Chapter 5-8 Assessment and Treatment: Attention and Perceptual Disorders Flashcards Preview

Clinical Neuropsychology, Chapters 1 - 12 > Chapter 5-8 Assessment and Treatment: Attention and Perceptual Disorders > Flashcards

Flashcards in Chapter 5-8 Assessment and Treatment: Attention and Perceptual Disorders Deck (79):

Are you ready to use your attentional resources on this flashcard game?

Hell to the yes.


What kind of perceptual organs are most involved when solving flashcard puzzles?

That's probably vision.


How many attentional resources does human beings on average have?

tree fiddy


The book identifies two important caveats when it comes to dealing with attention. Name and explain these.

1. Scrap "the attention". Doesn't exist.
- Different types of tasks calls for different types of
2. The assessment of attention should never be limited to performance on a single task.
- For example, recording of simple reaction time can
tell us something about the basic speed of
processing in a particular patient, but tells us little
or nothing about his or her ability to react flexibly
on a dual task, or to sustain attention over half an


Name at least 2 paradigms that tests attention.

1) Stroop Test
- You know it, I know it, my mother might know it, and
everyone probably knows it.
2) Visual search task
- Search through irrelevant information/recognize
relevant information from noise.
3) Sustained attention to response test
- The Sustained Attention Test is a computer-based
task designed to measure a person's ability to
withhold responses to infrequent and
unpredictable stimuli during a period of rapid and
rhythmic responding to frequent stimuli.
4) Posner Cueing Task
- Used to measure manual and eye-movement
reaction times to target stimuli in order to
investigate the effects of covert orienting of
attention in response to different cue conditions.


Can you assess attention using surveys?

To some degree. General difficulties can be identified with scales like Cognitive Failures Questionnaire and Rating Scale of Attentional Behaviour (RSAB).


Can you assess attention using observation?

Yeppely deppely doo. The book defines the clinical observation as one of the most important tools available.


According to McGurdi (the book) attentional tests can be categorized into two superordinate categories. Name these.

◆ speed or processing capacity;
◆ control or working memory.


Why is it beneficial to categorize these types of tests?

Shit varies, so it's nice to be able to choose a relevant task for assessing the desired skill or lack hereof.


What's the difference between processing speed and cognitive control?

What do you think? Stupid author of this stupid question.
The former assess the speed and capability of processing of dynamic information (e.g. reading speed).
The latter assess the capability to focus on a specific task or object for longer periods of time (self-control tasks).


Is it wise to test both divided attention and focused attention.

Yes. Just wanted to remind people of this distinction.


Describe in general terms how to assess divided attention.

The classic paradigm to test divided attention is a dual task, in which a subject is instructed to perform two or more tasks simultaneously.
* Example: The Determination Test (DT) of the Vienna Test System (Schuhfried, 2006) requires the division of attention between different stimulus modalities, namely visual and acoustic, as well as between different response possibilities, namely pressing a hand button or a foot pedal.


Describe in general terms how to assess focused attention.

When irrelevant stimuli can act as distractors, subjects have to focus on the relevant ones. Visual search tasks are attention tests that require some selectivity, as all stimuli are irrelevant except the ones designated as targets.
* Trailmaking is another good task example.


Is it fair to say that patients or subjects have poor attention if they perform the tasks slowly?

No. No it's not. Don't be mean just because they are slow. They might not become jetpilots but who cares.

*But seriously, neuropsychologists needs to be aware of this. Just because the patient doesn't compare to the norm, doesn't mean the end of the world.


Name disorders that can have a negative impact on attention.

Almost every disorder. I'll give you a few but try and think of some yourself!
- Dementia
- Schizophrenia


What is Hemi-inattention (hemi-neclect)?
Hint: Morten Overgaard knows one or two things about this.

It is a disturbance in a preconscious aspect, i.e. our normally symmetrical orientation with respect to the outside world.


Give examples of ways to assess hemi-neclect.

Observation. Does the patient bumb into things.
Tests like the stroop test is a good measure as well.


What would be good guidelines to cope with attentional limitations?

◆ Avoid or reduce time pressure.
◆ Create structure.
◆ Keep subtasks separate when possible.
◆ Avoid interruptions.
◆ Determine priorities in advance.


Do you remember compensatory strategies? Good! Think of one(s) that might be helpful in rehabilitation of attentional deficits.

Time Pressure Management (TPM). It consists of a general self-instruction (‘Let me give myself enough time to do the task’) followed by four specific steps in the form of questions the patient has to ask himself.

1 Anticipate time pressure by analyzing stages in the task where two or more things have to be done at the same time.
2 Make a plan for things that can be done before the actual task begins.
3 Make an emergency plan to deal as quickly and effectively as possible with overwhelming time pressure.
4 Make regular use of the anticipatory plan and the emergency plan.


Which of the authors of chapter 6 is the manliest?

Tom Manly.


Finish the sentence.
"Neclect is classically associated with lesions to the right posterior parietal.."

"..but has been observed following damage to a variety of brain structures including the right prefrontal cortex and subcortical areas as well".


Does natural and spontaneous recovery of neclect occur?



What can cause visual neclect?

Often times it's strokes.


Name four rehabilitation techniques relevant for visual neclect.

1) training patients to make compensatory left-ward scans

2) encouraging use of the left hand and arm,

3) prism adaptation therapy
- Prism lenses worn as spectacles induce an optical
deviation, making an object that is straight ahead
appear to be, say, to the right. When first wearing
such glasses, if asked to reach for the straight-
ahead object, individuals will tend to miss (the
misdirection reflecting the rightward distortion).

4) teaching self-alerting techniques


From a neuropsychological point of view the best known types of perceptual deficits are:

◆ auditory
◆ tactile
◆ visual
*A common term, ‘agnosia’, may be applied to all of them, implying
inability to know or interpret sensory experiences.


The auditory system includes:

The outer ear, the middle ear and the inner ear where neural impulses are generated (sensory transduction) and are transmitted to the brain via the auditory nerve.


Define the term ‘auditory sound agnosia.

Auditory sound agnosia refers to a loss of the ability to
recognize common sounds (e.g. bell ringing, dog barking, and train, that is not due to cortical deafness). .

* Auditory agnosia is often associated with bilateral
lesions in the region of the superior temporal lobe


Define pure word deafness (verbal auditory agnosia).

Refers to the impairment in analysing/understanding spoken words in the context of preserved recognition of nonverbal sounds and relative preservation of spontaneous speech, reading, and writing.


Describe the steps of assessing pure word deafness.
Hint: Typical for auditory assessments in general.

1) ask the patient to discriminate softly spoken words or finger snaps.
2) an audiological assessment is required. This includes measures of pure tone audiometry and speech detection thresholds.
3) (Provided significant auditory sensory deficits and aphasia are excluded) proceed by asking the patient to discriminate whether spoken pairs of words and non-words are the same or different (house/house versus house/mouse, pef/bef)

* be aware of:
- Prevent lip reading
- Make sure the patient is able to ‘hold’ in mind and
compare two items.
- Stimulus pairs may differ according to the
examiner’s voice and accent (use a native speaker
with clear articulation).


Define auditory amusia.

This refers to a loss of the ability to recognize familiar music (well- known melodies or a particular voice). Both hemispheres contribute to music appreciation and the anatomical correlates of amusia are multiple, underpinning the multifactorial nature of music.


Describe the guide to the assessment of disorders of touch by Caselli.

◆ Basic somaesthetic impairments include light touch, position sense, vibration, two-point discrimination, pain perception, and temperature (usually assessed by neurologists).

◆ Intermediate somaesthetic impairments include texture discrimination and simple form discrimination that is part of astereognosis (usually assessed by neurologists, sometimes by neuropsychologists).

◆ Complex somaesthetic impairments are disorders of pure forms of tactile agnosia, with preserved basic and intermediate functions.


What caveats do you have to be aware of when assessing visual deficits?

◆ A test involving drawing for example, may primarily be failed due to motor deficits (sensory/motor weaknesses, dyspraxia), or planning (executive) problems.
◆ Visual object recognition tests may be failed due to sensory deficits,visuospatial neglect, severely restricted visual fields, or impairments in eye movements. The latter include disorders involving subcortical/brainstem structures and frontal eye fields (e.g. Luria 1976).
◆ Tests dependent on verbal responses may not be appropriate for dysphasic patients.


Name the seven areas of ability in vision that can be distorted or impaired.

Eye fixation
Shape discrimination
Figure/ground discrimination


What is typically associated with impairments of acuity?

Occipital lobe damage may affect visual acuity similarly to disorders of the eye or optic nerve.

*There may be effects on the ability to detect the presence or absence of light, different changes in contrast sensitivity, and a target varying in size.


How can acuity be assessed?

Acuity can be assessed by Snellen charts and other similar ophthalmological instruments.


Name typical signs of visual disorientation.

Difficulties in visually locating objects and judging distances.

* They don't respond with eye blinking when the examinator does a rapid movement towards the patient.


What brain areas are typically impaired in visual disorientation?

Visual disorientation is associated with lesions in the occipito-parietal boundaries.


What tools are used to assess visual disorientation?

To assess visual disorientation, ask the patient to count or point to random arrays of dots (e.g. Counting Dots test, Visual Object and Space Perception (VOSP) battery; Warrington and James 1991), or to pick up small items (e.g. paper clips) from a desk.


Define akinetopsia.

Akinetopsia is motion blindness and is associated with lateral occipitotemporal lesions.


What type of injury is typically associated with impairments in the perception of forms and shapes?

Patients may become impaired in form perception due to bilateral occipital lesions.


What goes together?!

1)Dorsal stream
2) Ventral stream
A) Action perception
B) Visual discrimination and cognition

There are two visual systems, one serving action (dorsal stream) and the other serving visual discrimination and cognition (ventral stream) (Milner 1997).


What is Figure—ground discrimination?

Early visual processing skill involves figure—ground discrimination. This enables the viewer to analyse the defining outlines of a stimulus and its background separately.


What is Achromatopsia?

Refers to impairment in colour perception. A patient may be unable to see colour at all or perceive colours as lacking in intensity.


What can cause impairments in colour perception?

Impairments in colour perception are associated with occipitotemporal lesions. They may be confined to one visual field contralateral to a lesion (retinotopic).


How do you assess colour perception?

◆ Exclude congenital abnormalities.
◆ Ask the patient to name, match colour patches, or arrange them in a series according to brightness or saturation.
— The Holmgren Wool Test consists of pieces of wool that the patient is asked to sort according to their hues.
— The Farnsworth–Munsell 100-Hue and Dichotomous Test for Color Vision (Farnsworth 1943) is a more demanding task requiring the patient to arrange in the appropriate sequence coloured small counters (matched for saturation and brightness) according to hue.


Fun fact in regards to colour perception.

Unlike patients with retinal coloured blindness, achromatopsic patients are impaired in all sectors of the spectrum, although discrimination of shades of grey may be preserved.


What is colour agnosia.

Loss of colour knowledge (colour agnosia). These patients find it difficult to accurately colour with crayons black and white drawings of objects, fruit, animals (e.g. a frog may be painted blue).


What is texture perception?

The perception of texture gradients may provide precise information about the distances of surfaces and the sizes of stimuli on these surfaces. Abrupt changes in texture gradient may signal the presence of edges and corners, and strongly influence the perception of stimuli.


How do you assess texture perception?

Ask the patient to describe stimuli with different texture gradients. Impairment is identified when the patient is unable to perceive the effects of texture (analogous deficit to the inability to perceive
illusory phenomena).


Define prosopagnosia.

Inability to recognize faces.


What are higher visual recognition problems

Higher visual recognition problems are due to a failure in attainment of a coherent structured percept (structural perception) or in assignment of meaning to an object or face (semantic processing).


What's wrong if you have problems with structural perception?

You have difficulties in perceiving coherent structures.
(aperceptive agnosia).


What's wrong if you have problems with structural perception?

You have difficulties in assigning meaning to an object or face.
(associative visual agnosia).


How do you assess aperceptive agnosia?

The Object Decision test (one of the tests in VOSP) as well as many others.
Mental rotation tasks etc.


How do you assess associative visual agnosia?

Present patients with pictures or models of animals, tools, or other objects and ask them to name them, ask them about their properties and where they can be found. A naming test that includes different categories of stimuli can be used for this purpose (McKenna 1997).


Define optic aphasia.

Patients may be unable to identify objects by name, but will be able to demonstrate the use of objects by other (nonverbal) means.


What areas of the brain are associated with prosopagnosia?

FUSIFORM GYRUS! or in the posterior regions of the right hemisphere..


How do you assess deficits in the structural perception of faces?

Structural disorders in face recognition can be assessed with the Benton Facial Recognition Test (Benton et al. 1978). Patients are required to find a target face amongst six alternative faces shown in different viewpoints and different lighting conditions.


When does patients experience inability to recognize emotions?

Patients with right hemisphere damage are more
likely to be impaired than those with left hemisphere damage. They may become impaired in recognizing the emotion of fear (following amygdalectomy) and disgust (presymptomatic patients with Huntington’s disease).


What interventions can be made in regards to problems with visual acuity?

1) Magnification software (for PCs), or screen reading machines for permanent enlargement of printed text, pictures, and letters.
2) Improve visual search by providing the patient with a systematic (horizontal or vertical) saccadic search strategy. Acuity will improve when visual search is more systematic, quicker and when omissions are reduced


What is Foveal photopic adaptation?

It means the continuous adapting to a brighter illumination.


What does scotopic adaptation mean?

It means the adaptation to a darker illumination than the present one.


What is Convergent fusion?

It is a prerequisite of stereopsis (stereo vision) and refers to the fusion of the left and right eye’s image to one combined (fused) picture of the world.


How is impairment of convergent fusion treated?

Fusion and stereopsis can be trained together using simple orthoptic or binocular devices.
Therapy: Improvement of fusion and stereopsis by repetitive display of dichoptic images with increasing disparity angle; 8-20 sessions advisable.


What can cause small simple visual hallucinations?

Simple, formed, visual hallucinations (light dots, bars, lines, stars, fog, coloured sensations, etc.; Lance 1976) are frequently reported by patients (only when questioned systematically!) with posterior vascular lesions, and occur most frequently following occipital lesions.


More complex hallucinations are caused by...

temporal lobe lesions.


Treatment of hallucinations involves..

psychoeducation! Simple hallucinations are often transient and will go away. Complex ones might be caused by psyciatric disorders like schizophrenia or epilepsi.


How can problems with visual form recognition be treated?

Sometimes it can be trained with computer games.


What is done for patients with prosopagnosia?

They can be taught to recognize persons and objects by other cues than the holistic percept.


How do you rehabilitate somatosensory functioning?

a) Improve awareness of sensory dysfunction by allocating attention to it;

b) Start treatment with sensory tasks the patient can do in order to improve motivation and reduce frustration;

c) Use or develop tasks that are interesting and relevant for the patient, which involve selective attention because this improves sensory functioning;

d) Also use vision and the good hand during training to teach tactics and useful strategies of perception;

e) Frequent rests are necessary.


Give examples of systematic sensory training tasks:

- Identification of line orientations
- Discrimination of shape, size, weight, or temperature of objects placed in patient’s contralesional hand
- Identification of forms drawn with a pencil on the patient’s hand/arm from a visually presented multiple-choice display


What is Tactile extinction training?

- The objective is to improve the patient’s attention to double simultaneous stimulation (DSS) of the hand’s surface. For this purpose, either light touches of different fingers or positions on the hand or any other body region can be used. Patients are required to direct their attention to the touch on the impaired hand, which should be hidden from direct vision.


How do you improve tactile functioning by peripheral magnetic stimulation?

With this novel method the dorsal palm of the contralesional hand is stimulated magnetically (non-painfully).


Describe Auditory extinction of contralesional stimuli:

- This occurs after lesions of the auditory pathways in the temporal lobes (De Renzi et al. 1984) of either hemisphere, or in small lacunar lesions (Arboix et al. 1996).


What types of lesions can lead to cortical deafness?

- Cortical deafness Cortical deafness is an extremely rare condition resulting either from brain-stem lesions, subcortical lesions disrupting the auditory pathways, or from bilateral temporal lobe lesions destroying the primary auditory cortex bilaterally (cf. Polster and Rose 1998).


What is auditory agnosia?

- Auditory agnosia is the inability to recognise auditorily presented sounds independent of any deficit of processing spoken language. This may include the inability to recognise environmental (i.e. different vehicles) and human sounds (coughing, baby cries)


How can auditory agnosia be treated?

- — Sound imitation: The patient had to imitate or actually perform a typical sound of an object (e.g. telephone) and was then later confronted with the tape-recorded sound of this object and asked to decide whether they were the same;
- — Semantic association: The patient had to associate a sound to a specific object out of a sample of ten visually presented objects;
- — Auditory analysis: The therapist taught the patient acoustic features of specific sounds (a starting car first makes a deep sound, and then interrupted sounds according to the different gears).


Describe phonagnosia:

- Impaired recognition of familiar voices due to right hemispheric lesions (reviewed in Polster and Rose 1998).


Describe Voice discrimination disorders:

- Impaired perceptual discrimination of different voices (unfamiliar) after right temporal lesions (cf. Polster and Rose 1998).