Week 4: Non-motor neurological impairments

Question 1

What are the S&S’s of vesitbular impairments?

Answer 1

• dizziness and nausea
• disorientation to gravity
• nystagmus

Question 2

What question can you ask to identify a vestibular impairment?

Answer 2

Does lying down and/or turning over in bed make you feel dizzy?

Question 3

How can we train in the presence of dizziness/nausea?

Answer 3

• avoid movements which provoke symptoms initially
• start w/small, slow movements
• progress to larger amplitude
• vary support surface
• vary visual info.

Question 4

What is Pusher Syndrone?

Answer 4

• when Pt. pushes toward affected side in sitting and standing even if they will fall over
• scared to move

Question 5

How can we train Pt.’s w/Pusher Syndrome?

Answer 5

• do not physically force Pt. back to vertical - Pt. needs to realise they are not upright
• provide visual cues for vertical alignment

Question 6

What are 2 types of visual impairment?

Answer 6

• disruption of fixation (keeping eyes still while looking in one place)
• disruption of saccades (moving eyes to scan object/environment)

Question 7

What are some adaptive behaviours of Pt.’s w/visual impairments?

Answer 7

• omit objects or relevant parts of a scene in the blind visual field
• miss objects or critical features of objects in blind visual field
• bump into objects
• difficulty locating specific objects in a cluttered field
• difficulty reading

Question 8

How can we train in the presence of visual impairment?

Answer 8

• use visual cues (for upright) in training
• Pt. needs to practice moving eyes as well as head to scan objects and environments for key features in the blind visual field

Question 9

What is Broca’s (expressive) aphasia and how must we adapt training for these Pt.’s?

Answer 9

• language Impairment where a person can comprehend what is being said but cannot clearly express their own thoughts
• need to change the way we frame questions so that their answer doesn’t need to be too complex
• consult speech pathologist

Question 10

What is Wernicke’s (receptive) aphasia and how must we adapt training for these Pt.’s?

Answer 10

• language impairment where a person cannot comprehend what is being said to them and their reading/writing may also be affected
• need to use more non-verbal cues
• consult speech pathologist

Question 11

What are perceptual cognitive impairments (PCI)?

Answer 11

Impairments that affect a persons perception of the information they receive from senses

Question 12

What is slowed information processing and how can it impact practice?

Answer 12

• slowness in response to cognitive demands, decreased ability to do 2 things at once
• allow extra processing time
• written instructions

Question 13

What are the 3 types of inattention?

Answer 13

• sustained: decreased ability to attend to a task over time
• selective: distractible, decreased ability to attend to relevant and ignore irrelevant info.
• spatial (neglect): decreased ability to attend to info. on both sides of the body and environment

Question 14

What are the impacts of inattention on practice?

Answer 14

• sustained: Pt. becomes mentally fatigued after just a few repetitions
• selective: Pt. is distracted after just a few repetitions
• spatial neglect: Pt. unable to attend to stimuli on one side of their body/environment
• -> important to intellectualise the problem (i.e. explain that their brain is playing tricks on them)

Question 15

What are the 2 types of memory loss and what might be their impact on trainings?

Answer 15

• short-term memory loss: not enough reps
• post-traumatic amnesia: disorientation and confusion may result in denial of impairments and refusal to undertake practice

Question 16

What is apathy and how can it impact training?

Answer 16

• a behavioural impairment that causes reduced goal directed behaviour
• Pt.’s are unable to complete sufficient, appropriate practice to improve motor performance
• inability to plan and initiate activities

Question 17

What is emotional lability and how can it impact traning?

Answer 17

• outbursts of uncontrolled and inappropriate emotion e.g. crying or laughing
• decreases amount and retention of practice

Question 18

What are some considerations for training Pt.’s with emotional lability?

Answer 18

• instruct Pt. to “take a deep breath and breathe quietly through nose”
• hold jaw close and say “take a deep breath and stop crying”
• ask Pt. to blow gently
• medication
• continue training

Question 19

What is disinhibition and what is its potential impact on training?

Answer 19

• a behavioural impairment where a person is unable to control drives e.g. anger, sexual, hunger
• Pt.’s are unable to complete sufficient, appropriate practice to improve performance

Question 20

What are some considerations for training Pt.’s with disinihibition?

Answer 20

• fogging: “that may be so but now you need to…”
• broken record: stay calm and deliver same response
• contracts
• reinforcers
• TOOTS