Week Five Flashcards
What side of the brain needs to be working for perception
The right side which controls visual-spatial perception and constructional deficits
Sensory integratory area of the parietal lobe
What is perception and what does it involve
Creating of meaning out of a somatosensory inputs
- vision
- touch
- taste
Damage to the left hemisphere vs damage to the right hemisphere
Left: Dominant
Results in language deficits and temporal (sequencing) deficits (including problems with initiation)
Right: Non-dominant
Results in disordered visual-spatial perception and constructional deficits
Left brain function vs right brain function
Left: Logic Detail oriented Facts rule Words and language Maths and science Order/pattern perception Reality based Forms strategies Safe
Right: Uses feelings Big picture orientated Symbols and images present Can 'get it' - the meaning Can appreciate spatial perception Knows object function Fantasy based Risk taking
What is our role in perceptual rehabilitation
Testing done by OT’s
Recognise presence of perceptual and motor planning deficits
Apply simple tests to establish severity and monitor progress
Understand the implications of these deficits for movement retraining
Know how to modify PT management in the presence of these deficits in order to optimise motor retraining and functional capacity
What are the different types of perceptual deficits
Body schema Agnosia - including unilateral neglect Right/left discrimination Spatial relations Praxia Tactile perception
People with perception issues can’t work out speed or depth
What is body schema
Ask patient to point to named body parts
Draw a man
What is agnosia and what are the different types
May present as a complete denial of disability (anasognoisa)
Or as organ specific impairments (e.g. Visual agnosia - failure to recognise familiar objects)
Prosopagnosia - inability to recognise faces
Finger agnosia - failure to recognise which finger is touched (Gerstmann’s syndrome)
Important to note that the sensation in the organ is intact but the information is not being processed normally
May be associated with a cognitive impairment - e.g. Poor insight
What is unilateral neglect and what side is it most commonly on
Ask them to draw a clock, cross out all the lines, draw a face etc they will only do one side
Frequently on left side, due to right brain injury
What is left/right discrimination
Get them to show you their right hand, left ear, hold something in their right hand etc
Laterality
Sometimes need to tell them that their watch is on their left side - this may help them with L vs R
Spatial relations
Figure/ground (identify overlapping 2D or 3D objects)
Position one in front of the other
Verticality - rotate a ruler/walking stick in front of the patient and ask them to tell you when it is straight up and down
- associated with Pusher
What is tactile sensation and a test for it
Astereognosis - ask patient to recognise objects placed in their hand when their eyes are closed
What is a sensory inattention test
Tactile inattention or extinction
Able to identify and localised light touch when each limb is tested in isolation but not during bilateral simultaneous stimulation - will only say they can feel unaffected side
Perseveration
Observation of pen paper tasks, may be evident in speech and motor tasks
Patient becomes stuck at one component of the task and continues to repeat that component over and over again
An indication of failure to self monitor behaviour
What is praxia
Inability to perform a task, even though there’s nothing wrong with their motor path
Make sure when testing them that you use common objects and make common actions
Three types
- ideational
- ideomotor
- constructional
What is dyspraxia
Difficulty in performing a willed purposeful movement or imitating a movement
Disorder affecting the purposeful execution of learned and meaningful activities
Inability to perform the activity is not a result of primary motor or sensory impairments, or deficits in comprehension, memory or motivation
Due to damage in the somesthetic association cortex of the parietal lobe
More commonly found in left sided lesions
May also be associated with damage in the premotor cortex of the frontal lobe causing problems with the execution and sequencing of purposeful movements
Ideomotor dyspraxia
Inability to execute ideas or previously learned movements
Difficulty orientating items in the correct plane
Poor initiation, timing and direction of movements
Difficultly performing the movement on command but can do it voluntarily/automatic
- can’t roll on command but can do it to get out of bed
Ideational dyspraxia
Inability to understand purpose of action/task, incorrect object use
- unable to put a coat on
Difficulty sequencing tasks
Parts of task omitted/wrong order
Difficulty conceptualising the task
Difficulty initiating the task
Know it’s a coat but don’t know to put it on when it’s cold
Constructional dyspraxia
Difficulty coping with visual representation, even simple pictures
Writing may appear crowded and poorly spaced on page
Difficulty creating 3D objects
May have difficulty moving in space
Inability to do more with spacing a timing
How do you manage perceptual deficits
Reassure family they’re not crazy or wilful
Ensure you educate the patient
Encourage patient to compensate in terms of scanning
Advise patient and family that they will most improve
Avoid fatigued noisy/busy environments and stress as these will reduce the processing of information/emphasis deficits
