Perceptual Dysfunction

Question 1

Perception Definition

Answer 1

creating meaning out of sensory inputs

Question 2

Impairments Left VS Right hemisphere injuries

Answer 2

LEFT - language deficits and temporal/sequencing deficits

RIGHT - visuo-spatial perception and construction deficits

Question 3

Types of Perceptual Deficits

Answer 3

body schema 
agnosia 
right/left discrimination 
spatial relations 
dyspraxia 
tactile perception

Question 4

Agnosia

Answer 4

loss of ability to recognise objects and symbols through a particular sensory channel
actual sensory organ is intact, just perception is impaired

Question 5

Types of Agnosia

Answer 5

anasognosia - complete denial of disability
autopognosia - inability to recognise the patient’s own body or body parts
proposognosia - inability to recognise faces

Question 6

Dyspraxia

Answer 6

difficulty performing a willed purposeful movement or imitating movement
typically caused by lesion to somesthetic cortex of the parietal lobe
left sided lesions more common

Question 7

Types of Dyspraxia

Answer 7

ideomotor - inability to execute idea of previously learned skilled movement
ideational - inability to understand the purpose of the action/task
constructional - difficulty translating an object from one spatial dimension to another

Question 8

Assessment - Ideomotor

Answer 8

perseveration of movements - get caught on one aspect of a movement
difficulty orientating objects into the correct plane
poor timing and direction of movements
difficulty performing movement under command but can perform movement automatically

Question 9

Assessment - Ideational

Answer 9

inappropriate object use 
difficult sequencing tasks 
parts of the task are omitted
parts of the task performed in the wrong order
difficulty conceptualising the task 
difficulty initiating the task

Question 10

Assessment - Constructional

Answer 10

difficulty coping with visual representation
writing may appear crowded/poorly spread on the page
difficulty creating 3D structures
difficulty moving in space

Question 11

Assessment - Unilateral Neglect

Answer 11

instruct patient to do various activities
- bisect a line, copy a house, draw a clock etc.
analyse result - left out any information

Question 12

Assessment- left/right discrimination

Answer 12

instructions - show me your right hand, show me your left ear etc.

Question 13

Assessment - spatial relations

Answer 13

identify overlapping 2D or 3D objects

copy/draw a 3D object

Question 14

Assessment - tactile sensations

Answer 14

Astereognosis - patient close their eyes, identify objects placed in their hands
Sensory Inattention Test - can’t isolate touch during bilateral stimulation

Question 15

Assessment - perseveration

Answer 15

patient becomes stuck at one component of task - repeats a certain component over and over again

Question 16

Functional Neurological Disorders

Answer 16

patient exhibits deficits without there being anything wrong physically - psychosomatic
no medical explanation
typically have one or more symptoms/deficits affected voluntary motor or sensory function
TYPICAL SYMPTOMS
weakness - in whole movements rather than muscle groups
sensory - inconsistent upon testing, incompatible with normal dermatomes
visual - diplopia, field deficits
gait - abnormalities inconsistent
pseudoseizures - occur only in the presence of other people

Question 17

Management of Perceptual Deficits

Answer 17

unilateral neglect - position patient so force attention to affected side
left/right discrimination - avoid using L/R commands
tactile/perceptual - train the patient to consciously attend to sensory cues
perseveration - don’t allow them to perseverate
shared attention/concentration - reduce distractions, maintain a consistent treatment routine

Question 18

Pusher’s Syndrome

Answer 18

can occur following left or right brain damage
patients actively push away from non-hemiplegic side causing a loss of balance
distorted sense of verticality towards their affected side
not a result of visuospatial deficits

Question 19

Behaviour of Pusher

Answer 19

active pushing to the hemiplegic side
inability to transfer weight to hemiplegic side
lack of awareness when falling to the hemiplegic side
fear of falling when corrected
overactivity/inability to relax the unaffected side

Question 20

Pusher Rating Scale

Answer 20

3 - severe pusher

• pushing evident in sitting
• resistance to passive movement to the unaffected side

2 - moderate pusher

• pushing not evident in sitting
• pushing evident in standing and walking
• resistance to pasive movement to the unaffected side

1 - mild pusher

• pushing not evident in standing, stepping or sitting
• resistance to passive movement to the unaffected side

0 - non pusher

• pushing not evident
• no resistance

Question 21

Management of Dyspraxia Physio

Answer 21

optimise subcortical cues - focus on giving visual instructions instead of verbal, provide physical guidance throughout movement
set up environment to encourage automatic movement patterns - focus on the whole task rather than breaking it into components
develop routine of movements to encourage automaticiy
use music, counting or other temporal cues

Question 22

Functional Neurological Disorder - assessment

Answer 22

don’t do structured physical assessment - patient’s don’t respond well and findings are usually unreliable
Remove focus from measurement and impairments
Focus on normal behaviours