UNIT 2 Flashcards
the integration of information that is psychologically meaningful
perception
the ability to select stimuli that requires attention and action
perception
why is discussing perception important?
- perceptual and cognitive deficits can lead to poor rehabilitation progress for patients, even despite motor skill return
- perception is important for learning
often co-occurs with other system screen
perceptual screen
a perceptual screen observes for:
- inattention to therapist during subjective interview
- inattention to half of the body
- decreased response to verbal cues
what is the purpose of examining perceptual deficits?
- determine which perceptual abilities are intact vs. impaired
formal testing is indicated when there is ______ loss unexplained by ____ or ____ impairments or deficits in comprehension
functional, motor, sensory
factors that influence the exam
- psychological and emotional status
- patients ability to detect relevant cues from the environment
- presence of anxiety
- receptive + expressive communication skills
- depression + fatigue
how do you sequence perception, sensation, and vision part of the exam?
- sensory exam FIRST!
- visual screen (visual field testing) - cognitive screen
- hearing screen
- consult with family about usual vs unusual behaviors
cannot be viewed as independent of sensation
more complex
perception
deficits do not lie with sensory ability itself, but rather the interpretation of sensation and the follow up response
perception
awareness of stimuli through organs of special sense, peripheral cutaneous sensory system, or internal receptors
sensation
inattention or neglect of visual stimuli presented on the involved side
perceptual deficit / visual neglect
ex. hemianopsia
patient is aware of the deficit & may compensate
visual field impairment
consideration of visual impairment
- one of the most common forms of sensory loss in those with hemiplegia
common impairments for visual deficit include:
- poor eyesight
- diplopia
- homonymous hemianopsia
- damage to the visual cortex or retina
a visual screening should include:
visual acuity, smooth pursuit test (h-test), visual field testing
the relationship of the body parts to each other and the relationship of the body to the environment
body scheme
visual and mental image of one’s body that includes feeling about one’s body
body image / body awareness
impairments that have in common a difficulty in perceiving the relationship between self and two or more objects in the environment
spatial relations
inability to recognize incoming information despite intact sensory capacities
agnosias
body scheme / body image impairments
-unilateral neglect
-anosognosia
-somatagnosia
-right-left discrimination
-finger agnosia
lack of awareness of part of the body or external enviorment which is not due to sensory loss
unilateral neglect / unilateral spatial neglect
patient with unilateral neglect should be observed for
limited use of the more involved extremity
patient with unilateral neglect will have limited reaction to _____
sensory stimuli
pertains to the body is neglect of ________
personal space
example for neglect of personal space
failing to wash the left side of body
area within arm distance from the body is neglect of ____
peripersonal space
example for neglect of peripersonal space
failing to use objects on the contralesional/contralateral side of their plate
the area of scape beyond the arm length is neglect of ______
extrapersonal space
example for neglect of extrapersonal space
failing to negotiate obstacles, doorways, etc
what does neglect look like?
-ignoring dressing to the left half of body
-forgetting to shave the left half of face
-neglecting to put makeup on the left side of face
-neglecting to eat from the left half of the plate
-bumping into objects on the left side
-propelling in a wheelchair and veering off to the right (strong side)
despite no sensory loss, individuals lack an ability to register and integrate stimuli from one side of the body and the environment
neglect
where is the lesion area for neglect?
inferior-posterior regions on the right parietal lobe
what test can be performed to determine if neglect is present?
behavioral inattention test (BIT) and observation of ADLs
what are the treatment strategies for neglect?
remedial approach vs compensatory approach
interventions to address hemianopsia & unilateral neglect
-encourage awareness and use of the environment on the hemiparetic side and use of the hemiparetic extremities
-active visual screening through turning the head and axial trunk rotation
-visual, verbal or motor cues to direct patients attention
-active voluntary movements of neglected limbs while encouraging patient to look at his or her limbs
-functional activities that encourage bilateral interaction
-optimizing visual, tactile, and proprioceptive stimuli on the more dominant side
the lack of awareness, denial, or paretic extremity as belonging to the person OR lack of insight concerning, or denial of, paralysis or disability
anosognosia
anosognosia limits the patients ability to….
recognize the need for compensatory techinques
maintains that “nothing is wrong” or disowns their more involved limb
clinical example of anosognosia
may refuse to accept responsibility for their more involved limb
clinical example of anosognosia
may utilize words such as “my arm has a mind of its own”
clinical example of anosognosia
lack of awareness of denial in paretic extremity
anosognosia
lesion area for anosognosia
unclear, proposal of supramarginal gyrus
testing for anosognosia
subjective interviewing and asking questions such as “what happened to your arm or leg?”
prioritize safety
treatment strategies for anosognosia
impairment of body scheme
somatagnosia
lack of awareness of the body structure and the relationship of body parts to oneself or others
somatagnosia
somatagnosia can also be called ______
body agnosia
patients with somatagnosia often have difficulty following _______
instructions
patient with somatagnosia often report extremities as _____
heavy
example of somatagnosia
difficulty with transfers, dressing, and with exercises requiring body parts moving in relation to others
lesion area for somatagnosia
dominant parietal lobe, often seen with right hemiplegia
lack of awareness of the body structure and the relationship of body parts to oneself or to others
somatagnosia
how to test patient with somatagnosia
patient is asked to point to body parts named by the therapist on themselves, the therapist, and on a picture of a human figure
remedial approach to facilitate body awareness
treatment strategies for somatagnosia
inability to identify the right and left sides of one’s own body or that of the examiner
right-left discrimination
patient with right-left discrimination will have a difficult time verbally responding to commands that include ________
the terms right and left
a patient will have a difficult time imitating movement with ______
right-left discrimination
-patient is unable to tell their left arm from their right
-incorrect shoe placement
-difficulty with gait cues such as “turn right around the corner”
examples of right left discrimination
lesion area of right left discrimination
parietal lobe of either hemisphere
the patient is asked to point to body parts on command is example of testing for
right left discrimination
treatment strategies for right left discrimination
compensatory approach
-avoid left and right
how to rule out with right left discrimination
test first without the terms “left” and “right”
an inability to identify the fingers of the hand or that of the examiners
finger agnosia
lesion area for finger agnosia
parietal lobe at the region of the angular gyrus of the left hemisphere
portion of Sauguet’s test that includes items such as therapist touching the patients hand, recognition of a picture, and with imitation
example of testing for finger agnosia
treatment strategies for finger agnosia
limited evidence BUT remedial approach can be attempted
spatial relations syndrome impairments
figure-ground discrimination, form discrimination, spatial relation, position in space, topographical disorientation, depth and distance perception
inability to distinguish a figure from the background in which it is embedded
figure ground discrimination
difficulty ignoring irrelevant visual stimuli, increased distractibility, shortened attention span, frustration, and reduced safety
functional relevance for figure-ground discrimination
lesion area for figure - ground discrimination
parieto-occiptal lesion of the right hemisphere
what test can be done for figure-ground discrimination?
the ayres figure ground test
remedial and compensatory
treatment strategies for figure ground discrimination
impairment of discrimination in the ability to perceive or attend to subtle differences in form and shape
form discrimination
lesion area in form discrimination
pareto-temporoccipital region in the non-dominant lobe
the patient is asked to identify several items similar in shape and different in shape
testing for form discrimination
treating strategies for form discrimination
remedial and compensatory approach
inability to perceive the relation of one object in space to another object
spatial relations disorder/spatial disorientation
spatial relation skills are required to manage ____________
most ADLs
what are examples of spatial relation disorders?
- difficulty with setting the table
- difficulty reading a clock
- difficulty with preparing for a transfer
lesion area for spatial relations
inferior parietal lobe or parieto-occipital junction on the right
testing for spatial relations
riverbed perceptual assessment battery (RPAB)
arnadottir OT -ADL neurobehavioral evaluation (A -ONE)
remedial approach: providing instruction to the patient to position themselves in relation to the therapist or another object, setup a maze, incorporation of midline crossing activities
treatment strategies for spatial relations
inability to perceive and interpret spatial concepts such as up, down, over, under
position in space
lesion area for position in space
non-dominant parietal lobe
utilize a shoe and shoebox and ask the patient to place in the shoe in different positions in relation to the shoe box
example of testing for position space
figure-ground difficulty, apraxia, incoordination, and lack of comprehension should be ruled out
position in space
what is the retaining approach?
3 or 4 identical objects are placed in the same orientation with an additional object placed in different orientation
