Lecture 31 (Bonus Lecture): CTSIB and Perceptual Disorders

What are the three sensory inputs for balance and postural control

Vision (60%)

Somatosensory (30%)

Vestibular (10%)

CTSIB Conditions

Condition 1: Stable surface with eyes open

Condition 2: Stable surface with eyes closed

Condition 3: Stable surface with visual conflict

Condition 4: Unstable surface with eyes open

Condition 5: Unstable surface with eyes closed

Condition 6: Unstable surface with visual conflict

LOB with condition 1 indicates what system is impaired

All 3 systems

LOB with condition 2 indicates what system is impaired

Somatosensory

LOB with condition 3 indicates what system is impaired

Somatosensory

LOB with condition 4 indicates what system is impaired

Vision

LOB with condition 5 indicates what system is impaired

Vestibular

LOB with condition 6 indicates what system is impaired

Vestibular

Dependence on vision for balance will demonstrate increased sway with what conditions

2, 3, 5, 6

Dependence on somatosensory for balance will demonstrate increased sway with what conditions

4, 5, 6

Dependence on vestibular for balance will demonstrate increased sway with what conditions

5, 6

A 66-year-old patient complains of loss of balance while walking on a thickly carpeted floor in the middle of the night when its completely dark. Which condition on the CTSIB would the patient present with increased body sway?

A. Condition 2

B. Condition 3

C. Condition 4

D. Condition 5

D

A PT uses CTSIB to test standing balance of a patient. The patient demonstrates increased sway and experiences a fall during condition 4. Which sensory input system could the PT suspect to be impaired?

A. Vision

B. Somatosensory

C. Vestibular

D. Somatosensory and vision

A

What are the four types of perceptual disorders

- Spatial

- Apraxia

- Agnosia

- Body Scheme Disorders

What is figure ground discrimination

Inability to visually distinguish and object from background

What is form discrimination

Inability to perceive or attend to subtle differences in form and shape

What is topographical disorientation

Difficulty comprehending the relationship of one location to another

What is depth and distance perception

inaccurate judgement of direction, distance, and depth

What is vertical disorientation

Distorted perception of vertical (affects upright posture)

What is apraxia

Loss of the ability to execute or carry out learned (familiar) movements, despite having the desire and the physical ability to perform the movements

What is ideomotor apraxia

Ideomotor apraxia the patient is unable to produce a movement on command but is able to move automatically.

What is ideational apraxia

inability to produce movement on command or automatically

What is agnosia

inability to recognize objects

What is visual agnosia

Inability to recognize familiar objects

What is simultanagnosia

The inability to combine elements of a scene into a coherent whole

What is prosopagnosia

inability to recognize faces

What is color agnosia

inability to recognize colors

What is auditory agnosia

Inability to recognize sounds, words and non-words.

What is tactile agnosia / astereognosis

Inability to recognize forms by handling them

What is unilateral neglect

Inability to register and integrate stimuli and perceptions from one side of the body and environment

What is anosognosia

Lack of awareness, or denial, of a paretic extremity as belonging to the person, or a lack of insight concerning, or denial of, paralysis and disability

What is somatoagnosia

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

In PT session, the therapist commands the patient to wear a shirt, but the patient is unable to complete the task due to inability to find buttons on his shirt. Which of the following is the MOST APPROPRIATE diagnosis for this deficit?

A. Form discrimination

B. Figure-ground discrimination

C. Vertical disorientation

D. Topographical disorientation

B

A PT examines a 59-year-old patient with sub-acute stroke. She cannot drink from the bottle on command and automatically. What sort of perceptual disorder does this patient have?

A. Ideomotor apraxia

B. Ideational apraxia

C. Form discrimination

D. Topographical disorientation

B

A PT is treating a patient and is working on weight shifts and reaching activities. The PT asks the patient to place the L hand on his L thigh and use the R hand to reach diagonally across the body and touch the target. The patient has difficulty following the instructions and performs the task incorrectly. Which of the following is the MOST probable diagnosis in this case?

A. Somatoagnosia

B. Prosopagnosia

C. Depth perception disorder

D. Tactile Agnosia

A

A therapist is treating a patient with right parietal lobe lesion. He holds a cane vertically in front of the patient then turns it sideways horizontally and gives to the patient to turn it back to the original position. The patient takes the cane and places it at an angle and informs the therapist he has successfully completed the task. Which of the following MOST appropriate regarding this presentation?

A. Depth perception disorder

B. Visual agnosia

C. Vertical disorientation

D. Ideomotor apraxia

C