Perceptual Impairments Flashcards
Agnosia
- Inability to recognize familiar objects using one or more of the sensory modalities, while often retaining the ability to recognize the same object using other sensory modalities
- Pt’ is unable to conceptualize the sensory stimulus so defect is in the transmission of the sensory signal to the conceptual level
Types of Agnosia
- Visual object agnosia
- Auditory Agnosia
- Tactile Agnosia
- Anosognosia
Visual Object Agnosia
- inability to visually recognize familiar objects
- Vision in tact
- Using tactile sense, pt may be able to recognize item
Auditory Agnosia
- Inability to recognize non-speech sounds or to discriminate between them (doorbell, dog bark)
- Usually occurs in combination with other communication disorders
- Usually seen with R Hemi
Tactile Agnosia
- Astereognosis
- Inability to recognize forms by handling proprioceptive and thermal receptors intact
Anosognosia
- A severe condition, including denial, neglect, and lack of awareness of the presence or severity of ones paralysis
- Poor prognosis for rehab (unable to recognize or compensate for deficits)
- Pt may not acknowledge involved limbs
- Very difficult to treat
Figured Ground Discrimination
- Inability to distinguish visually a figure from the background in which it is embedded
Functional Implications for Figured Ground Discrimination
- Pt has difficulty visually locating objects (purse, edge or stairs)
- Pt often distracted easily
- Short attention span
- Frustrated
- Decreased independence in ADL’s
How to test for Figured Ground Discrimination
- Can pt distinguish a white towel, on a white sheet
Treatment for Figured Ground Discrimination
- Compensation through cognitive awareness
- Pt taught to be aware and to use touch to help
- Adaptation and simplification of the environment
ie: decrease clutter
Consistent placement of items
Form Discrimination
- Inability to perceive or to attend to subtle differences in form and shape
- Pt is likely to confuse objects of similar shape or not to recognize an object placed in an unusual position (razor from toothbrush)
Test for Form Discrimination
- collect a number of items similar in shape and different size and ask the pt to identify items (First seperately, and then in a group)
Treatment for Form Discrimination
- Make pt aware of deficit
- Practice describing, identifying, demonstrating usage
- Sort like objects and focus on differences
- If pt can read, label items
Form Constancy
- Ability to recognize an object presented in different ways as the same object
ie: A shirt is a shirt, whether its inside or out or outside out, or hanger or folded
Body image
- usually refers to a visual and mental image of one’s body that includes feelings about one’s body, especially in realation to health and diesease
Body Scheme
- Usually refers to a postural model of the body of the body including the relationship of he body to the environment
Body image and body scheme
- are often used interchangeably
Somatognosis
- Body Scheme Impairment
- Lack of awareness of the body structure and relationship of body parts on one’s self or on others
- Awareness of body scheme is essential for the performance of all purposeful motor behavior
- Lack of proprioception may underlie or compound this disorder
Signs of Somatognosis
- Pt unable to dress
- Unable to correctly perform ex’s when movement of body parts on affected side is required or if required to cross midline
How to test for Somatognosis
- Have pt point to body parts on self, therapist or picture
- Have pt copy-cat motions of PT/PTA
- Ask- “are your knees below your head?” “Show me your feet” “Touch your knee”
Treatment for Somatognosis
- Sensory stimulation to increase body awareness
(pt may rub the appropriate body part with a rough cloth as therapist names it) - Repetitive identification of body parts
Unilateral Neglect or Spatial Neglect
- Visual Hemi-Inattention
- Inability to register and to integrate stimuli and perceptions from one side of the body and environment
- Vision Intact
- Often accompanied with sensory loss
Clinical signs of Unilateral/Spatial Neglect
- Pt ignores Left or involved half of body
- Dresses, shaves, makeup only on the Right side
- Veers Right when walking
- Does not attend to Left side of environment
Test for Unilateral/Spatial Neglect
- Draw or copy a picture of a man, clock, or house (L side will be missing)
- Cancellation of tasks (cross out all 8’s,A’s in a line)
- Different then Constructional Apraxia
Treatment for Unilateral/Spatial Neglect
- Increase awareness of he Left or involved side with sensory stimulation
- Cognitive awareness (pt taught to visually scan)
- Functional approach (repeated practice of activities using the L or involved side and crossing midline tasks
- Adapt environment
- Initially place things on R for function
- Begin to move objects left, if possible
Right - Left Discrimination
- Inability to identify the R and L sides of one’s own body or that of the examiner
- Be aware of this or directions to pt can be confusing
Spatial Relations Disorders
- Inability to perceive the relationship of one object in space to another object or to one’s self
- Inability to perceive and to interpret spatial concepts such as up, down, under, in out, front, behind
Functional Implications Spatial Relations
- Causes an increasing problem with constructional tasks and dressing
- Pt may also have difficulty with crossing mdline
Test for Spatial Relations
Ask:
- Is the shoe inside the box?,….beside…
- Put the shoe inside the box…. beside….
Duplicate a particular pattern or blocks, puts number in clock face
Treatment for Spatial Relations
- Duplicate Cards (matching)
- Maze with instructions(Step over, stand next to) as needed
- Crossing midline tasks (reaching for cones)
Topographic Disorientation
- Refers to the difficulty in understanding and remembering the relationship of one place to another
- Pt can’t describe or draw a familiar route
Functional Limitations of Topographic Disorientation
- Pt cannot find the way from one place to another; despite being shown repeatedly
Treatment for Topographic Disorientation
- Practice simple routes, with verbal instruction and cueing
- Adapt environment (colored dots or marks to help)
- Gradually decreased verbal, visual and/or tactile cues
Depth and Distance Impairments
- Pt experiences defective judgment of direction, distance depth
Functional Limitations from Depth and Distance Impairments
- Pt may have difficulty navigating stairs, may miss the chair when attempting to sit, may continue pouring once the glass if filled
- May bump into objects
Testing Depth and Distance Impairments
- Pt reaches for object (overshoot/undershoot)
- Have pt fill a glass with water
Treatment for Depth and Distance Impariments
- Increase cognitive awareness
- Practice skills and compensate by using other senses (especially touch)
