Week 1

Question 1

Perception:

Answer 1

the ability to process and interpret sensory

information

Question 2

Perceptual Impairments

Classification

Answer 2

1. Unilateral Neglect
2. Inattention/extinction
3. Agnosias
4. Other impairments of visuospatial awareness
5. Pushing Behaviour

Question 3

Unilateral Neglect

Definition:

Answer 3

– The failure to report, respond or orient
– To novel or meaningful stimuli
– Presented to the side opposite a brain lesion
– When this failure cannot be attributed to either
sensory or motor impairments

Question 4

Unilateral Neglect

Incidence:

Answer 4

– 11–82 % following stroke in the right side of the brain

Question 5

Unilateral Neglect

• Neglect associated with

Answer 5

– longer length of stay in rehabilitation

– poorer functional outcome following stroke

Question 6

Unilateral Neglect

• Synonyms

Answer 6

– Unilateral spatial neglect
– Inattention (X)
– Hemi‐neglect
– Hemi‐spatial neglect
– Neglect syndrome
– Contralesional neglect
– Visual spatial neglect

Question 7

What side is neglect more common on and why?

Answer 7

• Left neglect following
right sided stroke is most
common
• Right hemisphere directs
attention to both right
and left hemispaces
• Left hemisphere directs
attention primarily to
right hemispace
-– does not usually result in UN
– intact right hemisphere can direct attention to
both hemispaces

Question 8

Types of unilateral neglect

Answer 8

– sensory neglect
– motor neglect
– representational neglect

Question 9

Unilateral Neglect

• Sensory neglect

Answer 9

• Sensory neglect
– decreased awareness of sensory stimulation in
the contralesional hemispace
– despite intact primary sensory cortical area and
sensory pathways

Question 10

Unilateral Neglect

• Motor neglect

Answer 10

– Decreased ability to move in the contralesional
hemispace
– Despite being aware of a stimulus in that space
– Not a deficit of the motor pathway

Question 11

Unilateral Neglect

• Representational neglect

Answer 11

• Representational neglect
– person ignores the contralesional half of
internally generated images
– Internally generated images are mental
representations or visualizations of a task, action,
or environment

Question 12

Unilateral Neglect

Distribution of neglect

Answer 12

• Personal

– contralesional ½ of body

• Spatial:

       – Peripersonal • contralesional near space within reaching distance
       – Extrapersonal • space beyond reaching distance

Question 13

Looking for neglect during functional assessment

Answer 13

• Note failure to use or attend to one side of body or
environment
• Note any mismatch between:
– Strength observed during assessment in chair/on
bed
– Functional use of limbs during STS or gait etc.

Question 14

Possible observations UN physio assessment neglect

Answer 14

Possible observations during Functional Assessment
• Gaze to the lesion side (often right)
• May slump or lean to lesion side
• Ignore objects in the contra‐lesional visual field
• Run into objects and doorways on contra‐lesional side
• May leave hemiplegic arm behind when rolling
• Difficulty crossing midline

Question 15

Unilateral neglect impairment measures

Answer 15

Line bisection
Cancellation Tasks
The Bells Test
Star cancellation test

Question 16

Behavioural assessment of neglect

Answer 16

• Catherine Bergego Scale

* The Behavioural Inattention Test

Question 17

Most sensistive neglect measure

Answer 17

• Behavioural assessment of neglect in daily life was more

sensitive than any other single measure of neglect. (Catherine Bergego Scale)

Question 18

Agnosias

Answer 18

Agnosias
• The inability to recognise objects or symbols in
the absence of impairments of the primary
senses
• Visual, auditory, tactile or proprioceptive

Question 19

Astereognosis (tactile agnosia)

Answer 19

• The inability to recognise objects
by touch even though tactile,
thermal and proprioceptive
functions are intact

Question 20

Autotopagnosia

Answer 20

• Disturbed perception of the patient’s own body parts
• May be unaware of existence of one side of body
• May be unable to distinguish right from left (laterality)

Question 21

Anosognosia

Answer 21

• Failure to recognise the presence or severity of paralysis
• In subjective examination ‐ observe if patient is unrealistic
about their condition

Question 22

Verticality perception

Answer 22

• Subjective postural vertical

* Subjective visual vertical

Question 23

Before assessing visual perception, must first test

Answer 23

• Acuity
• Eye movements
• Visual fields

Question 24

Subjective postural vertical

Answer 24

• Perception of own body orientation
• Observe posture
• Move person into various positions
– ask if they feel ‘straight’ or ‘falling/leaning
to one side’
– do they have a fear of falling?

Question 25

Subjective Visual Vertical

Answer 25

Perception of position of objects in environment
– Hold a stick against a background with no cues
– Slowly rotate stick
– Ask person to

Question 26

Distance perception

Answer 26

Difficulty determining the relative
distance between objects and oneself
• May present as difficulty with stairs or
curbs or negotiating obstacles

Question 27

Size, colour or shape perception

Answer 27

• Functionally patient may show
inappropriate fear
– e.g. fear of rolling off edge of
bed when there is ample space

Question 28

Figure‐ground perception

Answer 28

– Inability to distinguish a specific stimulus
from its background
– Visual or auditory systems may be involved

Question 29

Direction sense

Answer 29

• Patient may have difficulty perceiving directions
despite having intact language skills:
– up
– down
– left
– right
– forwards
– backwards

Question 30

• Route finding impairment

Answer 30

• Inability to find one’s way in
familiar surroundings or to
learn the way in a new situation

Question 31

Pushing Behaviour

Answer 31

• Characterised by:
• an asymmetrical trunk
posture towards the
hemiplegic side
• active pushing towards
the hemiplegic side

Question 32

Pushing Behaviour

• Other terms in literature include:

Answer 32

– Pusher syndrome
– Contraversive pushing
– Ipsilateral pushing
– Lateropulsion

Question 33

PB Clinical Features

Answer 33

• Overactivity of the nonparetic
ipsilesional arm and leg
– extend the unaffected arm and leg
and actively push away from the
nonparetic side

• Resistance to attempts at passive
correction of posture towards the
ipsilesional side
• Falling towards hemiplegic side
• Fear of falling towards the ipsilesional side

Question 34

PB Clinical Features ‐ Severity

Answer 34

• Severity of PB appears to:
– Vary between individuals
– Vary within individuals over time
– Become more obvious when the base of support is
reduced

Question 35

Mechanism for Pushing Behaviour

Theories:

Answer 35

1. Disturbed perception of verticality:
– ? SVV
– ? SPV
– ? BOTH
2. Graviceptive Neglect
– Disrupted processing of graviceptive information
3. Right hemisphere syndrome
– PB is frequently associated with unilateral neglect but not always

Question 36

Management of Unilateral Neglect

Answer 36

• Approaches are classified into Top Down or Bottom Up

Question 37

Management of Unilateral Neglect

Top Down Approaches

Answer 37

• Aimed at cognitive level
• Train the person to voluntarily
compensate for their neglect
during activity
• Require awareness of the
impairment
• Interventions train clients to direct
attention to the neglected side

• Increase the person’s awareness and understanding of their
impairments using their intact verbal and cognitive ability
– e.g. if they have a disturbance of subjective postural
vertical:
• Point out that they are mistaken about the nature of
vertical
• Encourage them to align themselves with known
vertically oriented objects (e.g. a door frame)
Visual scanning training
• Initially train scanning to side of neglect
• Later train to scan to neglected side then back to other side
• Use bright objects, cards, numbers on wall