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Neuro Rehab I > Perceptual Dysfunction > Flashcards

Perceptual Dysfunction Flashcards

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1
Q

What is the definition of Perception?

A

“Integration of sensory impressions into information that is psychologically meaningful”. Awareness of objects and experiences within the environment enables the individual to make sense out of complex and constantly changing internal and external sensory environment.

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2
Q

What common neurological conditions are associated with perceptual dysfunction?

A

Stroke and Traumatic Brain Injury (TBI).

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3
Q

Explain the difference between Sensation and Perception.

A

Sensation is the appreciation of senses through organs of special senses. Perception is the ability to interpret the sensation accurately.

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4
Q

Why is it important to conduct a sensory examination before perceptual testing?

A

To avoid incorrectly attributing poor performance to perceptual problems and to rule out hearing or visual problems.

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5
Q

List three clinical indicators of perceptual dysfunction.

A

Difficulty participating in PT for reasons that cannot be accounted for by lack of motor ability, sensation, comprehension and motivation; Inability to do simple tasks; Difficulty in switching from one task to another; Inability to identify objects needed for task completion; Unable to follow step commands; Activity may take long time to complete; May deny presence or extent of their disability.

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6
Q

Describe the Remedial Approach to treating perceptual dysfunction.

A

Focuses on the patient’s deficits and attempts to retrain.

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7
Q

Describe the Compensatory Approach to treating perceptual dysfunction.

A

Utilizes intact behaviors that can be used to compensate for the ones that are impaired. It involves changing the environment for task completion, so the patient is safe and independent.

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8
Q

Name the four main categories of perceptual impairments.

A

Body scheme/body image impairments, Spatial relation impairments, Agnosia, Apraxia.

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9
Q

Define Body Scheme.

A

Postural model of the body including relationship of body parts to each other and relationship of body to the environment.

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10
Q

Define Body Image.

A

Visual and mental image of one’s body that include feelings about one’s body in relation to health and disease.

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11
Q

What is Unilateral Neglect?

A

“Inability to register and integrate stimuli and perceptions from one side of the body (body neglect) and the environment (spatial neglect of the area surrounding one side of the body), which is not due to sensory loss”. Also called as hemi-inattention, hemi-neglect, or visual inattention.

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12
Q

What is the common lesion site for Unilateral Neglect?

A

Inferior posterior regions of the right parietal lobe.

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13
Q

What are the three contralesional spaces affected in unilateral neglect?

A

personal space (pertaining to the body)
peripersonal space (space within arms distance)
extrapersonal space (space beyond arms distance).

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14
Q

Why do patients with unilateral neglect often not compensate for their problem?

A

Patients have intact vision but seem unaware of the problem and therefore, do not attempt to compensate by turning the head.

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15
Q

Name two traditional treatment methods for Unilateral Neglect.

A

Cueing (e.g., red ribbon on the left margin when reading); Mirror to draw attention to the neglected side.

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16
Q

Name two “new concept” treatments for Unilateral Neglect.

A

Prism glasses; Eye patching; Virtual reality/computer training.

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17
Q

What is Right-Left Discrimination?

A

Inability to identify right and left sides of one’s body or of that of the examiner. Unable to follow instructions using the concept of right, left.

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18
Q

What is the lesion site for Right-Left Discrimination deficits?

A

Parietal lobe of either side.

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19
Q

What is Anosognosia?

A

Denial/lack of awareness of the paretic extremity as belonging to the person, or lack of insight concerning or denial of the presence of severity of one’s paralysis.

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20
Q

How is Anosognosia typically identified?

A

By talking to the person, asking how the limb feels and why it cannot be moved (patient will deny the paralysis and disability, fabricate reasons why limb does not move).

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21
Q

What is Somatoagnosia?

A

Impairment in the body scheme, lack of awareness of body structure and the relationship of body parts to oneself or to others.

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22
Q

What is the common lesion site for Somatoagnosia?

A

Dominant parietal lobe, commonly seen with right hemiplegia.

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23
Q

How can Somatoagnosia be tested?

A

By asking the patient to name body parts, questions about the relationship of body parts (do not use the words right/left).

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24
Q

What are some treatment suggestions for Somatoagnosia?

A

Sensory stimulation of the body part affected; Patient verbally identifies the body parts.

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25
Name the sub-categories of Spatial Relations Disorders.
Figure ground discrimination, Spatial relations, Position in space, Topographical disorientation, Depth and distance perception, Vertical orientation.
26
What is Figure-Ground Discrimination?
Inability to visually distinguish a figure from the background in which it is embedded.
27
Provide an example of difficulty experienced by someone with Figure-Ground Discrimination impairment.
Cannot locate items in a drawer, cannot locate buttons on a shirt, unable to tell when one step ends and another begins on a flight of stairs.
28
What is the common lesion site for Figure-Ground Discrimination deficits?
Parieto-occipital region, commonly of the right hemisphere.
29
How can Figure-Ground Discrimination be tested?
Ayres figure ground test (showing patient overlapping line drawings and asking client to name these); Functional test like: pick out spoon from an unsorted array of eating utensils.
30
What are treatment suggestions for Figure-Ground Discrimination?
Practice visually locating objects; Educated and instructed to use other intact senses (e.g., located brake levers by touch); Red tape, example on the edges of the stair; Place few items in the drawer.
31
Define Spatial Relations (as a perceptual impairment).
Inability to perceive the relationship of one object in space to another object or to one self.
32
What behavior is commonly observed in patients with Spatial Relations impairment regarding midline?
Patient usually avoids crossing the midline.
33
What is the common lesion site for Spatial Relations impairment?
Inferior parietal lobe or parieto-occipital-temporal junction mostly of right side.
34
How is Spatial Relations impairment tested?
Rivermead perceptual assessment battery.
35
What are some treatment suggestions for Spatial Relations impairment?
Patient instructed to position themselves in relation to the therapist; Practice block design; PNF to encourage crossing the midline.
36
What is Position in Space (perceptual impairment)?
Inability to perceive or to interpret spatial concepts such as up, down, in, out.
37
Provide an example of difficulty for someone with Position in Space impairment.
Difficulty: raise the arm above the head, place the foot on the footrest.
38
What is the common lesion site for Position in Space impairment?
Non dominant parietal lobe.
39
How can Position in Space impairment be tested functionally?
Tell patient to describe relationship between 2 objects or place two items in relationship to each other for example: shoe in different position in relation to shoe box.
40
What is Topographical Disorientation?
Difficulty in understanding and remembering the relationship of one location to another.
41
What is the common lesion site for Topographical Disorientation?
Right parietal lobe.
42
How can Topographical Disorientation be tested?
Asked to draw/describe familiar routes, layout of his/her house.
43
What are some treatment suggestions for Topographical Disorientation?
Practices going from one place to another, simple routes and then complicated routes; Reminded not to leave the clinic, home unattended; Frequently travelled routes marked with colored dots, spaces between dots gradually increased.
44
What is Depth and Distance Perception impairment?
Inaccurate judgement of distance, direction and depth.
45
Provide an example of difficulty for someone with Depth and Distance Perception impairment.
Difficulty navigating stairs, may continue pouring juice once filled, may miss chair when attempting to sit.
46
What is the common lesion site for Depth and Distance Perception impairment?
Posterior right hemisphere in the visual association cortex, evident with right sided or bilateral lesions.
47
How can Depth and Distance Perception impairment be tested?
Object held in front of the patient and patient asked to grasp it (patient might under/over shoot but movement will be smooth); Asked to fill a glass of water.
48
What are some treatment suggestions for Depth and Distance Perception impairment?
Education, walk carefully from uneven surfaces and also stairs; Training for depth and distance; Feet on designated spots during gait training, touch the top of piles with foot.
49
What is Vertical Orientation impairment?
Distorted perception of what is vertical.
50
What is the common lesion area for Vertical Orientation impairment?
Non dominant parietal lobe.
51
How can Vertical Orientation impairment be tested?
Holding cane vertically and then horizontally.
52
What are some treatment suggestions for Vertical Orientation impairment?
Education; Compensate by using tactile cues while going through doorways, elevators.
53
What is Agnosia?
Inability to recognize or make sense of incoming information despite intact sensory capacities. Can affect any sensory modality (vision, audition, taste, touch) and anything (face, sound, color, familiar and less familiar objects).
54
What is Visual Agnosia?
Inability to recognize familiar objects despite normal function of eyes and optic tract (can recognize objects once handled).
55
Define Prosopagnosia.
Inability to recognize familiar faces.
56
Define Color Agnosia.
Unable to identify or name colors on command.
57
What is the common lesion area for Visual Agnosia?
Occipito-temporo-parietal association area.
58
How is Visual Agnosia tested?
Asked to name object or point to the object named.
59
What are some treatment suggestions for Visual Agnosia?
Practice discrimination between colors, faces (objects) and objects; Use intact sensory modality.
60
What is Auditory Agnosia?
Inability to recognize non speech sounds or to discriminate between them.
61
Provide an example of difficulty for someone with Auditory Agnosia.
Cannot tell the difference between door bell, telephone ring.
62
What is the common lesion for Auditory Agnosia?
Dominant temporal lobe.
63
How is Auditory Agnosia typically tested?
By speech language pathologist, asking patient to close eyes and identify the source of various sounds.
64
What is Tactile Agnosia (Astereognosis)?
Inability to recognize forms by handling them.
65
What is the common lesion for Tactile Agnosia?
Parieto-temporo-occipital lobe of either hemisphere.
66
How is Tactile Agnosia tested?
Identify objects placed in hand without visual cues.
67
What are some treatment suggestions for Tactile Agnosia?
Patient practices feeling various object, noting their special characteristics; Visual compensation.
68
What is Apraxia?
Inability to perform purposeful movements which cannot be accounted for by the inadequate strength, loss of coordination, impaired sensation, attentional difficulties, poor comprehension.
69
What is the common lesion for Apraxia?
Dominant hemisphere lesion.
70
What other condition often co-occurs with Apraxia?
Aphasia.
71
Name the two main types of Apraxia discussed.
Ideomotor apraxia and Ideational apraxia.

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