Cognitive and Perceptual Dysfunction, CH 29 p 1149

Question 1

Localized CVA vs. Generlaized TBA

Answer 1

Patient with an initial CVA is thought to have focal or localized damage to discrete areas of the brain resulting in discrete cognitive or perceptual problems
TBA patients are presumed to have generalized brain damage resulting in attention, ,memory, learning problems
What we are trying to get at with both groups is their true residual abilities
Patient with an initial CVA is thought to have focal or localized damage to discrete areas of the brain resulting in discrete cognitive or perceptual problems

Question 2

3 steps to the process model.

Answer 2

selects, intergrates, and interperts

Question 3

Cognitive process includes (KUAJD)

Answer 3

Knowing
Understanding
Awareness
Judgment
Decision making

PERCEPTION , ACTION , THINKING, MEMORY

Question 4

Cognitive processes are generally defined as,

Give examples of higher functions like reading, and writing

Answer 4

Abilities that enable us to think, including concentrate, pay attention, remember, & learn
Executive functions- capacity to plan, manipulate information, initiate & terminate activates, recognize errors, problem solve, think abstractly (HIGHER ORDER COGNITIVE FUCNTIONS/ METACOGNITIVE FUCNTIONS

Question 5

What is a preception then what is sensation (more just sensory)

Answer 5

Is the integration of sensory impressions into information that is psychologically meaningful
Ability to select stimuli that require attention/action
Integrate with other info
Interpret info
Sensation is the appreciation of stimuli through organs, peripheral cutaneous sensory system

Question 6

Charateristics of cognitive decfecit like oh now where did I put my shoes. How do I walk down the stairs I forgot :/

Answer 6

Inability to do simple tasks independently or safely,
Difficulty in imitating or completing a task
Difficulty switching from task to task
Diminished capacity to locate visually or to identify objects that seem obviously necessary for task completion
Unable to follow simple one stage instructions
Repeated mistakes
Longer time to complete activates or done impulsively
Hesitate, appear distracted, frustrated, exhibit poor planning
Frequently inattentive of one side of their body

Question 7

THEORETICAL FRAMEWORKS

1. Transfer to training

Answer 7

Practice of one task with particular perceptual requirements will enhance the performance of other tasks with similar perceptual demands (focus is the process)
Neistadt 1995, learning capacity is key to a patient’s ability to generalize

Question 8

Sensory intergrative Apporach

Answer 8

Ayres, explain relationship between neural functioning & the behavior of children with sensor motor or learning problems
Neurobehavioral literature
Integration of sensorimotor functions
Development of tactile, proprioceptive, vestibular proceeds in a developmental sequence in the normal child within the context of goal-directed, meaningful activity
(like trying to balance on a skateboard)

Question 9

Treatment modalites used in the sensory approach

Answer 9

Rubbing
Icing
Resistance
Weight bearing
Spinning

Question 10

What are splinter skills?

Answer 10

In young children avoid Compensatory or Splinter skills, (acquired in a manner incapable of being integrated with already present skills)

Question 11

Neurofunctional Approach

Answer 11

Giles and Wilson 1992 based on learning theory
In direct contrast to the retraining approach
Practice in true context
Retrain real world skills

Question 12

Neurodevelopmental Approach

Answer 12

NDT
Perception is facilitated during normal infant neuromotor development by kinethetic, proprioceptive, tactile, & vestibular feedback received through normal movement experiences
Sensations are used as a progression from early physiological flexion to movement against gravity for sitting, crawling, kneeling, standing, & initial walking
Provides a sense of midline orientation, two side awareness & full body awareness
PERCEPTION is imperative to handling techniques that provide sensory inputs & the FB accompanying correct movement during retraining

Question 13

Rehabilitative /Compensatory Functional Approach

Answer 13

Most widely used for perceptual dysfunction
Adults with brain trauma will have difficulty generalizing learning from non similar tasks
Require direct repetitive practice of tasks
Address the functional problems
Therapy is a learning process that takes into consideration individual strengths & limitations
Composed of two complementary components
Compensation, change in patient’s approach
Adaptation, alterations in human and physical environment

Question 14

Compensation,how to deal with it

Answer 14

Cognitive awareness of deficiencies
Teach circumvention by using intact sensations & perceptual skills
Attend to Cues/successful habits

Use simple directions
Establish and carry out routine
Do each activity in a consistent manner
Employ repetition as needed

Question 15

Cognitive Rehabilitation and the Quadraphonic Approach

Answer 15

Focuses on training individuals with BI to structure & organize information
Memory, language disorders, perceptual dysfunction under one umbrella
Information processing, problem solving, awareness, judgment, decision making

Question 16

What four things are incoporated in the cognitive approach

Answer 16

Use of multiple learning environements
Task analysis
Training on ability awareness, task difficulty, self assessment
Relate new info to previously learned ones

Abreu’s model- quadraphonic approach: Fig. 29.1,2 p 1155/56 Works on both the Micro level like memory, attention, postural control etc. Then on the macro level like more job like tasks to match the patients enviorment

Question 17

Assessment of Cognitive & Perceptual Problems what can influence an assessment

Answer 17

Task analysis
Determine which Cognitive & Perceptual abilities are intact & which are limited
What can influence an assessment?
Psychological, emotional status
Level of relevant cue detection
Anxiety over capabilities
Reduced receptive & expressive communication
Depression
Fatigue
Medications
Premorbid status
Must conduct sensory assessment prior to cognitive or perceptual testing

Question 18

How do we distinguish between Sensory & Cognitive/Perceptual Problems?

Answer 18

Deep (proprioceptive) sensations (kinesthesia, position sense, vibration)
Superficial sensations (pain, temp, light touch, pressure)
Combined cortical sensations (stereognosis, tactile localization 2 point discrim, barognosis, graphesthesia, recognition of texture)
Hearing
visual

Question 19

Visual disturbances

Answer 19

Hemiplegia,
poor eyesight, 
diplopia (double vision), 
homonymous hemianopsia (visual field deficit),
 damage to visual cortex, 
retinal damage

Question 20

Review figure 29-4 pg 1158

Visual field deficits and associated lesions sites

Answer 20

Remember:
result is a loss of incoming information from half of the visual surround contralateral to the side of the lesion
If you loss left half of visual field occurs with left hemiplegia

Loss of right visual field accompanies right hemiplegia

Question 21

Tests for presesnce of hemianopsia

Answer 21

Figure 29.7 p 1160

gaze tracking task in sitting

Question 22

2 types of eye movements

Answer 22

Visual fixation, near far object focus
Ocular pursuits, following moving objects & visual scan abilities

What is cortical blindness? total or partial loss of vision in a normal-appearing eye caused by damage to the brain’s occipital cortex.

Who performs better right or left hemi with regard to visual perceptual issues? dont know

Question 23

Things to remember

Answer 23

Performance may vary daily
Number of short sessions on successive days is preferred
Perceptual testing along with ADL self care

Question 24

Standardized cognitive and perceptual tests

Answer 24

Table 29.1 p 1162

Question 25

Intervention what can we do

Answer 25

categorized the 5 major approaches for cognitive and perceptual rehab into either,

Remedial approaches, focus on deficits & retraining specific perceptual components of behavior for the recovery or reorganization of deficient CNS functioning, bottom up approach, “Neurotherapeutic approaches”,
SI, COGNITIVE,RETRAINING APPROACHES

Adaptive/Compensatory Approach, direct training of functional deficiencies, limit generalizability, top down approach, may foster learned non use/splinter skill development
NEUROFUNCTIONAL, REHABILITATIVE

         Education, FB- Knowledge of Results & Performance

Question 26

Review Table 29-2 pg 1163

Common assumptions of adaptive and remedial approaches

Who uses the “top down” vs “bottom up” approach

Answer 26

Review Table 29-2 pg 1163

Common assumptions of adaptive and remedial approaches

Who uses the “top down” vs “bottom up” approach

Question 27

Lab focusing on integrating cognitive and perceptual impairments Table 29.3 p 1165

Answer 27

Attention deficits
Memory disorders
Executive function impairments
Body image disorders
Spatial relation disorders
Agnosias
Apraxia