Week 10: Cerebrum and Perceptual Screening

Question 1

Diencephalon

Answer 1

Center of the cerebrum (all around the thalamus) coordinating with the endocrine system to release hormones, relaying sensory and motor signals to the cerebral cortex, and regulating circadian rhythms (the sleep wake cycle).

Question 2

Cerebral blood supply

Answer 2

Circle of Willis
- Most strokes occur in the middle cerebral artery (70%)

Question 3

Blood Brain Barrier

Answer 3

• Blood vessels in the brain are more tightly aligned together than in the rest of the body
• Allows for protection of the brain from potentially harmful substances
• Astrocytes mediate the formation and functioning of the blood brain barrier

Question 4

Ventricles

Answer 4

• Four spaces within the brain filled with cerebrospinal fluid
• Cerebrospinal fluid provides nutrients to the CNS and removes waste
• The fourth ventricle drains into the subarachnoid fluid to the spinal cord
• Cerebrospinal fluid is drained into lymphatic channels for waste removal

Question 5

Thalamus

Answer 5

Relay center to/from cortex
- the thalamus is composed of different nuclei that each serve a unique role, ranging from relaying sensory and motor signals, as well as regulation of consciousness and alertness

Question 6

Hypothalamus and Pituitary Glad

Answer 6

Hypothalamus controls pituitary gland hormonal release to effect:
- Helps with body temperature, hunger/thirst, mood, sex drive, blood pressure, and sleep
- Sympathetic nervous system activation

Question 7

Corpus Callosum

Answer 7

Primary connection between brain hemispheres
- Bridge of white matter tracts
- Assists with bilateral movement planning and performance
- Split-brain experiments provided much of today’s knowledge on brain lateralization

Question 8

Internal Capsule

Answer 8

Space between basal ganglia and thalamus where white matter travels to/from cerebral cortex

Question 9

Cerebral cortex functions

Answer 9

Frontal: Executive functions, thinking, planning, organizing and problem solving, emotions and behavioral control and personality
Parietal: Perception, making sense of the world, spelling
- Temporal lobe: memory, understanding, and language
- Occipital lobe: Vision

Question 10

Cortical layers

Answer 10

6 layers of the cerebral cortex
- Layers 1-3: Cortico-cortico
- Layer 4: Main input from thalamus
- Layer 5: Main output to brain and spinal cord
- Layer 6: Output to thalamus

Question 11

Traumatic Brain Injury

Answer 11

Various methods for force to travel through the brain

Question 12

Stroke

Answer 12

Brain damage from blood supply interruption
- Ischemic: blood supply is interrupted or reduced, preventing oxygen from reaching brain regions
- Hemorrhagic: Less common bleeding into the brain by blood vessel rupture
Acute signs = impaired balance, one sided weakness and facial dropping, impaired speech
Flaccid —-> Spastic
- Frequent shoulder subluxation during flaccid stage
- Flexions synery posturing and movements. Difficult to move out of flexion synergy
- Compensatory trunk movements
- Leg circumduction
**There may be decline in one region of motor map dur to non-used leads to expanded map in adjacent regions, independent of the injury

Question 13

Visual agnosia

Answer 13

An umbrella term for the inability to identify and recognize familiar objects and people despite intact visual anatomical structures (client asked to identify person or object)

Question 14

Prospagnosia

Answer 14

The inability to idetnify family faces because he patient cannot perceive the unique expressions of facial muscles (show client picture of family or celebrities)

Question 15

Simultanagnosia

Answer 15

The inability to interpret a visual stimulus as a whole (focus in on a specific aspect e.g., show a forest - pt. can tell you there are trees but not that they are looking at a forest)

Question 16

Metamorphopsia

Answer 16

Involves a visual distortion of the physical properties of objects so that objects appear bigger, smaller, heavier, or light than they really are (Show client every day objects and ask them to estimate each object’s size and weight by observation alone)

Question 17

Color Agnosia

Answer 17

Inability to remember the appropriate colors for specific objects. An example is that the person thinks a banana is blue (ask the client to name the correct color for an apple, fire engine, a stick of butter, coffee)

Question 18

Color Anomia

Answer 18

The inability to remember the names of colors (Ask the client the name of a color)

Question 19

Right-left discrimination dysfunction

Answer 19

The inability to accurately use the concepts of right and left (ask the pt. to point to their own left and right body parts or following right-left commands)

Question 20

Figure-ground discrimination

Answer 20

An inability to distinguish objects in the foreground from objects in the background (ask the patient to pick a kitchen tool from a disorganized drawer)

Question 21

Form-constancy

Answer 21

The inability to recognize subtle variations in form or changes in form such as size variations in the same object (Cannot sort silverware can’t determine it is a fork if it is not right side up)

Question 22

Position-in-space

Answer 22

Involves difficulty using concepts relating to positions like up/down and in/out (ask the client to put things in, on underneath, on top of different surfaces)

Question 23

Topographical disorientation

Answer 23

Involved difficulty comprehending the relationship of 1 location to another (ask the client to find their way from one location to another location)

Question 24

Depth perception

Answer 24

An inability to describe whether objects in the environment are near or far in relation to each other and in relation to the patient (ask the client to identify which objects in the room are close/far in relation to each other)

Question 25

Unilateral neglect

Answer 25

The inability to integrate and use perceptions from 1 side of the body or 1 side of the environment (draw a clock or a human)

Question 26

Agnosognosia

Answer 26

Extensive neglect syndrome involving failure to recognize one’s paralyzes limbs as ones one - no concept of having left side of the body (Ask the patient to show you his or her affected upper extremity)

Question 27

Wernicke’s aphasia

Answer 27

Difficulty comprehending the literal meaning of language (ask simple questions like what is your name, they will not be able to understand and will offer an answer that does not make sense, clear meaningless gibrish)

Question 28

Alexia

Answer 28

The inability to comprehend the written word or the inability to read (Ask patient to read a sign or a paragraph with glasses on)

Question 29

Dyslexia

Answer 29

The impaired ability to read. Letters are misunderstood. (Ask the patient to read a sign or a paragraph

Question 30

Asymbolia

Answer 30

Difficulty comprehending gestures and symbols (Demonstrate a gesture and ask your patient what that means)

Question 31

Aprosodia

Answer 31

Aprosodia is impaired comprehension of tonal inflections use in conversation. (Say a neutral sentence but change inflection and ask patient to identify your emotion)

Question 32

Broca’s aphasia

Answer 32

Patients can understand what is spoken but cannot express their ideas in an understandable way (Ask simple questions like what is your name and they will speak in not fluent sentences that do not make sense)

Question 33

Agrammatism

Answer 33

The inability to arrange words sequentially so that they form intelligible sentences in conversation or writing. (Ask the patient to write or verbally repeat a sentence in the right order)

Question 34

Agraphia

Answer 34

The inability to write intelligible words and sentence (Ask the patient to write their address, they will attempt but it will look like scribble)

Question 35

Dysgraphia

Answer 35

The inability to write because the patient cannot break words into letters (The writing of a patient contains words with reversed letters, flipped letters, and mixed-up sequences of letters)

Question 36

Ideational apraxia

Answer 36

Inability to cognitively understand the motor demands of a task involving multiple, sequential steps (example does not know that a shirt is an article of clothing to be worn on the upper extremit)

Question 37

Ideomotor apraxia

Answer 37

The loss of kinesthetic memory of motor patterns - the motor plan for a specific task lost (Patients knows that a toothbrush is for brushing but can’t access an appropriate motor plan and uses the toothbrush to brush their hair)

Question 38

Dressing apraxia

Answer 38

Inability to dress oneself due to body-schema disorder or apraxia - patients understanding of his or her body in spaces has become distorted.

Question 39

2 & 3 dimensional constructional apraxia

Answer 39

Involves an inability to copy or build 2- and 3- dimensional designs (ask client to construct a 3d block design by copying 2D instructions, instruct the client to construct a house using Legos based on a 3D model) - Most likely to affect trades and craft persons e.g., carpenter, plumber, and architect

Question 40

An OT asks a client if they typically wear glasses. The client responds by saying “pumpkin shopping cart” After the client sees the OTR looking perplexed, the client retrieves their glasses from the bedside table. This is an example of which of the following?

Answer 40

Broca’s aphasia

Question 41

During the inpatient OT session, the client’s wife walks in the room. The client, however, is unable to recognize his wife. This is an example of which condition?

Answer 41

Prosopagnosia

Question 42

An OTR is working in acute care when a client’s meal tray was delivered. The client takes the plate cover off and puts it on their head as a hat. Which of the following is most likely affected?

Answer 42

Ideational apraxia

Question 43

During an inpatient rehabilitation evaluation, the OTR asks the client to write their address. Instead the client just scribbles. Which of the following is most likely to be affected?

Answer 43

Agraphia

Question 44

An OTR walks into a clients room in inpatient rehab, and notices the client coloring in an adult coloring book. In the book, the OTR notes that the client made the sky brown, flower petals green, and clouds red. Which of the following is most likely indicated?

Answer 44

Color agnosia

Question 45

Which artery do most strokes occur in?

Answer 45

Middle cerebral artery

Question 46

Which brain structure is known as the relay center to/from the cerebral cortex?

Answer 46

The thalamus

Question 47

The ____ lobe of the cerebral cortex is primarily involved with perception.

Answer 47

Parietal Lobe

Question 48

A ____ stroke involves bleeding in the brain by blood vessel rupture

Answer 48

Hemorrhagic

Question 49

A typical flexion synergy posture of the UE post-stroke involves which forearm and wrist position

Answer 49

Forearm pronation and wrist flexion