Week 2 - Perceptual Deficits

Question 1

A hemisphere in the brain which controls (R) sided voluntary movements and is responsible for the verbal-analytical activities

Answer 1

Left hemisphere (dominant)

Question 2

A hemisphere which controls (L) sided voluntary movements and is responsible for visuo-spatial functions

Answer 2

Right hemisphere (non-dominant)

Question 3

Type of unilateral neglect where there is a failure to generate movement responses to a stimulus even though person is fully aware of the stimulus and can not be explained by weakness

Answer 3

Motor (output neglect, intentional neglect)

Question 4

Failure to respond, report, or orient to stimuli presented to the contralesional side of the body or space and this failure can not be attributed to either sensory or motor deficits

Answer 4

Unilateral spatial neglect

Question 5

Type of unilateral neglect where there is unawareness of sensory stimuli on the contralesional side. Can be visual, auditory, or somatosensory

Answer 5

Sensory (inattentive, attentional neglect)

Question 6

What is extinction?

Answer 6

Failure to respond to recognise a stimulus on the affected side when simultaneous stimuli are presented on both sides of the body in the same area

Question 7

Representational/imagery neglect

Answer 7

Ignores contralaesional half of the internally generated images (eg. ask patient to visualise task, action/environment but they can only remember half)

Question 8

How do we assess for visuospatial neglect?

Answer 8

• Observe how patient moves within the environment
• “Point at all blue chairs in the room”
• Drawing tests: clock, house, line bisection
• Tests for double simultaneous stimulation for sensory and visual inattention

Question 9

What is egocentric neglect?

Answer 9

Ignoring items on the left side of a display

Question 10

What is allocentric neglect?

Answer 10

Ignoring the left side of items regardless of position in the display

Question 11

What is agnosia and what are the 3 types?

Answer 11

It is a perceptual deficit that deals with a person’s lack of recognition of familiar objects as perceived through senses
- Visual: patient may fail to recognise family or physician
- Tactile: inability to recognise object by touch
- Auditory: unable to determine familiar sounds (eg. piano in background, but patient is unable to recognise whether audio is piano or drum)

Question 12

Unaware of own body parts, disturbance in perception of own body parts. Patient may deny owning a limb and can neglect on side of the body

Answer 12

Autotopagnosia

Question 13

Unawarenesss of a condition or denial of an illness. Minimises responsibility for resulting problems (eg. blind patient: “room is so dark please turn light on)

Answer 13

Anosognosia

Question 14

What is motor impersistance?

Answer 14

Failure to persist in/sustain a motor activity/contraction due to inability to sustain directed attention (eg. keeping eyes closed, get stuck/lose track half way through reaching task)

Question 15

What is (R) (non dominant) hemisphere - Constructional apraxia?

Answer 15

Impairment in producing designs in 2 or 3 dimensions by copying, drawing, and or constructing, whether on command or spontaneously. Patients can’t incorporate spatial information into task

Question 16

What is (R) (non domintnat) hemisphere - Dressing apraxia?

Answer 16

Inability to dress oneself because of a disorder in body scheme and/or spatial relations (clothes inside out/upside down)

Question 17

What is topographical disorientation?

Answer 17

Inability to find one’s way in familiar surroundings or to learn in a new situation. Having difficulty in understanding and remembering relationships of places to one another

Question 18

How do we assess for topographical disorientation?

Answer 18

• Ask patient to draw floor plan of home
• Show way back to ward/how to move from room to physio room
• Ask them to walk you through plan

Question 19

How do we assess for constructional apraxia?

Answer 19

• 2D tests: drawing, copying matchstick patterns
• 3D tests: copying block designs, puzzles
• Use verbal strategy since trouble with spatial

Question 20

How do we assess dressing apraxia?

Answer 20

• Observe patients attempting to dress, note problems
• Use cues, colour codes, labels, set procedures

Question 21

What is poor spatial judgement and how do we assess it?

Answer 21

Inability to judge distance, depth, size or shape. Verticality (position of self, position of objects in external environment)

Ask patient to identify which object is bigger/closer. Hold up stick against plain background and ask patient if it is upright

Question 22

What is (L) (dominant) hemisphere - Ideomotor apraxia?

Answer 22

Inability to imitate gestures/perform purposeful movement on command even though concept is fully understand

Question 23

How to help with ideomotor apraxia?

Answer 23

Do not break movement/task up into separate parts, train task as a whole

Question 24

What is (L) (dominant) hemisphere - Ideational apraxia?

Answer 24

Inability to carry out activities automatically or on command because no longer understands concept or idea behind the act (eg. might put shoes on before socks)

Question 25

How to help with ideational apraxia?

Answer 25

Cueing, breaking down task into components
- Responds best to simple, automatic cues
- More facilitation and handling to give idea of movement
- Use of objects to give idea of the motor task required

Question 26

How do we assess ideomotor and ideational apraxia?

Answer 26

Patient is given a command to do movement/motor task (eg. roll over, drink from cup, brush teeth)
Observe response; automatic task easier with ideomotor

Question 27

What is the Goodglass Assessment for apraxia?

Answer 27

1. Pantomine (show me how to comb your hair)
2. Imitation (watch how I comb it then you do)
3. Use of actual object
4. Imitation of examiner using actual object

Question 28

What are some treatment strategies for perceptual problems?

Answer 28

• Functional approach used (identify by observing what the issue is, then breakdown. Repeat & practise & reinforce)
• Use visual cues/spatial ability with planning problems
• Use verbal strategy with spatial problems
• Use verbal & cognitive ability with L hemiplegics
• Use gesture, automatic cues and only simple verbal cues with R hemiplegics

Question 29

Three types of neglect in relation to where in space

Answer 29

• Personal space: one’s own bubble (eg. dressing, shaving)
• Peri-personal space: within reaching distance
• Extra-personal space: beyond arm’s reach