Week 6: Assessment of Perceptual Dysfunction Flashcards
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)
True
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
Arnadottir OT-ADL Neurobehavioral Evaluation (A-ONE)
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
Toglia’s Multicontext Treatment Approach
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
AMPS (assessment of motor and process skills)
comprehensive profile of visual perceptual and motor skills and involve both motor free and constructional functions
LOTCA (Loewenstein OT cognitive assessment) and Rivermead Perceptual Assessment Battery
assess basic visual perceptual abilities
MVPT-R (Motor Free Visual Perceptual Test Revised
provides multiple choice format, test items require higher level of visual analysis compared with MVPT, and test is untimed
TVPS-UL (test of visual perceptual skills upper level)
requires individual mentally assemble fragmented drawings of common objects
Hooper Visual Organization Test r
high level assessment of visual organization, requiring mental rotation of fragmented geometric shapes
Minnesota Paper Form Board Test
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
Agnosia
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,
Agnosia
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)
Color agnosia
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.
Color agnosia
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)
Color Anomia
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.
Color Anomia
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)
Metamorphopsia
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.
Metamorphopsia
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
Prosopagnosia
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.
Prosopagnosia
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)
Simultanagnosia
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)
Simultanagnosia
Difficulty distinguishing targeted object from background
Figure ground discrimination dysfunction
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
Figure ground discrimination dysfunction
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)
Form-Constancy Dysfunction
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).
Form-Constancy Dysfunction
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)
Position in space
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
Position in space
Ability to accurately use concepts of right and left
Right-Left Discrimination Dysfunction
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
Right-Left Discrimination Dysfunction
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
Stereopsis
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
Stereopsis
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
Asterognosis
Assessment: client’s vision occluded, OT hands client object, client should name object or describe it. OT notes how quickly and correctly identified
Asterognosis
Inability to recognize numbers, letters, or forms written on the skin
Agraphesthesia
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 _____
Agraphesthesia
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
Body Schema Perception Disorders
inability to discriminate fingers of hand, can also be part of disorder
Finger agnosia
ask individual to draw human figure or point to body parts on command.
Body Schema Perception Disorders
can be evaluated by having client’s vision occluded and client identify each finger as OT touches it.
Finger agnosia
It can be observed during occupational performance as client ignores affected limb or states that a body part is not their own.
Unilateral body neglect
may be clinically indicated if client is unable to correctly identify parts of their body
Body schema perception disorder
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
Apraxia
Also known as conceptual apraxia - Inability to use real objects appropriately (may use wrong tool for task) or difficulty sequencing acts in proper order
Ideational Apraxia
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
Ideomotor Apraxia
Inability to plan effective motor actions required during dressing one’s upper and lower body
Dressing Apraxia
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
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
FAST (florida apraxia screening test), Movement Imitation test, Use of Objects test, LOTCA, Santa Clara Valley Medical Center Praxis test, Solet Test for Apraxia
Apraxia assessments
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
Constructional Disorder
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
Constructional Disorder
