Perceptual Impairments

Question 1

Agnosia

Answer 1

• 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

Question 2

Types of Agnosia

Answer 2

• Visual object agnosia
• Auditory Agnosia
• Tactile Agnosia
• Anosognosia

Question 3

Visual Object Agnosia

Answer 3

• inability to visually recognize familiar objects
• Vision in tact
• Using tactile sense, pt may be able to recognize item

Question 4

Auditory Agnosia

Answer 4

• 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

Question 5

Tactile Agnosia

Answer 5

• Astereognosis

- Inability to recognize forms by handling proprioceptive and thermal receptors intact

Question 6

Anosognosia

Answer 6

• 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

Question 7

Figured Ground Discrimination

Answer 7

• Inability to distinguish visually a figure from the background in which it is embedded

Question 8

Functional Implications for Figured Ground Discrimination

Answer 8

• Pt has difficulty visually locating objects (purse, edge or stairs)
• Pt often distracted easily
• Short attention span
• Frustrated
• Decreased independence in ADL’s

Question 9

How to test for Figured Ground Discrimination

Answer 9

• Can pt distinguish a white towel, on a white sheet

Question 10

Treatment for Figured Ground Discrimination

Answer 10

• 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

Question 11

Form Discrimination

Answer 11

• 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)

Question 12

Test for Form Discrimination

Answer 12

• 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)

Question 13

Treatment for Form Discrimination

Answer 13

• Make pt aware of deficit
• Practice describing, identifying, demonstrating usage
• Sort like objects and focus on differences
• If pt can read, label items

Question 14

Form Constancy

Answer 14

• 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

Question 15

Body image

Answer 15

• 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

Question 16

Body Scheme

Answer 16

• Usually refers to a postural model of the body of the body including the relationship of he body to the environment

Question 17

Body image and body scheme

Answer 17

• are often used interchangeably

Question 18

Somatognosis

Answer 18

• 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

Question 19

Signs of Somatognosis

Answer 19

• 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

Question 20

How to test for Somatognosis

Answer 20

• 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”

Question 21

Treatment for Somatognosis

Answer 21

• 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

Question 22

Unilateral Neglect or Spatial Neglect

Answer 22

• 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

Question 23

Clinical signs of Unilateral/Spatial Neglect

Answer 23

• 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

Question 24

Test for Unilateral/Spatial Neglect

Answer 24

• 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

Question 25

Treatment for Unilateral/Spatial Neglect

Answer 25

• 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

Question 26

Right - Left Discrimination

Answer 26

• 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

Question 27

Spatial Relations Disorders

Answer 27

• 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

Question 28

Functional Implications Spatial Relations

Answer 28

• Causes an increasing problem with constructional tasks and dressing
• Pt may also have difficulty with crossing mdline

Question 29

Test for Spatial Relations

Answer 29

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

Question 30

Treatment for Spatial Relations

Answer 30

• Duplicate Cards (matching)
• Maze with instructions(Step over, stand next to) as needed
• Crossing midline tasks (reaching for cones)

Question 31

Topographic Disorientation

Answer 31

• Refers to the difficulty in understanding and remembering the relationship of one place to another
• Pt can’t describe or draw a familiar route

Question 32

Functional Limitations of Topographic Disorientation

Answer 32

• Pt cannot find the way from one place to another; despite being shown repeatedly

Question 33

Treatment for Topographic Disorientation

Answer 33

• Practice simple routes, with verbal instruction and cueing
• Adapt environment (colored dots or marks to help)
• Gradually decreased verbal, visual and/or tactile cues

Question 34

Depth and Distance Impairments

Answer 34

• Pt experiences defective judgment of direction, distance depth

Question 35

Functional Limitations from Depth and Distance Impairments

Answer 35

• 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

Question 36

Testing Depth and Distance Impairments

Answer 36

• Pt reaches for object (overshoot/undershoot)

- Have pt fill a glass with water

Question 37

Treatment for Depth and Distance Impariments

Answer 37

• Increase cognitive awareness

- Practice skills and compensate by using other senses (especially touch)