographical Disorientation?

A
  • Difficulty with describing home layout
  • Difficulty getting to and from the therapy gym despite exposure
100
Q

Where is the lesion located for patient who suffer from Topographical Disorientation?

A

Right Retrosplenial Cortex, Bilateral pareital lesions. L parietal lesion

101
Q

What is the remedial approach for topographical disorientation?

A

practice going from one place to another
- simple to more complex
- verbal instructions should be used

102
Q

What is the compensatory approach for topographical disorientation?

A
  • frequent routes can be marked with colored dots
  • safety considerations such as not leaving home independently
103
Q

What will a patient with depth and distance perception experience?

A

inaccurate judgement of direction, distance and depth

104
Q

What are clinical examples of depth and distance perception?

A
  • a patient may miss a chair when returning to sit
  • pt may continue pouring water despite a full glass
105
Q

Where is the lesion with depth and distance perception?

A

posterior right hemisphere in the superior visual association cortices

106
Q

How do we test for depth and distance perception?

A
  • object grasp on a table o rin the air
  • fill a glass of water
107
Q

How can we treat depth and distance perception?

A
  • assist the patient in becoming aware of the deficit
  • provide education on uneven terrain and stair negotionation
108
Q

What is a remedial treatment approach for depth and distance perception?

A
  • place feet on designated spot during gait training
  • touch foot to a pile to re-establish sense of depth and distance
109
Q

What is a compensatory approach for depth and distance treatment strategies?

A

utilize UE support to sit squarely within a chair

110
Q

What is vertical disorientation?

A

distorted perception of what is vertical

111
Q

Where is the lesion with vertical disorientation?

A

nondominant parietal lobe

112
Q

How do we test for vertical disorientation?

A

therapist holds a cane and then turns it sideways to a horizontal positon and the patient is asked to return the cane back to the original positon

113
Q

What are treatment strategies with vertical disorientation?

A

enhance awareness and cue tactile input to assist

114
Q

What is pushers syndrome also known as?

A

ipsilateral pushing or contraversive pushing

115
Q

What is pusher’s syndrome?

A

motor behavior characterized by active pushing with the stronger extremities toward the hemiparetic side with a lateral postural imbalance

116
Q

What does pushers syndrome result in?

A

a loss of balance towards the hemiparetic side

117
Q

What area is affected with pusher’s syndrome?

A

posterolateral thalamus

118
Q

What is the result with pusher’s syndrome?

A

altered perception of the bodys orientation in relation to gravity

119
Q

What is there a misconception about with pusher’s syndrome?

A

subjective postural vertical

120
Q

What often happens with sitting in a wheelchair with pusher’s?

A

a thrust push over the wheelchair arm

121
Q

What kind of transfers are often less successful with pusher’s?

A

to the less involved side

122
Q

What happens with standing with pusher’s

A

results in instability on the hemiparetic limb resulting in increased fall risk

123
Q

What are some common impairments with walking with pushers?

A

difficulty with weight transfer toward the less involved LE, postural scissoring of the more involved LE, and difficulty with unilateral AD training

124
Q

What is the examination critera for pusher’s?

A
  • spontaneous body posture with tilting towards 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
125
Q

What will pusher’s syndrome invdividuals resist?

A
  • any attempy at passive correction to midline
126
Q

with pusher’s syndrome, the brain will compensate with….

A

therapeutic training
- reorienting patients to true vertical
- managing the environment to optimize these visual cues

127
Q

What is agnosia?

A

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

128
Q

What kind of agnosias are there?

A
  • visual object agnosia
  • auditory agnosia
  • tactile agnosia
129
Q

What is visual object agnosia?

A

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

130
Q

What are clincial examples of visual object agnosia?

A
  • difficulty recognizing people, possessions, and common objects
  • ex: dimultanagnosia, prosopagnosia, color agnosia
131
Q

What is the lesion area of visual object agnosia?

A

occipito-temporo-parietal association areas of either hemisphere

132
Q

How do we test for visual object agnosia?

A

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

133
Q

What can make visual object agnosia difficult to recognize?

A

aphasia and apraxia

134
Q

What is a remedial approach for visual object agnosia treatment?

A

practice drills to discriminate between faces of importance to the patient, discriminate between colors and common objects

135
Q

What is a compensatory approach for visual object agnosia?

A

encourage use of intact sensory modalities to distinguish people and objects

136
Q

What is auditory agnosia?

A

an ability to recognize non-speech sounds or to discriminate between them

137
Q

What are clinical examples of auditory agnosia?

A
  • inability to distinguish the ring of a doorbell and that of a telephone
  • inability to distinguish between the bark of a dog and thunder
138
Q

Where is the lesion with auditory agnosia?

A

dominant temporal lobe

139
Q

How is audority agnosia tested for?

A

performed by a SLP

140
Q

what are treatment strategies for auditory agnosia?

A
  • drill the patient on sounds but reduced effectiveness overall
141
Q

What is tactile agnosia?

A

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

142
Q

What are clinical examples of tactile agnosia?

A

inability to recognize a familiar object when it is handed to the patient

143
Q

Where is the lesion with tactile agnosia?

A

parieto-temporoocipital lobe (posterior association areas) of either hemisphere

144
Q

How do we test for tactile agnosia?

A

object identification in the hand without visual cues

145
Q

What is the remedial approach for tactile agnosia?

A

instruct feeling objects placed within the hand followed by immediate visual feedback

146
Q

What is the compensatory approach for tactile agnosia?

A

visual compensation

147
Q

How do we mitigate impairments for agnosia?

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
148
Q

____________ is key

A

collaboration

149
Q

Who should we communicate and collaborate with an _____ ______ to enhance assessment and intervention strategies utilized

A

occupational therapist

150
Q

Who is specifically trained to treat perceptual deficits?

A

OTs

Neuromuscular Exam and Rehab Exam 2 (8 decks)

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