Phys Cognition/sensation/perception Flashcards
Levels of consciousness:
Full consciousness
Lethargy -
Lethargy - general slowing of cognitive & motor processes
- Interactions can easily get diverted, need frequent redirection
Levels of consciousness:
Obtundation -
- Dulled or blunted sensitivity, difficult to arouse
- Respond slowly when awake, frequently confused when awake
Levels of consciousness:
Stupor -
State of semi-consciousness, only arouses with intense stimulation (deep pressure pain)
Levels of consciousness:
Coma -
Unconsciousness
What system is interrupted when consciousness goes wrong?
Ascending reticular activating systems - functions to arouse and awake the brain and control sleep/wake cycles
How do we measure level of consciousness? (WHAT SCALE?) What three areas of consciousness do we measure? What scores (3-15) mean?
Glasgow Coma scale: 1. Eye opening 2. Motor response 3. Verbal response <8: severe 9-12: moderate 13-15: mild
What three measures for orientation?
- Person (What is your name, how old are you, where are you from?)
- Place (Where are you right now? What city/state? What is the name of this place?)
- Time (What day, month, year, season?)
- Situation (What happened? Why are you here?)
Sustained attention -
How test for it?
Sustained attention - sustain and focus attention over duration of time
Test: Cancellation test - template with different pictures, have patient circle all birds and can they do it without losing attention?
Selective Attention -
How test for it?
Selective attention - ability to screen and process relevant sensory info about the task and environment while screening out irrelevant information
Test: Stroop test - say out loud the color of the word, not what color the word reads
Divided attention -
How test for it?
Divided attention - ability to perform 2 task simultaneously
Test: Walkie-talkie test - can walk alongside me with a conversation without either degenerating
Alternating Attention -
How to test for it?
Alternating attention - Attention flexibility
Test: Supine to sit to immediate sit to stand
Declarative (explicit) memory -
conscious recollection of facts and events
Non-declarative (procedural, implicit)
recall of movements/movement schema without conscious recollections
Immediate recall -
After short interval of time (sec-min)
Ex: repeat after me…
Short-term memory -
Recent or working memory (min-hours/day)
EX: day to day events/learning new material
Long-term memory -
Remote memory (months-years) EX: birthdays, historical events
Executive function -
What part of brain?
Any specific tests?
- Capacity to engage successfully in independent, purposeful, self-directed behavior
- Prefontal cortex
- No specific tests
Executive function:
1. Volition/Planning -
Goal planning and task initiation
Executive function:
2. Problem solving/reasoning -
Abstract thinking, flexibility
Executive function:
3. Insight/awareness -
Poor judgment
Executive function:
4. social pragmatics -
Inappropriate behavior
Executive function:
5. Self-regulation/purposeful action -
initiate, maintain, switch, and stop tasks
What is the difference between sensation and perception?
Sensation - raw data
perception - interpretation of data
Spinothalamic sensation:
What type of receptors?
Fiber characteristics? (Conduction velocity/myelination)
- Free nerve endings
- Small, thin, slow conducting, no myelination
Dorsal column sensation:
What type of receptors?
Fiber characteristics? (Conduction velocity/myelination)
- Muscle spindle, GTO, joint receptors
- Large, thick, rapidly conducting, well myelinated
Spinocerebellar sensation:
What type of receptors?
Fiber characteristics? (Conduction velocity/myelination)
- Muscle spindle, GTO, joint receptors
- Fast, direct, heavily myelinated
Sensory Exam Components: (9)
- Light touch
- Tactile location (discriminatory touch)
- Pain
- Bilateral touch (sensory extinction)
- Proprioception
- Kinesthesia
- Stereognosis
- 2-pt discrimination
- Vibration
Perceptual Exam Components: (4)
- Body scheme and body image impairments
- Spatial relationships
- Agnosias
- Apraxia
Perceptual deficits usually injury to what lobe/side of brain?
Parietal
R>L
Body image -
Visual and mental image of one’s body (in relation to health/disease)
Body scheme -
- Postural model of body
- Includes relationship of body parts to each other and their relationships of the body to the environment (body awareness/purposeful movements)
T/F: With neglect, a patient will also experience sensory, motor and visual deficits
False: failure to orient toward, respond to, or report stimuli despite normal sensory, motor and visual systems
Patients with neglect usually have damage to with side of brain/lobe?
Why?
- Mostly R temporoparietal junction, posterior parietal lesions
- Why Right? right side does more in regard to vision
- Right hemi lesions = entire left side of perception gone
- Left hemi lesions = right side does bulk of work and makes up for it
Representational neglect -
How test for it?
-Loss of internally generated images (memories)
Test ex: draw clock from memory
Visual neglect -
How test for it?
Test ex: cancellation test, have patient draw a house from a copy (will only draw half)
Auditory neglect -
How test for it?
Test ex: give a command to patient on right (uninvolved side) and give command again on left (involved side)
Motor neglect -
How test for it?
-“Output neglect”
-Failure to generate movement response to stimuli even though patient is aware of stimuli
Test ex:
1. Patient produce movement (bicep curl) on Right side (uninvolved)
2. While patient visually attends to left side limb (involved side) repeat curl
3. Have perform both at same time (bimanual) - usually only 1 will curl (uninvolved side)
Personal neglect -
How test for it?
-Lack of exploration or awareness of contralateral side of body (total loss of perception of one side)
Test ex: Pick up affected arm and ask patient to identify ownership of arm
-Ask patient how many arms/legs they have (cross arm into other side to eliminate visual neglect)
Peripersonal (spatial) neglect -
-failure to acknowledge stimuli of contralateral side within reaching space (one side of desk)
Extrapersonal (spatial) neglect -
-failure to acknowledge stimuli of contralateral side in far space
How to test for peri vs extra personal vs visual neglect?
- Place object within arms reach of patient
- Then further away
If visual - Won’t see either
If peripersonal - Won’t see it up close but will see it far away
If extrapersonal - Will see it up close but won’t see it far away
Somatoagnosia -
Where is lesion?
How to test for it?
-(impairment of body scheme) lack of awareness of relationship of body parts (how each part of body relates to next)
-Lesion: dominant parietal lobe
Test ex: Ask patient to point out body parts on a picture, then on therapist, then on themselves - if +, will not be unable to do on themselves
R/L discrimination -
Where is lesion?
How to test for it?
-Decreased R/L differentiation with body parts and with following directions
-Lesion: Either parietal lobe
Test ex: Have patient respond to cues to raise R/L arm/leg or have patient walk and cues to turn head/body R/L (if +, may pause or go other way than cued)
Difference between visual neglect and R/L discrimination when told to turn R/L -
Visual - will have difficulties only turning Left
R/L - difficult turning both ways, turn opposite way than told
Vertical/midline orientation -
How to test for it?
-Can’t identify when body is in midline (standing up straight)
Test ex: easily identified via observation - if not sitting/standing midline ask patient if they think they are straight (will answer yes)
Pusher syndrome -
Where is lesion?
-Leaning and active pushing toward hemiplegic side w/o compensation for instability and with resistance to passive correction toward midline (high fall risk)
Lesion: R posterolateral thalamus
Figure Ground -
How to test for it?
-Inability to distinguish a figure from the background in which it is embedded
Test ex: Place handful of distinctly different objects on table and ask patient to pick up specific object
Spatial relations disorder -
Where is lesion?
How to test for it?
-Inability to perceive relationship of one object in space to another object or to one’s self
-Lesion: right inferior parietal lobe
Text ex: place 3-4 cones on ground, each varying in distance from patient and instruct patient to walk up to cones until they are about 2 ft away (will end at different distance each time)
Position in space disorder -
How to test for it?
-decreased ability to perceive and interpret spatial concepts
Test ex:
1. Ask patient to position arm “above” their head
2. Instruct patient to stand behind the table
3. Tell patient to go up stairs
Topographical disorientation -
How to test for it?
-Difficulty perceiving relationship from one location to another in environment
Test ex: Take patient to familiar place (nursing station) and instruct them to find way back to room
Depth and distance perception -
Where is lesion?
How to test for it?
-Inaccurate judgement of direction, distance and depth (height of object based on our distance to it)
Lesion: right or bilateral visual association cortex
Test ex: Obstacle course - space out 3 steps of variable heights down the hallway and have patient negotiate them
Visual Agnosia -
Where is lesion?
How to test for it?
-Inability to recognize familiar objects despite normal eye function
Lesion: occipital and temporal (L or R)
Test ex: Ask patient to name objects, places, and faces (family members) by name
Auditory Agnosia -
Where is lesion?
How to test for it?
-Inability to recognize familiar sounds or to discriminate between them
Lesion: Left temporal lobe
Test ex: Play familiar sounds and have patient identify them
Tactile Agnosia -
Where is lesion?
How to test for it?
-Inability to recognize objects when handling them
Lesion: parietal/temporal/occipital association area (L or R)
Test ex: reach into bag and grab certain object (3 distinct objects inside)
Anosognosia -
Denial or lack of awareness of presence or severity of one’s deficits
-May deny ownership of limbs
Apraxia -
Lesion:
-Impairment of voluntary, skilled, well-learned movement
Lesion: left frontal or parietal lobes
Ideomotor apraxia -
Test for it:
-breakdown between concept (idea) and performance (motor)
-Lose ability to carry out task on command but can do it on their own
Test ex: they can tell you what a comb is used for but will try and brush teeth
Ideational apraxia -
Test for it:
-Failure to conceptualize task
-Can’t do it on own or on command
Test ex: give patient a brush, they can’t describe what to do with it or do it
