Week 1

Question 1

Perception:

Answer 1

the ability to process and interpret sensory

information

Question 2

Perceptual Impairments

Classification

Answer 2

1. Unilateral Neglect
2. Inattention/extinction
3. Agnosias
4. Other impairments of visuospatial awareness
5. Pushing Behaviour

Question 3

Unilateral Neglect

Definition:

Answer 3

– The failure to report, respond or orient
– To novel or meaningful stimuli
– Presented to the side opposite a brain lesion
– When this failure cannot be attributed to either
sensory or motor impairments

Question 4

Unilateral Neglect

Incidence:

Answer 4

– 11–82 % following stroke in the right side of the brain

Question 5

Unilateral Neglect

• Neglect associated with

Answer 5

– longer length of stay in rehabilitation

– poorer functional outcome following stroke

Question 6

Unilateral Neglect

• Synonyms

Answer 6

– Unilateral spatial neglect
– Inattention (X)
– Hemi‐neglect
– Hemi‐spatial neglect
– Neglect syndrome
– Contralesional neglect
– Visual spatial neglect

Question 7

What side is neglect more common on and why?

Answer 7

• Left neglect following
right sided stroke is most
common
• Right hemisphere directs
attention to both right
and left hemispaces
• Left hemisphere directs
attention primarily to
right hemispace
-– does not usually result in UN
– intact right hemisphere can direct attention to
both hemispaces

Question 8

Types of unilateral neglect

Answer 8

– sensory neglect
– motor neglect
– representational neglect

Question 9

Unilateral Neglect

• Sensory neglect

Answer 9

• Sensory neglect
– decreased awareness of sensory stimulation in
the contralesional hemispace
– despite intact primary sensory cortical area and
sensory pathways

Question 10

Unilateral Neglect

• Motor neglect

Answer 10

– Decreased ability to move in the contralesional
hemispace
– Despite being aware of a stimulus in that space
– Not a deficit of the motor pathway

Question 11

Unilateral Neglect

• Representational neglect

Answer 11

• Representational neglect
– person ignores the contralesional half of
internally generated images
– Internally generated images are mental
representations or visualizations of a task, action,
or environment

Question 12

Unilateral Neglect

Distribution of neglect

Answer 12

• Personal

– contralesional ½ of body

• Spatial:

       – Peripersonal • contralesional near space within reaching distance
       – Extrapersonal • space beyond reaching distance

Question 13

Looking for neglect during functional assessment

Answer 13

• Note failure to use or attend to one side of body or
environment
• Note any mismatch between:
– Strength observed during assessment in chair/on
bed
– Functional use of limbs during STS or gait etc.

Question 14

Possible observations UN physio assessment neglect

Answer 14

Possible observations during Functional Assessment
• Gaze to the lesion side (often right)
• May slump or lean to lesion side
• Ignore objects in the contra‐lesional visual field
• Run into objects and doorways on contra‐lesional side
• May leave hemiplegic arm behind when rolling
• Difficulty crossing midline

Question 15

Unilateral neglect impairment measures

Answer 15

Line bisection
Cancellation Tasks
The Bells Test
Star cancellation test

Question 16

Behavioural assessment of neglect

Answer 16

• Catherine Bergego Scale

* The Behavioural Inattention Test

Question 17

Most sensistive neglect measure

Answer 17

• Behavioural assessment of neglect in daily life was more

sensitive than any other single measure of neglect. (Catherine Bergego Scale)

Question 18

Agnosias

Answer 18

Agnosias
• The inability to recognise objects or symbols in
the absence of impairments of the primary
senses
• Visual, auditory, tactile or proprioceptive

Question 19

Astereognosis (tactile agnosia)

Answer 19

• The inability to recognise objects
by touch even though tactile,
thermal and proprioceptive
functions are intact

Question 20

Autotopagnosia

Answer 20

• Disturbed perception of the patient’s own body parts
• May be unaware of existence of one side of body
• May be unable to distinguish right from left (laterality)

Question 21

Anosognosia

Answer 21

• Failure to recognise the presence or severity of paralysis
• In subjective examination ‐ observe if patient is unrealistic
about their condition

Question 22

Verticality perception

Answer 22

• Subjective postural vertical

* Subjective visual vertical

Question 23

Before assessing visual perception, must first test

Answer 23

• Acuity
• Eye movements
• Visual fields

Question 24

Subjective postural vertical

Answer 24

• Perception of own body orientation
• Observe posture
• Move person into various positions
– ask if they feel ‘straight’ or ‘falling/leaning
to one side’
– do they have a fear of falling?

Question 25

Subjective Visual Vertical

Answer 25

Perception of position of objects in environment – Hold a stick against a background with no cues – Slowly rotate stick – Ask person to

Question 26

Distance perception

Answer 26

Difficulty determining the relative distance between objects and oneself • May present as difficulty with stairs or curbs or negotiating obstacles

Question 27

Size, colour or shape perception

Answer 27

• Functionally patient may show inappropriate fear – e.g. fear of rolling off edge of bed when there is ample space

Question 28

Figure‐ground perception

Answer 28

– Inability to distinguish a specific stimulus from its background – Visual or auditory systems may be involved

Question 29

Direction sense

Answer 29

``` • Patient may have difficulty perceiving directions despite having intact language skills: – up – down – left – right – forwards – backwards ```

Question 30

• Route finding impairment

Answer 30

• Inability to find one’s way in familiar surroundings or to learn the way in a new situation

Question 31

Pushing Behaviour

Answer 31

``` • Characterised by: • an asymmetrical trunk posture towards the hemiplegic side • active pushing towards the hemiplegic side ```

Question 32

Pushing Behaviour | • Other terms in literature include:

Answer 32

– Pusher syndrome – Contraversive pushing – Ipsilateral pushing – Lateropulsion

Question 33

PB Clinical Features

Answer 33

``` • Overactivity of the nonparetic ipsilesional arm and leg – extend the unaffected arm and leg and actively push away from the nonparetic side ``` ``` • Resistance to attempts at passive correction of posture towards the ipsilesional side • Falling towards hemiplegic side • Fear of falling towards the ipsilesional side ```

Question 34

PB Clinical Features ‐ Severity

Answer 34

``` • Severity of PB appears to: – Vary between individuals – Vary within individuals over time – Become more obvious when the base of support is reduced ```

Question 35

Mechanism for Pushing Behaviour | Theories:

Answer 35

``` 1. Disturbed perception of verticality: – ? SVV – ? SPV – ? BOTH 2. Graviceptive Neglect – Disrupted processing of graviceptive information 3. Right hemisphere syndrome – PB is frequently associated with unilateral neglect but not always ```

Question 36

Management of Unilateral Neglect

Answer 36

• Approaches are classified into Top Down or Bottom Up

Question 37

Management of Unilateral Neglect | Top Down Approaches

Answer 37

``` • Aimed at cognitive level • Train the person to voluntarily compensate for their neglect during activity • Require awareness of the impairment • Interventions train clients to direct attention to the neglected side ``` • Increase the person’s awareness and understanding of their impairments using their intact verbal and cognitive ability – e.g. if they have a disturbance of subjective postural vertical: • Point out that they are mistaken about the nature of vertical • Encourage them to align themselves with known vertically oriented objects (e.g. a door frame) Visual scanning training • Initially train scanning to side of neglect • Later train to scan to neglected side then back to other side • Use bright objects, cards, numbers on wall