Week 6: Assessment of Perceptual Dysfunction

Question 1

T/F: Importance to use bottom up approach to evaluate impairments in visual foundation skills (acuity, oculomotor function, visual field function, visual attention, and visual scanning prior to evaluating higher level perceptual skills covered)

Answer 1

True

Question 2

which evaluates perceptual and perceptual motor dysfunction in context of ADL and functional mobility tasks including ideational apraxia, ideomotor apraxia, unilateral neglect, body scheme disorders, organization/sequencing dysfunction, agnosias, and spatial dysfunction

Answer 2

Arnadottir OT-ADL Neurobehavioral Evaluation (A-ONE)

Question 3

focuses on remediating and compensating for perceptual and cognitive impairments by promoting generalization of functional skills across multiple context
Key concepts: visual processing strategies, task analysis, establish criteria for transfer of learning, practice in multiple environments
Assist client with TBI to gain self awareness of perceptual and cognitive strengths and weaknesses to promote use of strategies for remediation or compensation of skills across multiple contexts

Answer 3

Toglia’s Multicontext Treatment Approach

Question 4

evaluates performance skills needed for engagement in areas of occupation by assessing 16 motor skills and 20 process skills (e.g. temporal organization, organizing space and objects) OT needs training and certification

Answer 4

AMPS (assessment of motor and process skills)

Question 5

comprehensive profile of visual perceptual and motor skills and involve both motor free and constructional functions

Answer 5

LOTCA (Loewenstein OT cognitive assessment) and Rivermead Perceptual Assessment Battery

Question 6

assess basic visual perceptual abilities

Answer 6

MVPT-R (Motor Free Visual Perceptual Test Revised

Question 7

provides multiple choice format, test items require higher level of visual analysis compared with MVPT, and test is untimed

Answer 7

TVPS-UL (test of visual perceptual skills upper level)

Question 8

requires individual mentally assemble fragmented drawings of common objects

Answer 8

Hooper Visual Organization Test r

Question 9

high level assessment of visual organization, requiring mental rotation of fragmented geometric shapes

Answer 9

Minnesota Paper Form Board Test

Question 10

Not being able to verbally identify objects via visual input
Cannot recognize and identify an item using only visual means. If person holds object, they can identify object via tactile input or smell but not vision
Caused by lesion in right occipital lobe or posterior multimodal association area
Person with BLANK can demonstrate normal visual foundation skills

Answer 10

Agnosia

Question 11

Assessment: ask person to identify 5 common objects by sight (ex. Keys, comb, pencil, eyeglasses, watch). If client demonstrates word finding difficulties, offer client a choice of 3 answers. Ask client to indicate correct choice through a head nod. If client unable to name 4 out of 5 objects,

Answer 11

Agnosia

Question 12

Client’s inability to remember and recognize specific colors for common objects in environment (e.g. Walter couldn’t recognize color paints he was using, painted grass blue instead of green)

Answer 12

Color agnosia

Question 13

Assessment: present client with 2 common objects that are accurately colored and 2 objects not accurately colored. Ask client to pick out objects that are not accurately colored.

Answer 13

Color agnosia

Question 14

Client’s inability to name the color of the objects. Client understands differences between diff. Colors of objects, but can’t name them accurately (e.g. Walt can recognize color red but not able to name it such)

Answer 14

Color Anomia

Question 15

Assessment: ask client to name color of various objects in his environment. If client has aphasia, ask him to nod yes or no after offering patient choice of colors.

Answer 15

Color Anomia

Question 16

Refers to visual distortion of objects, such as physical properties of size and weight (e.g. can’t distinguish between football, basketball, volleyball because each of them appeared heavier, lighter, smaller than they actually were, making it hard to distinguish differences between them through observation alone)

Answer 16

Metamorphopsia

Question 17

Assessment: present client with various objects of diff. Weights and sizes (e.g. ball, cup with water, puzzle pieces) and ask client to place each object according to size or weight through observation alone.

Answer 17

Metamorphopsia

Question 18

Inability to recognize and identify familiar faces caused by lesion of right posterior hemisphere
Difficulty recognizing his or her own face, faces of family and friends, or celebrities
Person compensate by relying on auditory cues or distinctive features like long wavy hair
Brain lesions can also impair ability to interpret facial expressions

Answer 18

Prosopagnosia

Question 19

Assessment: Test of Facial Recognition - presents multiple choice matching of faces presented in front view and side view and under various lighting conditions.
Informal assessment: have client identify names of people in photographs, with people in real life, or by having client identify their own face in mirror.

Answer 19

Prosopagnosia

Question 20

Inability to recognize and interpret visual array as a whole, and it is caused by lesions to right hemisphere of brain. Can identify individual components of visual scene but aren’t able to recognize and interpret scene as whole (e.g. Walt can identify flowers and trees but can’t interpret setting as landscape surrounding his house)

Answer 20

Simultanagnosia

Question 21

Assessment: [resenting client with a photograph with detailed visual array (e.g. family photo at beach) and asking cient to describe scene as whole. Client can identify specific features (e.g. sand castle) but can’t describe context/meaning of whole scene (e.g. family trip to beach)

Answer 21

Simultanagnosia

Question 22

Difficulty distinguishing targeted object from background

Answer 22

Figure ground discrimination dysfunction

Question 23

Assessment: during dressing activity, you may ask client to identify the white undershirt that is located on top of his white sheets. In kitchen, ask client to pick out spoons from disorganized utensil drawer. ________ dysfunction indicated if client is unable to discriminate foreground from background

Answer 23

Figure ground discrimination dysfunction

Question 24

Inability to recognize various forms, shapes, objects regardless of location, position or size (e.g. can’t perceive all pencils on a desk in various sizes or positions in pencil holder)

Answer 24

Form-Constancy Dysfunction

Question 25

Assessment: ask client to identify familiar objects in his environment through observation alone when objects are placed upside down or on their side (e.g. in kitchen, ask client to identify cup that is turned upside down or toaster oven placed on side).

Answer 25

Form-Constancy Dysfunction

Question 26

Position in space or spatial relations is relative orientation of a shape or object to the self (e.g. this perception allows person to recognize tip of pencil is pointed away from him)

Answer 26

Position in space

Question 27

Assessment: have client place common objects in relation to self or other objects using directional terms: top/bottom, up/down, in/out, behind/in front of, etc. If client can’t discern relationships of objects to self, may have _____ dysfunction

Answer 27

Position in space

Question 28

Ability to accurately use concepts of right and left

Answer 28

Right-Left Discrimination Dysfunction

Question 29

Assessment: ask client to point to various body parts or assess client’s’ ability to accurately navigate environment through verbal commands using right and left

Answer 29

Right-Left Discrimination Dysfunction

Question 30

Inability to perceive depth in relation to self or in relation to various objects in environment
Clients with visual dysfunction in one eye may demonstrate stereopsis because binocular visual input from both eyes is required to perceive depth

Answer 30

Stereopsis

Question 31

Assessment: place variety of common objects on table surface and ask client to identify which object is closer and which is farther away. _____ if client can’t judge distance between objects in environment

Answer 31

Stereopsis

Question 32

Deficit of stereognosis (which we all should know by now… but to recap: skill enabling person to identify common objects through tactile perception without aid of vision)
Person with astereognosis must monitor use of their hands during activities, so they must be very slow and purposeful in movements

Answer 32

Asterognosis

Question 33

Assessment: client’s vision occluded, OT hands client object, client should name object or describe it. OT notes how quickly and correctly identified

Answer 33

Asterognosis

Question 34

Inability to recognize numbers, letters, or forms written on the skin

Answer 34

Agraphesthesia

Question 35

Assessment: client’s vision occluded and traces numbers, letters, shapes on fingertips or palms with dull pointed pencil or similar tool. If they can’t identify symbol written on hand, they have _____

Answer 35

Agraphesthesia

Question 36

Disorder of body schema or autotopagnosia - person’s sense of own body shape and position is distorted (esp. After CVA or TBI)
Can be noted in person’s attempt to draw human figure or unrealistic expectations of performance abilities (e.g. person with left hemiplegia after TBI expressed his intention to return to manual labor job of installing doors)
Disorder can affect egocentric perception of one’s own body or allocentric orientation of another person’s body
May neglect one side of body or demonstrate distorted impressions of body’s configuration
May confuse his or her body with that of another

Answer 36

Body Schema Perception Disorders

Question 37

inability to discriminate fingers of hand, can also be part of disorder

Answer 37

Finger agnosia

Question 38

ask individual to draw human figure or point to body parts on command.

Answer 38

Body Schema Perception Disorders

Question 39

can be evaluated by having client’s vision occluded and client identify each finger as OT touches it.

Answer 39

Finger agnosia

Question 40

It can be observed during occupational performance as client ignores affected limb or states that a body part is not their own.

Answer 40

Unilateral body neglect

Question 41

may be clinically indicated if client is unable to correctly identify parts of their body

Answer 41

Body schema perception disorder

Question 42

deficit in execution of learned movement which cannot be accounted for by either weakness, incoordination, or sensory loss, or by incomprehension of or inattention to commands. Result from damage to either side of brain or corpus callosum, but mainly left hemisphere. Often seen in persons with aphasia though not all aphasic persons are apraxic, and vice versa. May occur after CVA or TBI

Answer 42

Apraxia

Question 43

Also known as conceptual apraxia - Inability to use real objects appropriately (may use wrong tool for task) or difficulty sequencing acts in proper order

Answer 43

Ideational Apraxia

Question 44

Inability to carry out motor act on verbal command or imitation. However, is able to perform act correctly when asked to use the actual object (e.g. person unable to mime action of brushing teeth on request but is observed using toothbrush correctly when he is performing grooming activities in context)
Impairments are demonstrated only in testing environment and appear to have little functional impact as compared to ideational apraxia

Answer 44

Ideomotor Apraxia

Question 45

Inability to plan effective motor actions required during dressing one’s upper and lower body

Answer 45

Dressing Apraxia

Question 46

Important that assessment of sensory function, muscle strength, dexterity completed BEFORE OR AFTER test of praxis because deficits in these areas would complicate any assessment of apraxia

Answer 46

Important that assessment of sensory function, muscle strength, dexterity completed before test of praxis because deficits in these areas would complicate any assessment of apraxia

Question 47

FAST (florida apraxia screening test), Movement Imitation test, Use of Objects test, LOTCA, Santa Clara Valley Medical Center Praxis test, Solet Test for Apraxia

Answer 47

Apraxia assessments

Question 48

Inability to organize or assemble parts into a whole, as in putting together block designs or drawings
Affect dressing, organizing food in fridge, following instructions to assemble IKEA furniture, loading dishwasher

Answer 48

Constructional Disorder

Question 49

Assessments: Formal: test of visual motor skills for adults, Benton visual retention test, rey complex figure assessment, three-dimensional block construction. Informal: have build structure matching model, drawing
Type of tests affect score, better scores on 3D models as guides for construction rather than photographs/drawings

Answer 49

Constructional Disorder