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Neurological Physiotherapy > Week 6 : Retraining Sensory, Perceptual and Behavioural Deficits > Flashcards

Week 6 : Retraining Sensory, Perceptual and Behavioural Deficits Flashcards

1
Q

List the 2 types of somatosensory impairments

A

proprioception

tactile impairments

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2
Q

Proprioception is made up of a range of sensations including

A 
recognition of movement 
movement heaviness
awareness of movement direction 
position in space 
sense of force 
timing of muscular contraction
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3
Q

Proprioception is critical to multisegmental movements

give a couple of examples

A 
STS 
stand to sit
manipulation 
gait 
balance
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4
Q

loss of proprioception is associated with what

A

poor motor function and reduced functional independence

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5
Q

sensory loss in proprioception impairments can be very specific, give an example

A

patient may recognise limb movement and position, but not movement direction

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6
Q

Tactile functions

A

sensory functions involve localisation and discrimination of stimuli

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7
Q

Is tactile function more essential in UL or LL?

A

UL

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8
Q

Difficulty in sustaining muscular contraction without tactile feedback results in what

A

slowness and clumsiness in many manual tasks

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9
Q

sensory impairments are linked to poor spontaneous limb use, T or F?

A

T

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10
Q

Functional impact of somatosensory impairments

A

relationship between motor and sensory function
impairments may be a major cause of functional disability
Individuals may recover the ability to activate muscle groups and control their limbs, however their activity and participation may still be very restricted in their natural environment
Tactile and proprioceptive sensation are critical to regaining effective motor function, especially upper limb
Somatosensation is required for the learning of new skills
Sensation functions in both regulatory and adaptive modes, guiding movements during their execution and correcting movements in order to improve the next attempt

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11
Q

give an example of the functional impact of somatosensory impairment

A

a patient may be able to effectively perform all components required for drinking, however poor sensory feedback may result in them dropping their glass
a patient may effectively mobilise on stairs, however when stepping down a curb poor sensory feedback may result in fear and reduced confidence

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12
Q

Assessment of somatosensory impairment

A

largely subjective
reliability and validity unconfirmed
common tests developed for peripheral lesions
cerebral lesions- emphasis needs to be on how stimulus is perceived and interpreted, not just nerve conduction
important to conduct thorough Ax of sensation
inc Hx of sensory loss and recovery, prognostic importance and treatment effectiveness
Determine how sensory impairments relate to performance of functional activities and participation

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13
Q

Specific assessments of somatosensory impairments

A 
light touch 
double simultaneous stimulation 
stereognosis 
pinprick 
temperature
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14
Q

rehabilitation of somatosensory impairments

A
  • founded on the assumption that sensory activation is specific to the task and the environment in which it is being performed
  • system is selective in the inputs utilised for specific functional activities

meaningful task practice
- task oriented training is directed toward enabling the patient to perform critical everyday actions more effectively and efficiently in the relevant environment and involves practice of the actions themselves (+/- action/ environmental modification)

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15
Q

During rehabilitation of somatosensory impairments, the pt must be an active participant because

A

non specific stimulation of a passive recipient is unlikely to affect the awareness of specific sensation

cognitively directed approach to motor training is required

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16
Q

pt’s need challenging and meaningful functional based rehabilitation with pt attending to sensory inputs and their relationship to the task, give an example

A

STS practice provides the opportunity to be aware of inputs from tactile and pressure receptors in the soles of the feet and kinaesthetic input from muscle and joint receptors, and may assist in limb positioning and loading

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17
Q

Visual impairments

- visual field loss

A

Vision is our major source of information about the environment and our place in it

Eye-head coordination is particularly critical for manipulating and negotiating the environment

Neurological lesions may result in oculomotor dysfunction (double vision, impaired saccadic movement), dry eyes or cognitive and perceptual manipulations of visual inputs (e.g. visual field loss, visuospatial agnosia)

Loss of visual information from half the visual field is not uncommon following stroke

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18
Q

Review slide 16 on visual field defects

A

especially for end of term exam

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19
Q

functional impact of visual field loss

A

Visual impairments have a negative impact upon a patient’s ability to engage actively in rehabilitation and participate in activities of daily living

The ability to locate and maintain stable gaze on a fixed target, and to move eyes while keeping the head still in order to locate objects in the peripheral field is critical to functional task performance

Movement is guided by visual information about the location of an object and the body, and about the relationship of different body limbs and segments

Visual impairments may result in a patient bumping into objects, missing utensils on a table, having difficulty reading etc

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20
Q

Specific assessment for visual field loss

A

Subjective examination (pre-existing visual impairments and management strategies in place)
Visual acuity
Eye movements (CN III, IV, VI)
Visual fields

must be informed about the state of the patient’s visual system, given its critical role in movement control

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21
Q

Rehabilitation of visual field loss

A

Ensure pre-existing visual impairments are corrected (e.g. glasses in situ)

Understand specific visual impairments to give consideration to environmental factors such as glare and lighting during motor training

Compensation training is usually necessary
– Encourage eye and head movements to bring objects into view
– Encourage patient to pay attention in detection tasks

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22
Q

List the three perceptual-cognitive impairments

A

apraxia
visual perceptual impairments
unilateral neglect

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23
Q

What is apraxia

A

difficulty performing everyday activities not accounted for by weakness, sensory loss, incoordination, inattention or lack of comprehension

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24
Q

list two types of apraxia

A

ideational apraxia

ideomotor apraxia

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25
Q

What is ideational apraxia

A

characterised by absentmindedness and lack of purpose in performing various actions

26
Q

what is ideomotor apraxia

A

hinders the individual’s ability to select, sequence and use object

27
Q

Patient presentation with apraxia

A

Patients with apraxia often appear to be absent minded, act impulsively and may be thought to have intellectual deteorioration as opposed to a lack of awareness of the appropriate movement at a specific time

28
Q

apraxia is often assessed and described in terms of functional terms, give a couple examples

A

walking, dressing

29
Q

What are visual perceptual impairments

A

may include distortion of the perception of verticality; difficulty appreciating the three-dimensional nature of objects; difficulty navigating from place to place; inability to discriminate numerical symbols; incapability of telling the time; difficulty visualising familiar people and objects; poor understanding of up-down, in-out, front-back; difficulty with figure-ground perception

30
Q

patient presentation with visual perceptual impairments

A

often appear to be deaf or lacking in concentration

31
Q

What is unilateral neglect

A

a complex disorder of spatial representation, spatio-motor programming and spatial attention which results in the failure to attend or respond to, identify or orientate toward meaningful stimuli presented to the side contralateral to the lesioned hemisphere

32
Q

unilateral neglect is multimodal, involving what systems

A

visual, auditory, olfactory and proprioceptive systems

33
Q

Which side is usually affected with unilateral neglect

A

left side due to right side lesion

34
Q

unilateral neglect is also referred as what

A

hemi-agnosia, hemi-neglect, unilateral visual inattention, hemi-inattention, neglect syndrome, spatial neglect, hemi-spatial neglect

35
Q

Unilateral neglect is typically associated with what
may be present in what
or associated with what

A

stroke

post TBI

cerebral tumours

36
Q

reported incidence of unilateral neglect

A

29-85%

37
Q

what sort of prognosis is unilateral neglect associated with

A

poorer

38
Q

unilateral neglect is multidimensional in terms of distribution and modality, list the 4 modalities

A

Personal: failure to acknowledge stimuli on contralateral side of body
– Spatial: failure to acknowledge stimuli in contralateral side of space
– Sensory: deficit in awareness of contralateral sensory stimuli (visual, auditory, somatosensory)
– Motor: failure to respond to stimulus when person is aware of it – not due to weakness or spasticity

39
Q

Functional impact of perceptual-cognitive impairments

A

Significant functional consequences as patient’s have reduced ability to carry out many everyday tasks which restricts their independence

Serious effects of outcome of rehabilitation, discharge destination, length of stay and independence

40
Q

Assessment for perceptual cognitive impairments

A

Must be informed about the state of a patient’s perceptual-cognitive impairments to guide appropriate rehabilitation interventions and determine capacity to participate in rehabilitation
Perceptual-cognitive impairments most commonly assed by neuropsychologists and occupational therapists, however many become evident through functional task performance and thus must be recognised and referred
No single test identifies all perceptual-cognitive impairments, nor will impairments manifest themselves in all tasks
No clear consensus on evaluation

41
Q

rehabilitation of perceptual cognitive impairments

A

More research required to identify optimal interventions

Recovery and trainability of everyday actions likely to be affected by presence of perceptual-cognitive impairments

Compensation may be required (rehabilitation goals… prognosis… safety)

Difficult to plan treatments due to lack of clear understanding of underlying mechanisms of perceptual and cognitive deficits and poor evidence, with many promising techniques lacking generalisability

42
Q

Remediation of perceptual cognitive impairments

A

Overall aim is to address specific deficits by increasing the patient’s awareness of the nature of their impairments and training them to reorient their attention to particular situations while practicing functional tasks

Emphasis on attending to visual stimuli is critical

Training should include cues found in everyday life

Apraxia: cueing (proprioceptive, tactile and kinaesthetic) – verbal or physical prompts at each stage of a task

Neglect: draw attention to affected side (adapt environment to present visual, auditory and tactile stimuli); train affected side with active intentional movements in neglected part of extrapersonal space

43
Q

Remediation during physiotherapy for perceptual cognitive impairments

A

Emphasise visual scanning to search for targets
Encourage head and eye movements to locate apparently ‘missing’ objects
Use marks to assist in anchoring vision
Reorient during physiotherapy to ensure attention is focused
Avoid using criticism or words with negative connotations
– Do not use the term ‘neglect’ – Don’t nag

44
Q

what is dysphasia

A

disturbances of language caused by an insult to

specific brain regions

45
Q

list two types of dysphasia

A

receptive

expressive

46
Q

what is expressive dysphasia

A

problem producing the correct word or sequence of words

us

47
Q

what is receptive dysphasia

A

problem of understanding language

48
Q

Dysphasia usually occurs with lesions of what

A

left cerebral cortex

49
Q

what is dysarthria

A

disturbance of articulation

50
Q

what is dysphonia

A

disturbance in vocalisation

51
Q

what is dyspraxia

A

impaired planning and sequencing of muscles required for speech

52
Q

What is wernickes dysphasia

A

Lesions usually dominant temporal lobe Deficit in comprehension
Severe difficulty reading and writing Repetition of spoken language impaired Naming impairedFluency preserved or increased

53
Q

What is Broca’s dysphasia

A

Frontal lobe lesion
“Expressive dysphasia” Comprehension usually preserved Language expression affected Repetition of spoken language impaired Naming impaired
Fluency decreased
May result in almost complete loss of language expression to a slowed, deliberate speech utilising only key words and simple grammatical structure

54
Q

functional impact of language impairments

A

Language is distinguished from other kinds of human communication by its creativity, form, content and use
In written and spoken forms, language represents social and interactive activities
Loss or impairment of language has a profound effect
Patients often very isolated and easily frustrated as attempts to communicate fail

55
Q

assessment of language impairments

A

Early diagnosis of language impairment by a speech pathologist is essential to identify the patient’s specific problems so that the family and rehabilitation team can understand the nature and extent of the communication deficits and the best ways of communicating

56
Q

rehabilitation of language impairments

communication strategies for phyios

A

Don’t exclude the patient from conversation or answer on their behalf
Keep sentences short and simple
Provide time for the patient to respond and to switch from one topic to another
Phrase questions so that they can be answered with yes/no or some other form of short response where there is expressive dysphasia
Use gestures, situational cues, visual prompts, facial expressions to enhance communication and comprehension
Engage in eye contact as eye contact facilities communication and more positive attitudes
Be honest in establishing communication and a relationship with your patient
– Communicate misunderstanding
– Utilise prompts
– Divert behaviour if the patient becomes frustrated
Discourage perseveration on words and phrases as iit interferes with real communication

57
Q

Rehabilitation strategies for wernickes dysphasia

A

Picture cards
One stage commands
Break down questions into key words Use demonstration
Use gestures and facial expression Short and simple questions

58
Q

Rehabilitation strategies for broca’s dysphasia

A

Ask yes/no questions
Use visuals scales eg. VAS
Give patient time to get words out Use probing questions, e.g. What is it used for? What does it start with?

59
Q

summary #1

A

Significant relationship between motor and sensory function
Tactile and proprioceptive sensation are critical to regaining effective motor function, especially upper limb
Eye-head coordination is particularly critical for manipulating and negotiating the environment
Loss or impairment of perceptual-cognitive and language functions has a profound effect on indepedendence
Somatosensation is required for the learning of new skills

60
Q

summary #2

A

Given their critical role in movement control, physiotherapists must be informed about the state of a patient’s somatosensory and perceptual-cognitive functions, to guide appropriate rehabilitation interventions and determine capacity to participate in rehabilitation
Assessment is multi-disciplinary (physiotherapist, neuropsychologist, occupational therapists, speech pathologist)
Challenging and meaningful functional based rehabilitation with patient attending to sensory inputs and their relationship to the task

61
Q

Summary #3

A

Overall aim of rehabilitating somatosensory and perceptual-cognitive impairments is to address specific deficits by increasing the patient’s awareness of the nature of their impairments and training them to reorient their attention to particular situations while practicing functional tasks
Compensation training is usually necessary for visual, perceptual-cognitive and language impairments

Neurological Physiotherapy (13 decks)

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