Sensorimotor

Question 1

Pathognomonic Signs of Sensorimotor issues

Answer 1

Hard Signs:
Marked unilateral sensory or motor deficit, abnormal reflexes, changes in pupil size, eyelid dysfunction, visual field loss, and hearing loss can all be symptoms of brain damage. (Hard signs: clear signs of brain damage.)
Soft Signs:
Motor overflow, motor incoordination, left-right confusion, motor weakness on one side, distractibility, hypo-or-hyperactive, and emotional lability, all better interpreted as signs of dysfunction rather than damage (Soft signs: less predictive of brain damage and are quite common in children and youth.)

Question 2

Cranial Nerve Functions

Answer 2

Olfactory – Smell
Optic – Vision
Oculomotor – Eye movement (eye drift outward), pupil constriction, eye lid
Trochlear – Eye movement (eye drift up)
Trigeminal – Somatosensory (touch, pain) from face and head, muscles for chewing
Abducens – Eye movement (eye drift in)

Question 3

Cranial Nerve Functions (cont.)

Answer 3

Facial – Taste, somatosensory from ear, muscles for facial expression
Vestibular – Hearing, balance
Glossopharyngeal – Taste, somatosensory from tongue, tonsils, pharynx, swallowing
Vagus – Sensory, motor, and autonomic functions of glands, digestion, heart rate
Spinal Accessory – Muscles in head movement
Hypoglossal – Muscles of tongue

Question 4

Visual Presenting or Observed Problems

Answer 4

• Trouble copying from the board or during assessment
• Loses place when reading or scanning assessment stimuli
• Skips lines of text unknowingly
• Reads slowly; difficulty decoding quickly
• Neglects portions of homework or assessment materials
• Turns head to read see sections of a page
• Poor handwriting
• Squints, rubs eyes, places head close to the paper, complains of headaches
• Says that words “move around” on the page

Question 5

Neuroanatomy of Vision

Answer 5

*The right and left optic nerves converge at the base of the brain to form the optic chiasm
*Fibers from the nasal retinas cross over to the ipsilateral side
* Some fibers go on from there to terminate in the superior colliculus, which is located in the midbrain. Most fibers, however, proceed from the optic chiasma to form the right and left optic tracts.
*These tracts ascend to the thalamus which is a subcortical relay station for all senses except olfaction.

Question 6

Neuroanatomy of Vision (cont.)

Answer 6

*Optic radiation carries information from the thalamus to the occipital lobe for processing
* Meyer’s loop carries information from the inferior retina (which is the superior visual field)
* Baum’s loop carries information from the superior retina (which is the inferior visual field)

Question 7

Visuospatial Dysfunctions

Answer 7

Can severely impact learning potential and social functioning.
Reading and math both rely heavily on the use of symbols and accurate visual perception is vital.
Writing also has a large visuospatial component
Navigating tasks such as using maps, driving, and finding your way to the classroom rely heavily on visuospatial skills.

Question 8

The striate cortex

Answer 8

The striate cortex is the initial projection area within the occipital lobe for perception.
(Luriaʼs primary zone)
* Functions include: perception of color, sensitivity to contrast, ability to detect fine details, and temporal (time) resolution.

Question 9

The extrastriate cortex

Answer 9

Neurons in the striate cortex send axons to the extrastriate cortex, where perception of objects takes place. (Luriaʼs secondary zone).

Question 10

Dorsal stream:

Answer 10

Ascends to the posterior parietal cortex
* Recognizes where the object is located and whether it is moving.
* Occipital-parietal pathway
* Functions include perception of movement, location, visual attention, and control of eye and hand movements.

Question 11

Ventral stream:

Answer 11

Moves forward to the inferior temporal cortex
* Recognizes what an object is and its color.
* Occipital-temporal pathway.
* Functions include perception of objects/faces/text.
*Damage to ventral stream can lead to visual agnosia

Question 12

Visual Agnosia/Associative visual agnosia

Answer 12

impaired ability to recognize visual information
Associative visual agnosia: Difficulty with understanding the meaning of what they are seeing.
* May result from damage to axons connecting the visual association cortex with regions of the brain used for verbalization and thinking in words (bilateral inferior occipitotemporal cortex).
* Can draw or copy but do not know what they have drawn.
* Can describe or mime actions appropriate to the objects they see but cannot identify the object.
* Can’t link the visual stimuli to prior experience.

Question 13

Visual Agnosia/Apperceptive visual agnosia

Answer 13

an abnormality in visual perception and discriminative despite the absence of basic visual deficits.
* May result from damage to the parietal, occipital cortex.
* Cannot recognize objects, draw a figure, or copy a figure.
* Cannot perceive correct forms of the object, although
knowledge of the object is intact.
* Can describe details and recognize objects by touch.
* Unable to group the parts together and name the object
accurately.
Dorsal Stream Damage can cause Apperceptive visual agnosia

Question 14

Simultanagnosia

Answer 14

A patient with dorsal simultanagnosia may report only one of pictured items contained in a picture and disregard the rest of the images

Question 15

Prosopagnosia

Answer 15

Failure to recognize faces, including close friends or relatives (ventral stream damage)

Question 16

Fusiform Cortex

Answer 16

The development of this region may be a result of extensive experience looking at faces. The fusiform face area is underdeveloped in people with ASD.

Question 17

Rey Complex Figure Test

Answer 17

Examinee copies the figure and later reproduces it from memory after a short- and long-delay.
Primarily a visual memory test but it taps into many different neurocognitive abilities:
* Visual processing
* Visuospatial abilities
* Fine motor/motor planning
* Executive function planning
* Anxiety management

Question 18

Other Subtests to Consider

Answer 18

NEPSY-II
* Visuomotor Precision
* Picture Puzzles and Geometric Puzzles - visuospatial
* Arrows – eye tracking
* Route Finding - visuospatial
* Block Design – 3 dimensional visuospatial
* Memory for Designs – Spatial score
D-KEFS: Trail Making Test
* WISC/WAIS: VSI and FRI subtests; cancellation
* WJ-IV Cog: Pair Cancellation
* TEA-Ch2: Balloons 5 and Hector B Cancellation
identi-Fi:

Question 19

Interventions for Visual Problems

Answer 19

Referrals to other professionals
* Preferential seating (left or right side)
* Copies of notes/slides to reduce copying from board
* Audio texts to reduce tracking when reading
* Reading shields/strips to keep track of place in text

Question 20

Sensory-Motor Integration

Answer 20

The sensory systems of the body also
interact with motor functions.
* Children with sensory-motor integration problems may have difficulties with balance, movement, using both sides of the body in a unified fashion, and confusion over right versus left sided movements.

Question 21

Motor Problems in the Classroom

Answer 21

Poor fine motor
* Handwriting
* Construction tasks (e.g., art)
* Poor gross motor (e.g., clumsy)
* Physical Education
* Recess and sports
* Walking in line
* Speech production difficulties

Question 22

Neuroanatomy of Motor Functions

Answer 22

All of the body’s voluntary movements are controlled by the brain. One of the brain areas most involved in controlling these voluntary movements is the motor cortex.
* The motor cortex is located in the rear portion of the frontal lobe, just before the central sulcus that separates the frontal and parietal lobe.

Question 23

motor cortex

Answer 23

The motor cortex is divided into
two main areas: Brodmann’s Area 4 and Area 6.
* Area 4 is also known as the primary motor cortex.
* Area 6 lies immediately forward of Area 4. Area 6 is wider and subdivided into two distinct subareas:
* supplementary motor cortex
* premotor cortex.

Question 24

Area 4: Primary Motor Cortex

Answer 24

While performing operations to alleviate patients’ epileptic symptoms, Penfield stimulated various areas of the cortex to identify vital ones that should not be removed.
* Stimulations applied to the precentral gyrus triggered highly localized
muscle contractions on the contralateral side of the body

Question 25

Area 6: Premotor Cortex

Answer 25

Premotor Cortex (PMA) helps to guide body movements by integrating sensory information and controlling the muscles that are closest to the body’s main axis.

Question 26

Area 6: Supplemental Motor Cortex

Answer 26

Supplemental Motor Cortex (SMA) is involved in planning complex movements and in coordinating movements involving both hands.

Question 27

Basal Ganglia

Answer 27

The basal ganglia is a group of several structures in the brain:
* caudate nucleus,
* putamen,
* globus pallidus,
* subthalamic nucleus.
The substantia nigra is a midbrain structure distinct from the basal ganglia but often associated with it.

Question 28

Basal Ganglia Functions

Answer 28

Information from the frontal, prefrontal, and parietal areas of
the cortex passes through the basal ganglia, then returns to the
supplementary motor area via the thalamus.
* Facilitates movement by channeling information from various
regions of the cortex to the supplemental motor cortex.
* Acts as a filter, blocking the execution of movements that are
unsuited to the situation.

Question 29

Cerebellum

Answer 29

Cerebellum plays several roles:
* stores learned sequences of movements
* fine tunes and coordinates movements produced elsewhere in the brain
* integrates all of these to produce movements so fluid and harmonious that we are not even aware of them.
* Involved in the unconscious adjustment of muscles in the body for coordinated, smooth, and complex motor activity.
In humans, the cerebellum plays a role in analyzing the visual signals
and timing associated with movement. The cerebellum appears to calculate the speed of these movements and adjust the motor commands accordingly.

Question 30

Damage to the Cerebellum

Answer 30

Damage to the Cerebellum may result in ataxia, which is a problem of muscle coordination.
Dysarthria (slurred speech)
* Nystagmus (jerking which causes blurred vision and dizziness)
* Hypotonia (loss of muscle tone)
* Problems coordinating balance and posture
* Uncertain gait, spread feet widely apart as they strike the ground
* Reflexes can try to compensate for imbalance and overreact resulting in
oscillations of the entire body.
* Difficulty tilting trunks forward or backward without losing their balance.

Question 31

Motor Disorder Terms

Answer 31

*Ataxia
* Dystonia
* Sensory-motor dysfunction
* Perceptual-motor dysfunction
* Developmental dyspraxia
* Minimal brain dysfunction
* Visuomotor difficulties
* Clumsy child syndrome
* Dyspraxia
* Motor-learning difficulties
* Dysgraphia

Question 31

Developmental Coordination Disorder (DCD)

Answer 31

A DSM-V Diagnosis
* Display motor coordination that is substantially below expected levels
compared to same-aged peers
* Clumsiness, slowness, awkward
* Difficulty mastering gross motor tasks (e.g., catching a ball)
* Difficulty with fine motor coordination (e.g., handwriting)
* Interferes with daily living, academics, vocational, play
* Onset in early developmental period (not often recognized before age 5)
* Not better accounted for by other conditions
* May be synonymous with Dyspraxia

Question 32

Speech Production

Answer 32

Oromotor Apraxia
* In articulation disorders, the underlying problem is commonly
associated with dysfunction in the peripheral nerves, the motor
cortex/systems, or physical structures (i.e., tongue, palate, lips,
and/or larynx).
* A disturbance in the motor programming aspects of speech
* May involve a poor ability to initiate nonverbal and/or verbal
movements of the speech musculature

Question 33

Speech Production

Answer 33

Verbal Apraxia
* Disturbance is limited to verbal content
* Associated with dysfunction of a small region of Broca’s area.
* Articulation errors in verbal apraxia are different from those seen in
articulation disorders.
* Errors are inconsistent and usually substitution errors, not sound distortions
errors.
* Errors are apparent in purposeful, but not automatic speech.

Question 34

Interventions for Motor Problems in the Classroom

Answer 34

Referrals to Physical Therapists, Occupational Therapists, and/or
Speech Language Pathologists
* Adaptive Physical Education classes
* Extra passing time between classes
* Reduce fine motor demands; teach keyboarding, oral examinations,
provide notes or assign a notetaker
* Mazes, puzzles, and tracing exercises improve hand-eye coordination
* Assistive technology

Question 35

Auditory Problems in the Classroom

Answer 35

Difficulty hearing the teacher and understanding instructions; asks for lots
of repetitions
* Doesn’t appear to recognize when being spoken to
* Speaks too loudly
* Has difficulty hearing in noisy environments
* Appears to be inattentive
* Easily distracted by auditory stimuli
* Difficulty discriminating sounds (e.g., /d/ vs. /b/ sounds).
* Omits or substitutes sounds when reading or speaking.
* Students with deficits in auditory/phonological processing will have
difficulties with reading acquisition using only phonological instruction.
* Students with severe deficits may learn to read by visually memorizing the
whole word rather than using typical phonics

Question 36

Neuroanatomy of Hearing

Answer 36

The primary auditory cortex is located in the superior part of the temporal lobe and buried within the sylvian fissure or lateral sulcus

Question 37

Interventions for Auditory Problems

Answer 37

• Referral to Pediatric Audiologist
• Providing quiet areas for studying and test taking
• Additional time to complete tasks/tests
• Copies of notes to reduce notetaking demands
• Reducing rate of speech
• Assistive listening devices (FM system)
• Sit on side of the room with the ear advantage.
• Computerized training programs may help

Question 38

Language - Presenting Problems

Answer 38

Oral Expression Difficulties
Slow labored speech.
* Limited vocabulary when speaking.
* Makes odd or unusual language or vocal sounds.
* Distorts sounds (e.g., slurring, stuttering).
* Difficulty finding the right word to say.
Receptive Language Difficulties
* Trouble understanding what others are saying.
* Does not do well with verbal directions.
* Does not follow conversations well.

Question 39

Neuroanatomical Basis of Language - Receptive

Answer 39

Speech signals are transmitted through the auditory nerve and discriminated in Heschl’s gyrus, in the primary auditory area of the temporal lobe. It has a distinct role in the analysis of music.
Wernicke’s area is where the interpretation, or comprehension of speech meaning, takes place. It is behind Heschl’s gyrus at the posterior section of the superior temporal gyrus (STG).

Question 40

Neuroanatomical Basis of Language - Processing

Answer 40

Supramarginal and Angular Gyrus
* Integrates visual, auditory, and somatosensory
information
* Link to reading disability
studies

Question 41

Neuroanatomical Basis of Language - Expressive

Answer 41

Broca’s area acts with the motor cortex to produce movements needed for
speaking. Broca’s area is in the dominant inferior frontal gyrus and is responsible
for the organization of grammar & syntax (syntactic encoding ) of speech

Question 42

Language Interventions

Answer 42

Positive evidence (i.e., SLP therapy works): Phonology; in particular, using
maximal oppositions, auditory discrimination, and phonological awareness, all done in short, intensive therapy sessions
* Some positive evidence: Morphology/syntax (strategies such as recast/reformulation, cueing, and verbal prompts), Vocabulary
* Emerging positive evidence: Narrative language
* Mixed evidence: Parent-mediated interventions like enhanced milieu teaching
(EMT) targeting overall language skills

Question 43

Tactile vs Kinesthetic vs Proprioception

Answer 43

Tactile: Detection of the sensation of touch on our skin. Often related
to fine motor tasks.
* Kinesthetic: Detection of limb position and movement through
sensory organs in muscles in ligaments. Often related to gross motor tasks.
* Proprioception: Conscious awareness of body and limbs and has several distinct properties: passive motion sense, active motion sense, limb position sense, and the sense of heaviness.

Question 44

Tactile/Kinesthetic/Proprioception Problems in the Classroom

Answer 44

Complaints about clothing/tags
* Can’t stand messy art projects
* Alternatively, touches everything and everyone
* May injure self because harm/pain doesn’t register
* Bumps into things, appears clumsy
* Poor gross and/or fine motor abilities
* Difficulty regulating pressure (writing, opening doors, playing with
others, etc.).

Question 45

Neuroanatomy of Touch

Answer 45

Two Pathways are important in touch:
* Dorsal columnmedial lemniscal
system for touch, proprioception, and movement.
* Anterolateral system for pain and temperature sense

Question 46

Somatosensory Cortex

Answer 46

The primary somatosensory cortex is located in a ridge of cortex called the postcentral gyrus, which is found in the parietal lobe. It is situated just posterior to the central sulcus, a prominent fissure that runs down the side of the cerebral cortex.

Question 47

Disorders of Touch

Answer 47

Tactile localization disorder: inability to localize a stimulus on the skin.
* Two-point discrimination disorder: inability to discriminate between a
single touch stimulus and two simultaneous nearby touch stimuli.
* Agraphesthesia: inability to recognize the shape, size, or letter that is
“written” on the hand.
* Haptic imperception: inability to recognize the shape, size, or texture
of an object touching the skin.
* Astereognosis: inability to recognize an object on the basis of its
three-dimensionality through palpation (touch).

Question 48

Interventions for Tactile/Kinesthetic/ Proprioceptive Problems

Answer 48

Referrals to Occupational Therapists
* Help students set boundaries for physical touch
* Provide alternative art supplies
* Sensory breaks (school assemblies, lunch room)
* Weighted lap pads or vests
* Address safety concerns
* Heavy work throughout the day
* Sensory play/fidgets

Question 49

Olfaction

Answer 49

Congenital anosmia is rare
* However, acquired anosmia is slightly more common:
* Head injuries can impair or sever the olfactory nerve
* Enlarged adenoids can impair olfactory sensitivity
* Exposure to heavy metals (e.g., cadmium, manganese) can be transported to
the olfactory bulbs and into deeper brain structures
* Deficits are linked to schizophrenia, Parkinson’s disease, Huntington’s
disease, alcoholic Korsakoff’s syndrome, and Alzheimer’s disease

Question 50

Neuroanatomy of Olfaction

Answer 50

Sensory information relayed through olfactory bulb travels
to the pyriform cortex.
* Signals are sent to the Amygdala for emotional responses and the Hippocampus for memory
* Primary pathway leads to the orbital frontal cortex for conscious perception
* Secondary pathway goes to the Thalamus for relay to other
regions of the brain

Question 51

Sensory Integration and Dysfunction

Answer 51

Overstimulated by sensory input to the point that sensory input may
be painful (e.g., child who is hypersensitive to touch. A light brush
against the childʼs skin could feel as if the skin has been set on fire).
Often become sensory avoidant.

Understimulated by sensory input, which can be dangerous (e.g., a
child falls while roller-skating and injures herself but does not respond
to the pain of the injury and returns to the activity). Sometimes
become sensory seekers.

Sensation seekers, sometimes to the exclusion of all other activities
(e.g., some children chew on their shirt sleeves excessively to the
point that their mouths are chapped and bleeding).

Question 52

Damage to the cerebellum can cause what types of dysfunction?

Answer 52

Ataxia
Dysarthia
Hypotonia

Question 53

What brain area is associated with comprehension of the meaning of speech

Answer 53

Wernicke’s area

Question 54

This part of the brain is involved in planning complex movements and in coordinating movements involving both hands

Answer 54

Supplemental motor cortex

Question 55

This DSM diagnosis is characterized by marked delays in reaching developmental motor milestones, difficulty mastering gross motor tasks, difficulty with fine motor coordination, and being poor at sports. What is this disorder?

Answer 55

Developmental Coordination Disorder

Question 56

The pathway for touch, proprioception, and movement is called the:

Answer 56

Dorsal column-medial lemniscal system

Question 57

The pathway for pain and temperature sense is called the:

Answer 57

Anterolateral system

Question 58

The primary auditory cortex is located in the:

Answer 58

Superior part of the temporal lobe.

Question 59

Fibers from the nasal retinas cross over to the ipsilateral side at what brain structure

Answer 59

Optic chiasm

Question 60

Sensory disorders may be manifested in which way:

Answer 60

Overstimulated
Under stimulated
Sensation seeking

Question 61

Pathognomonic hard signs are:

Answer 61

Clear signs of brain damage