Test 2: Perceptual Deficits

Question 1

what is perception

Answer 1

ability to select those stimuli that require attention to action and to integrate those stimuli with each other and prior info to finally interpret them

this awareness enables the individual to make sense of complex/dynamic sensory environment

Question 2

what are perceptual deficit

Answer 2

complex and intimately linked to the sensorimotor deficit associated (hemiplegia)

innappropriate interpretation of appropriate sensation

inability to perceive stimuli due to underlying sensorimotor deficit

Question 3

2 largest populations with perceptual deficits

Answer 3

stroke and TBI

Question 4

perception vs sensation

Answer 4

stimuli input required for sensation and perception; perception is not independent of sensation

sensation = cognitive appreciation/awareness of stimuli through organs of special sense, peripheral receptors, etc

perception = more complex than just appreciation; ability to interpret sensation accurately and resond appropriately

Question 5

pathophysiology of perceptual deficits

Answer 5

neuro injury to parietal lobe

MCA stroke, TBI, vascular disease

more common with injury to non-dominant R parietal lobe

examples: R MCA stroke can cause L unilateral neglect or left spatial relation disorders, L MCA CVA causes body agnosia

Question 6

what is agnosia

Answer 6

simple perception deficits

inability to recognize anything familiar or make sense of incoming information despite intact sensory capacities

visual, auditory, and tactile (astereognosis) types

Question 7

what is visual agnosia

Answer 7

inability to recognize familiar objects despine normal function of eyes

prosopagnosia is inability to recognize familiar faces

color agnosia is inability to recognize colors; NOT color blindness

Question 8

what is auditory agnosia

Answer 8

inability to recognize familiar non-speech sounds or discriminate between them

rarely occurs in absence of other communication disorders

Question 9

what is tactile or astereognosis agnosia

Answer 9

inability to recognize forms by handling them through tactile, proprioceptive, and thermal sensations may be intact

Question 10

what is body schema/body image

Answer 10

individuals perception of postural model of body including the relationship of body parts to each other and relationship of the body to the environment

more complex combo of multiple agnosias

“body awareness”/”body orientation”

Question 11

deficits of body schema include

Answer 11

unilateral neglect
ipsilateral pushing
anosognosia
somatoagnosia
R-L discrimination
finger agnosia

Question 12

what often accompanies unilateral neglect that relates to vision but is not due to visual dysfunction

Answer 12

homonymous hemianopsia

Question 13

unilateral neglect is caused by

Answer 13

posterior/inferior parietal lobe injury

R MCA most common resulting in L neglect

20% of stroke pts

Question 14

what is personal unilateral neglect

Answer 14

decreased self awareness

doesnt recognize own arm, remains half dressed

clinical presentation:
- half face of makeup
- half face shaved
- leaves arm behind

Question 15

what is spatial unilateral neglect

Answer 15

decreased environmental awareness

i.e. runs into doroways, only makes R turns

Peripersonal
- only eats half of the food in front of them; locks one side of WC

extrapersonal
- runs into doorways/people on neglected side

Question 16

what is anosognosia

Answer 16

denial of symptoms
safety awareness deficits

lack of awareness/denial of paretic limb as belonging to person; pt can recognize when other people with similar deficits have unsafe behaviors but could not recognize their own

severe form of unilateral neglect

often resolves spontaneously in first 3 months following stroke

important to maintain safety of neglected limb while performing rehab

Question 17

what is somatoagnosia (body agnosia or autotopagnosia)

Answer 17

lack of awareness of body structure and relationship of body parts to oneself or others

i.e. pt has trouble with transfers b/c he doesnt perceive the meaning of terms related to body parts such as “reach back with your arm and grab the armrest”

Question 18

how to test for somatoagnosia

Answer 18

have pt point to parts of body

“show me your hand and now the other hand”

“point to your elbow” and pt points to knee

Question 19

how to manage somatoagnosia

Answer 19

sensory stimulation to the body part affected

Question 20

what is R-L discrimination disorder

Answer 20

inability to identify R or L of ones own body or someone elses body

cant execute movements in response to verbal commands that include the terms R and L

close association with aphasia

as PT can cue “use arm with watch” or point directly to arm you want pt to use

Question 21

what are spatial relation disorders

Answer 21

difficulty in perceiving the relationship between self and two or more objects

most frequently happens with R sided lesions affecting parietal lobe (i.e. R MCA)

Question 22

examples of spatial relation deficits

Answer 22

figure ground discrimination

form discrimination

spatial relations

position in space

topographical disorientation

depth perception

vertical/”midline” orientation

Question 23

what is figure ground discrimination

Answer 23

cant visually distinguish a figure from the background

cant pick an object our of an array of other objects

cant locate important objects that aren’t prominent = frustration

increase of fall risk i.e. descending stairs and not seeing where one starts and another stops

Question 24

what is form discrimination

Answer 24

ability to perceive subtle differences in form and shape

pt is likely to confuse objects of similar shape or not to recognize an object placed in an unusual position

i.e. confuse pen with toothbrush or cant distinguish or set the place of utensils

Question 25

what is spatial (relations) disorientations

Answer 25

inability to perceive the relationship of one object in space to another object or to oneself spatial relation skills required to manage most ADLs can become a safety issue: - walking into doors - distance between sitting target - trouble reading analog clock, distance between hands

Question 26

what are position in space deficits

Answer 26

inability to perceive and interpret spatial concepts such as up, down, under, over, in, out, in front of, behind differs from proprioception alone i.e. if pt asked to lift arm over head that are confused or lift arm incorrectly

Question 27

how to test for deficits with position in space

Answer 27

pt is presented with 2 objects and asked to describe their relationship with one another i.e. toothbrush in cup and asked to describe this

Question 28

what is topographical disorientation

Answer 28

difficulty understanding and remembering relationship of one location to another pt unable to get from one place to another without cues/map

Question 29

how to test topographical disorientation

Answer 29

pt asked to describe or draw a familiar route such as the block on which they live or the layout of their house pt unable to do so pt asked to walk back to your room from therapy gym

Question 30

describe depth/distance perception

Answer 30

judgement of direction, distance, and depth pt may have difficulty navigating stairs, may miss chair when attempting to sit can be a contributing factor in faulty distance perception

Question 31

what is vertical orientation

Answer 31

difficulty finding midline/upright position distorted perception of true vertical can contribute to appearance of postural stability deficits or gait disturbance can be in presence or absence of homonymous hemianopia common presentation = most pts post R CVA in early phase

Question 32

what is pusher syndrome

Answer 32

active pushing toward neglected side feel like you are pushing them over if you try to correct severe vertical orientation deficit active resistance to passive correction can visually see they are vertical but perception of upright is skewed

Question 33

what is apraxia

Answer 33

inability to perform voluntary learned movement inability to perfom purposeful movements not related to: - inadequate strength - coordination loss - impaired sensation - poor comprehension - uncooperative - etc

Question 34

2 types of apraxia

Answer 34

ideomotor = cant perform on command but can do it automatically, unconscious muscle memory (i.e. cant go to the door if asked but may automatically if doorbell rings) ideational = cant perform task at all; hard to differentiate between aphasia and other disorders; no IDEA

Question 35

what is diplopia

Answer 35

double vision pt sees 2 of environment defective function of extraocular muscles in which both eyes are used but not in conjunction with the other treatment = exercise for eye muscles; eye patch on alternating eyes until condition clears

Question 36

what is homonymous hemianopia

Answer 36

"visual field cut" loss of vision from half (R or L) visual field of both eyes most common visual deficit with hemiplegia; MCA damage near internal capsule affecting optic tract; presents similar to PCA damage to visual cortex 17% of R MCA

Question 37

homonymous hemianopia vs unilateral neglect

Answer 37

HH = aware of problem and compensate automatically or learn to compensate by head turn; injury occurs along visual projectsions unilateral = may have intact vision but seems unaware of the problem and doesnt attempt to compensate spontaneously by turning head; possibly no injury to visual projections