Neuro impairments: perception, cognition

what are the components of the individual

1. cognition

2. PERCEPTION

3. action

what is sensation

the appreciation of stimuli through special sense organs (eyes, ears, nose, touch, taste, internal receptors for muscles, joints)

what is perception

integration of sensory impressions into psychologically meaningful information

what are the types of sensation

1. superficial sensation

2. cortical sensation

3. proprioception

4. kinesthesia

5. vibration

what is superficial snesation

pain, temperature, light touch, pressure

what is cortical sensation

1. tactile localization

2. 2 point discrimination

3. graphesthesia

4. stereognosis

what is tactile localization

can tell where someone is touching you

what is graphesthesia

ability to write letters and perceive these

what is stereognosis

ability to identify solid object by touch only

what is proprioception

ability to sense position of body relative to neighboring parts

-joint position sense: awareness of joints/joint position at rest without vision

what is kinesthesia

awareness of movement

what is vibration sensation

ability to perceive/detect vibration (rapid oscillating stimuli)

what does sensory deficits look like in CVA

1. altered quantity or quality of information/signs

2. typically in patchy or irregular distribution (unlike dermatome, PN distribution)

3. difficulty integrating sensory information

what are perceptual problems

difficulty interpreting sensory information accurately and then acting appropriately

what are the types of perceptual problems

1. unilateral neglect

2. spatial relations/position in space

what are the types of unilateral neglect

1. body

2. visual

what are sensory input sources

1. touch

2. vestibular/cerebellar

3. vision

4. higher order process (neglect)

what are the intervention basics for sensory retraining

1. sensory re-learning

2. applying current learning principles

3. task-specific training

4. home training

sensory re-learning is

1. touch discrimination of different surfaces and fabrics

2. touch discrimination of different sizes, shapes, temperatures, and weights

3. proprioception

4. tactile object recognition (stereognosis)

what is task-specific training?

1. exercises reflecting daily activities

2. fine motor training

3. gross motor training

what is home training

1. touch discrimination

2. stereognosis

3. meaningful activities

what is the vestibular system and cerebellum’s role in coordination

1. error correction mechanism: helps coordinate postural responses during walking by changing limb position

2. cerebellum: compares intended movement from cortex with actual motor performance

comparison of information via cerebral cortex (internal feedback) vs information from sensory receptors (peripheral/external) from:

1. golgi tendon organs

2. joint and cutaneous receptors

3. vestibular apparatus

4. vision

normal vision vs following stroke

1. acuity=ability to see far/near → decreased acuity (blurry)

2. depth perception → visual/spatial problems

3. seeing a single image → double vision

4. visual fixation → abnormal VOR

5. ocular pursuit (ability to follow a target/track)→nystagmus

6. peripheral vision → lost visual fields

what is homonymous hemianopsia

loss of vision in the contralateral half of each visual field, nasal half of one eye and temporal half of the other

what is neglect

inattention to one side of the body/environment

-not knowing what the deficit is (aware from other people telling them)

how is visual neglect tested

1. clock drawing

2. finding the small stars

3. line bisection

what are screening tests for vision and visual neglect

1. what is your baseline vision? do you wear correction such as glasses/contacts?

2. has your vision changes since your stroke/event

   1. double vision? (vertical or horizontal)

   2. acuity (read something near or far)

   3. other problems

what is a screen for vision/visual neglect

quadrant testing

how do you perform quadrant testing

1. pt look straight ahead

2. must hit all 4 corners (good to try the middle as well)

3. do both sides at some point- informal screen for visual neglect