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What is visual perceptual hierarchy?
an organized hierarchy of processes that interact with and sub serve each other
What is homonymous hemianopia? What is it confused with?
blindness in the nasal field of one eye (ipsilateral) and temporal field of the other eye (contralateral)
may be confused with USN
What is unilateral spatial neglect?
hemi-inattention, visual-spatial neglect, and visual neglect
deficit of attention
failure to report, respond, orient to meaningful stimuli presented to the side opposite the brain lesion, when this failure cannot be attributed to sensory or motor defects
What can USN result from?
an infarct to inferior parietal lobe of either hemisphere
What kind of neglect is more common and more severe?
left neglect = R hemisphere damage
What are the hypotheses between the R and L hemispheres?
R is dominant for attention
R knowledge of and attends to both R/L body schema and extra personal space
L knowledge of and attends to R body schema and extra personal space
Long-standing USN results in…?
longer rehab stays
lower levels of independence on D/C
greater difficulty with ADL
more frequent falls
higher risk for deterioration 1 year post-CVA
greater burden on caregivers
What are the types of USN?
personal or body neglect
extra personal neglect
motor neglect
What are manifestations of personal-body neglect?
does not wash L side of body
does not comb L side of hair
does not shave L side of face
Does not dress L side of body
does not use/incorporate L side into bed mobility
difficulty finding vertical position
severe cases do not recognize the L side of their body
What are manifestations of near extra personal neglect?
not eating food on L side of plate
unable to find items on L (fork, toothbrush)
unable to read
What are manifestations of far extra personal neglect?
locating clock on wall
propelling a w/c - hitting obstacles on L
watching TV
What are manifestations of motor neglect?
relatively intact movement when encouraged to use contralateral limb
no or little involvement of the contralateral limb in bimanual task
dropping, forgetting about items in L hand
What should be provided when performing remediation treatment?
graded sensory stimulation from the neglected hemisphere to the neglected side of the body
approach from L (auditory, visual)
tactile - touch pt on L
proprioceptive - wt bear on affected side
move into neglected space
move neglected side of body into neglected space *
What are specific evidence-based interventions for neglect?
visual scanning training into the left environment
visual smooth pursuits from right to left
trunk rotation and scanning
limb activation and spatio-motor cueing
mental imagery
mirror therapy - mirror visual feedback
video feedback
FES, TENS
virtual reality
prism adaptation
partial visual obstruction (glasses)
What are adaptations for someone with USN?
L side w/c brake extension
phone on R
nurse call button on R
anchoring
keeping L side of body safe
Visual spatial perception disorders are a result from what?
damage to parietal lobe of R hemisphere
Presence of visual-spatial deficits are associated with what?
increase in falls
decreased performance in basic ADL and mobility
What are typical deficits that come from problems with high-order visual processing?
Perceiving depth - stereopsis
figure-ground discrimination
interpreting spatial relations or position in space
What is a spatial relations deficit?
difficulty perceiving/understanding the relative orientation of an object in relation to the self
difficulty understanding the position of objects in relation to each other
What are manifestations of visual spatial perception disorders?
difficulty orienting clothing to body to get dressed
orienting dentures/glasses to apply
maneuvering self around obstacles
position w/c and self for safe transfer
What are remediation treatments for visual spatial perception disorders?
identify the spatial requirements of a task
decrease spatial requirement of tasks, then gradually increase spatial requirements
use cognition and backward chaining to re-teach spatial relationships
minimal visual cues, maximize verbal cues
What are adaptation treatments for visual spatial perception disorders?
decrease the spatial requirement of the task, adapt the task, adapt the environment
repetitive task practice - do same task over and over in same manner
use cognitive strategy training - self talk, external cues
What is apraxia or limb apraxia?
deficit in execution of learned movement that cannot be accounted for by either weakness, incoordination, or sensory loss, or by incomprehension or inattention to commands
Apraxia occurs due to the result of whatever?
damage to left inferior parietal lobe, prefrontal and premotor cortex
What is praxis?
idea-plan-execution
What are the types of apraxia?
conceptual or ideational
motor or ideomotor apraxia
What is ideational or conceptual apraxia?
pt no longer understands the concept of the task
breakdown in the knowledge of what is to be done to complete the task
loss of the metal representation of what needs to be done
disturbance in the conceptual organization of the task
What are manifestations for ideational apraxia?
inappropriate use of tools (toothbrush)
does not use objects (eats with fingers)
sequences task steps inaccurately (shoes/socks)
decreased initiation, perseveration
What is motor or ideomotor apraxia?
idea and purpose of the task is understood
difficulty is in the execution phase, carrying out the required movements
loss of access to kinesthetic memory patterns
What are manifestations for ideomotor apraxia?
clumsy or awkward movements
difficulty crossing midline to complete a task (adjusting hair brush, tooth brush)
difficulty orientating UE to pick up an object
What are general considerations with apraxia?
increased complexity of task - increases errors
learning new tasks is extremely difficult (transfers, ambulation aids, hemi-dressing)
What are remediation treatment for apraxia?
decrease complexity of task (gradually increase)
use hand over hand assistance, minimal verbal instruction
practice at level of task, not component parts
What are adaptation treatments for apraxia?
decrease complexity of task and environment
use cognitive strategy training (CST)
internal rehearsal
verbalization during task (self talking-questioning)
external cues