Neuromuscular 2 Unit 6 Cognition, Perception, and UE treatment

Question 1

What is the difference between Cognitive and Perceptual Deficits?

Answer 1

• For cognition, we are looking at the Frontal Lobe, specifically the Prefrontal cortex
• Perception is an area that dominates on the right hemisphere of our brian, specifically the temporal parietal association area

PT dont assess or treat cognitive and perceptual deficits

Question 2

With a deficit of Cognition, what are the impairments for Attention Deficits?

Answer 2

• Sustained attention (cant stay on task)
• Selective attention (Cant choose to stay on 1 activity with ignoring external stimuli)
• Divided attention (ability to be able to pay attention to more than 1 stimuli at once)
• Alternating attention (be able to shift from one activity to another)

Question 3

With a deficit of Cognition, what are the impairments for Memory Impairments?

Answer 3

• Immediate Recall
• STM
• LMT

Question 4

With a deficit of Cognition, what are the impairments for Executive Function impairments (Higher order cognition)?

Answer 4

• Volition (our desire to do something)
• Planning
• Purposive action
• Effective performance

Question 5

With a deficit of Perception, what are the impairments for Body Scheme/Body Image?

Answer 5

• Unilateral neglect
• Ansosgnosia (we dont acknowlege one side of our body)
• R-L discrimination
• Finger agnosia

Question 6

With a deficit of Perception, what are the impairments for Spatial Relation Impairments?

Answer 6

• Figure-ground discrimination
• Form discrimination
• Spatial relations
• Position in space
• Topographical disorientation
  etc.

Question 7

With a deficit of Perception, what are the impairments for Agnosia?

Answer 7

• Visual object
• Auditory
• Tactile

Question 8

With a deficit of Perception, what are the impairments for Apraxia?

Answer 8

• Ideamotor (inability to motorically execute use of an object)
• Ideational (more severe, you comletely lose the idea of of how to use an object or do the task at all)

Question 9

What is the difference between Sensory and Perceptual deficits?

Answer 9

• Our sensory deficits, or visual impairments are typically due because there has been damage to the visual pathway
• A true perceptual deficit is damaged more in the temporal occipital association cortex. Agnosia has visual agnosia, this is damage to typically the temporal parietal occipital association cortex that is interpreting visual information. But the sensory system of vision is intact

Question 10

With CVAs, how are these patients going to present with cognitive deficits?

Answer 10

• With Frontal Lobe damage (more with ACA stroke)
• May have immediate and STM loss (36% of pt)
• May have confusion, confabulation (where they will randomly fill in what they really truly believe are the facts of a story. To fill the gaps of missing memory) or Perseveration (difficulty shifting attention past one particular activity that they’re doing that has really kind of drawn in their attention and they just cannot move onto the next thing)
• May have multi-infarcts/vascular dementia
• In acute care we may see delirium or acute confusional state

Question 11

With CVAs, how are these patients going to present with Perceptual deficits?

Answer 11

• We may see R sided brain damage (mostly from MCA

Question 12

With MS, how are these patients going to present with cognitive deficits?

Answer 12

• We may see STM deficits
• May have difficulty with multi-tasking
• May have decreased attention and concentration
• May have diminished executive function
• May have diminished information processing speed
• May have visual-spatial abilities

Perceptual deficits are not as common

Question 13

With MS, what is the Goal Cognitive-Behavioral Training (CBT)?

Answer 13

The goal is to change the way an individual thinks or feels about a particular impairment

Question 14

With PD, how are these patients going to present with cognitive deficits?

Answer 14

• They’ll have prefrontal circuitry damage
• More typical in later stages
• May have problems with attention
• May have decreased speed of metal processing
• May have difficulty with problem-solving or executive function - May have memory deficits
• May have language abnormalities

Question 15

With PD, how are these patients going to present with Perceptual deficits?

Answer 15

Not as Common
- May have suble visual-perceptual difficulties

Question 16

What are the Treatment approaches for Cognitive and Perception deficits?

Answer 16

• The Remedial Approach
  -Retraining
  -Recovery of underlying skills
  -Recovery and reorganization of the CNS
  -Bottom-up approach
• The Adaptive/Compensatory approach
  -Direct training of functional skills
  -Top-down approach

These are typically used together

Question 17

With Cognitve and Perception Treatment, what is the Quadraphonic Approach?

Answer 17

• This is an interactive rehab approach
• This provides more of a holistic perspective for the management of diagnosis such as stroke, traumatic brian injury, cerebral palsy and othe neurologic conditions
• This adresses those cognitive, perceptual ad motor adaptive strategies, this can chage a clients or patients occupational performance

Question 18

With Cognitive Treatment, using the Remedial and Compensatory approachs, how can we treat Attention deficits?

Answer 18

Remedial
- Slowly scan environment
- Those with R hemiplegia speak with the pt slowly in order for them to process verbal info
- Those with L hemiplegia, encourage verbalization to improve performance
- Set a time for speed limits
- Grade the environment

Compensatory
- External cues in environment

Question 19

With Cognitive Treatment, using the Remedial and Compensatory approachs, how can we treat Memory deficits?

Answer 19

Remedial
- Organize material to be remembered to make logical associations
- Build on past strategies

Compensatory
- Have the patient use a diary, notebook, memory log
- Alarms, wall calender

Question 20

With Cognitive Treatment, using the Remedial and Compensatory approachs, how can we treat Executive Function deficits?

Answer 20

Remedial
- Structure, feedback, and giving a routine
- Ony successful if patient is aware of deficit

Compensatory
- Use other intact cognitive functions and/or modifying the environment to have minimal distractions

Question 21

With Perceptual Treatment, using the Remedial and Compensatory approachs, how can we treat Unilateral Spatial Neglect?

Answer 21

Remedial
- Simple verbal instruction
- Use of shapes to stimulate the right brain
- Minimize numbers and letters to avoid stimulating the L brain hemisphere
- Encourage client to turn their head and trunk to side of neglect
- Encourage motor activities on the left
- Eye patch, prism glasses, optokinetic stimulation, neck vibration, VR

Compensatory
- External cues to draw attention to the left side
- Arrange the environment for successs such as objects on the less affected side (right)
- Mirror to draw attention to that side

Question 22

With Perceptual Treatment, using the Remedial and Compensatory approachs, how can we treat Visual Agnosia?

Answer 22

Remedial
- Photographic drills to discriminate objects and faces
- The easy street environment

Compensatory
- Encourage patient to use other sensory modalities like tough

Question 23

With Perceptual Treatment, using the Remedial and Compensatory approachs, how can we treat Apraxia?

Answer 23

Remedial
- One command at a time and allow time for patient to complete
- Breaks tasks down into their components
- Guiding
- Repetition
- Perform task in a normal environment

Compensatory
- “Strategy training” such as a use of picture sequence

Question 24

When doing an UE assessment, what are the Lead-up skills that must be performed?

Answer 24

• Alignment
  -Trunk stability
  -Shoulder stability/mobility
  -Elbow stability/mobility
  -Wrist stability/mobility
• Gross movements
• Prehension
• Manipulation of objects

Question 25

With the UE, what are some examples of ADLs that deal with Gross Motor UE?

Answer 25

- Donning/doffing shirts/coats - Brushing teeth - Stabilization on edge of surface - Hand to mouth/feeding

Question 26

With the UE, what are some examples of ADLs that deal with Fine Motor UE?

Answer 26

- Prehension for finger feeding - Prehension for dressing (buttoning a shirt, tying shoes)

Question 27

With the UE, what are some examples of ADLs that deal with Bilateral Integration UE?

Answer 27

- Preparing food - UE sports - Caregiving

Question 28

When assessing the UE during therapy, we must recognize S/S of shoulder pain with the neurologic population. What are 2 common causes of shoulder pain and how do they arise?

Answer 28

**GH Impingment** - May occur with trauma to the joint - Improper handling - Poor positioning **Immobility** - Learned non-use - Atrophy

Question 29

To protect the Hypotonic Shoulder, what shoue be avoided?

Answer 29

- Lifting under axilla - Traction of UE - Avoid repositioning a patient by placing hands under the axilla - Simple slings (causes IR and Add) - Painful ROM

Question 30

To protect the Hypotonic Shoulder, what shoue be employed?

Answer 30

- Giv-Mohr Sling - Pain free ROM - Perform shoulder flexion and Abd with proper ER - Bilateral movements with the arms

Question 31

With those with a Hypotonic UE, what should we consider with Positioning?

Answer 31

- Proper alignment of the body is necessary regardless of the positioning (supine, sitting, etc). When sitting in a wheelchair, devices such as lap trays, or arm troughs or arm troughs may be used to correctly position the arm. - Use of Lap Traps, these allow for functional mobility - Use of Arm Trough, good for positioning in a neutral position, however may decrease functional mobility

Question 32

What are the benefits of Active weight bearing in the upper extremity? What are the 2 types?

Answer 32

**Benefits** - Improves cortical excitability - Support weight of upper trunk and body - Lift or more the body mass during transitional movements - Stabilize objects against a work surface for task performance **Types** - Forearm WB - Extended arm WB

Question 33

With Extended Arm Weight Bearing, what does this promote?

Answer 33

- Increased UE stability - Functional transitions (bed mobility, transfers, etc.) - Thoracic extension - Strength in scapular muscles - Challenge from forearm WB

Question 34

With Extended Arm WB, what are the handeling strategies we can use with the Standing/Modified Plantargrade?

Answer 34

- Stabilize GH - Facilitate tricep, down and in and avoid locking elbows

Question 35

WIth the UE, what are the 3 Weight bearing sequences?

Answer 35

- Body moves on a stable arm - Body and arm move together - Arm moving on stable body ## Footnote The first 2 sequences are best to begin with and are comprised of close-chained weightbearing activities on the more involved upper extremity

Question 36

What are the General UE Guidelines?

Answer 36

- Assess ROM at fingers and/or wrist -a ball or half foam roll may preserve natural arches of the hand -avoid painful movements -mobilize as needed if impingement is suspected - Align the trunk, shoulder, forearm, wrist to neutral - Positioning the hand on the surface -ulnar side first then roll to thenar eminence -perserve arches of the hand