Test 2: Perceptual Deficits Flashcards
what is perception
ability to select those stimuli that require attention to action and to integrate those stimuli with each other and prior info to finally interpret them
this awareness enables the individual to make sense of complex/dynamic sensory environment
what are perceptual deficit
complex and intimately linked to the sensorimotor deficit associated (hemiplegia)
innappropriate interpretation of appropriate sensation
inability to perceive stimuli due to underlying sensorimotor deficit
2 largest populations with perceptual deficits
stroke and TBI
perception vs sensation
stimuli input required for sensation and perception; perception is not independent of sensation
sensation = cognitive appreciation/awareness of stimuli through organs of special sense, peripheral receptors, etc
perception = more complex than just appreciation; ability to interpret sensation accurately and resond appropriately
pathophysiology of perceptual deficits
neuro injury to parietal lobe
MCA stroke, TBI, vascular disease
more common with injury to non-dominant R parietal lobe
examples: R MCA stroke can cause L unilateral neglect or left spatial relation disorders, L MCA CVA causes body agnosia
what is agnosia
simple perception deficits
inability to recognize anything familiar or make sense of incoming information despite intact sensory capacities
visual, auditory, and tactile (astereognosis) types
what is visual agnosia
inability to recognize familiar objects despine normal function of eyes
prosopagnosia is inability to recognize familiar faces
color agnosia is inability to recognize colors; NOT color blindness
what is auditory agnosia
inability to recognize familiar non-speech sounds or discriminate between them
rarely occurs in absence of other communication disorders
what is tactile or astereognosis agnosia
inability to recognize forms by handling them through tactile, proprioceptive, and thermal sensations may be intact
what is body schema/body image
individuals perception of postural model of body including the relationship of body parts to each other and relationship of the body to the environment
more complex combo of multiple agnosias
“body awareness”/”body orientation”
deficits of body schema include
unilateral neglect
ipsilateral pushing
anosognosia
somatoagnosia
R-L discrimination
finger agnosia
what often accompanies unilateral neglect that relates to vision but is not due to visual dysfunction
homonymous hemianopsia
unilateral neglect is caused by
posterior/inferior parietal lobe injury
R MCA most common resulting in L neglect
20% of stroke pts
what is personal unilateral neglect
decreased self awareness
doesnt recognize own arm, remains half dressed
clinical presentation:
- half face of makeup
- half face shaved
- leaves arm behind
what is spatial unilateral neglect
decreased environmental awareness
i.e. runs into doroways, only makes R turns
Peripersonal
- only eats half of the food in front of them; locks one side of WC
extrapersonal
- runs into doorways/people on neglected side
what is anosognosia
denial of symptoms
safety awareness deficits
lack of awareness/denial of paretic limb as belonging to person; pt can recognize when other people with similar deficits have unsafe behaviors but could not recognize their own
severe form of unilateral neglect
often resolves spontaneously in first 3 months following stroke
important to maintain safety of neglected limb while performing rehab
what is somatoagnosia (body agnosia or autotopagnosia)
lack of awareness of body structure and relationship of body parts to oneself or others
i.e. pt has trouble with transfers b/c he doesnt perceive the meaning of terms related to body parts such as “reach back with your arm and grab the armrest”
how to test for somatoagnosia
have pt point to parts of body
“show me your hand and now the other hand”
“point to your elbow” and pt points to knee
how to manage somatoagnosia
sensory stimulation to the body part affected
what is R-L discrimination disorder
inability to identify R or L of ones own body or someone elses body
cant execute movements in response to verbal commands that include the terms R and L
close association with aphasia
as PT can cue “use arm with watch” or point directly to arm you want pt to use
what are spatial relation disorders
difficulty in perceiving the relationship between self and two or more objects
most frequently happens with R sided lesions affecting parietal lobe (i.e. R MCA)
examples of spatial relation deficits
figure ground discrimination
form discrimination
spatial relations
position in space
topographical disorientation
depth perception
vertical/”midline” orientation
what is figure ground discrimination
cant visually distinguish a figure from the background
cant pick an object our of an array of other objects
cant locate important objects that aren’t prominent = frustration
increase of fall risk i.e. descending stairs and not seeing where one starts and another stops
what is form discrimination
ability to perceive 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
i.e. confuse pen with toothbrush or cant distinguish or set the place of utensils
what is spatial (relations) disorientations
inability to perceive the relationship of one object in space to another object or to oneself
spatial relation skills required to manage most ADLs
can become a safety issue:
- walking into doors
- distance between sitting target
- trouble reading analog clock, distance between hands
what are position in space deficits
inability to perceive and interpret spatial concepts such as up, down, under, over, in, out, in front of, behind
differs from proprioception alone
i.e. if pt asked to lift arm over head that are confused or lift arm incorrectly
how to test for deficits with position in space
pt is presented with 2 objects and asked to describe their relationship with one another
i.e. toothbrush in cup and asked to describe this
what is topographical disorientation
difficulty understanding and remembering relationship of one location to another
pt unable to get from one place to another without cues/map
how to test topographical disorientation
pt asked to describe or draw a familiar route such as the block on which they live or the layout of their house
pt unable to do so
pt asked to walk back to your room from therapy gym
describe depth/distance perception
judgement of direction, distance, and depth
pt may have difficulty navigating stairs, may miss chair when attempting to sit
can be a contributing factor in faulty distance perception
what is vertical orientation
difficulty finding midline/upright position
distorted perception of true vertical
can contribute to appearance of postural stability deficits or gait disturbance
can be in presence or absence of homonymous hemianopia
common presentation = most pts post R CVA in early phase
what is pusher syndrome
active pushing toward neglected side
feel like you are pushing them over if you try to correct
severe vertical orientation deficit
active resistance to passive correction
can visually see they are vertical but perception of upright is skewed
what is apraxia
inability to perform voluntary learned movement
inability to perfom purposeful movements not related to:
- inadequate strength
- coordination loss
- impaired sensation
- poor comprehension
- uncooperative
- etc
2 types of apraxia
ideomotor = cant perform on command but can do it automatically, unconscious muscle memory (i.e. cant go to the door if asked but may automatically if doorbell rings)
ideational = cant perform task at all; hard to differentiate between aphasia and other disorders; no IDEA
what is diplopia
double vision
pt sees 2 of environment
defective function of extraocular muscles in which both eyes are used but not in conjunction with the other
treatment = exercise for eye muscles; eye patch on alternating eyes until condition clears
what is homonymous hemianopia
“visual field cut”
loss of vision from half (R or L) visual field of both eyes
most common visual deficit with hemiplegia; MCA damage near internal capsule affecting optic tract; presents similar to PCA damage to visual cortex
17% of R MCA
homonymous hemianopia vs unilateral neglect
HH = aware of problem and compensate automatically or learn to compensate by head turn; injury occurs along visual projectsions
unilateral = may have intact vision but seems unaware of the problem and doesnt attempt to compensate spontaneously by turning head; possibly no injury to visual projections
