Cognitive and Perceptual Disorders

unilateral neglect

inability to register and integrate stimuli and perceptions from one side of the body (body neglect) and the environment or hemispace (spatial neglect of the area surrounding one side of the body), which is not due to sensory loss

neglect is most common following ______ cerebral infarction

right (affecting the left side of the body)

unilateral neglect: contralesional personal space

shaving only the fight half of the face or failing to wash the left side of the body

unilateral neglect: contralesional peripersonal space

failing to use objects on the contralesional side of the meal tray

(within arm distance)

unilateral neglect: contralesional extrapersonal space

failing to negotiate obstacles, doorways, and so forth during locomotion

(beyond arm length)

left sided hemianopia

actual loss of vision from the left visual filed of both eyes

lesion area for unilateral neglect

inferior-posterior regions of the right parietal lobe

what test can be used to examine unilateral neglect

behavioral inattention test (BIT)

Remedial approach

Typically addresses body functions and structures; aims to fix underlying impairments. Often used in the early stages of recovery and rehabilitation.

compensatory approach

the pt is initially educated about the condition, and then strategies to assist managing everyday activities are devised

anosognosia

a 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

example of ansognosia

the pt maintains that there is noting wrong and may disown the paralyzed limbs and refuse to accept responsibility for them

tx suggestions for anosognosia

often resolves spontaneously w/in first 3 months following stroke

right-left discrimination

inability to identify the right and left sides of one's own body or that of the examiner

example of right-left discrimination

the pt cannot tell the therapist which is the right arm and which is the left arm

lesion area of right-left discrimination

parietal lobe of either hemisphere

finger agnosia

the inability to identify the fingers of one's own hands or of the hands of the examiner

example of finger agnosia

difficulty naming fingers on command, identifying which finger was touched, and mimicking finger movements

spatial relations disorders

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

(right parietal lobe)

figure-ground discrimination

inability to visually distinguish a figure from the background in which it is embedded

example of figure-ground discrimination

the pt cannot locate items in a pocketbook or drawer, locate buttons on a shirt, or distinguish the armhole from the remainder of a solid-colored shirt

pt may not be able to tell when one step ends and another step begins on a flight of stairs, especially when descending

form discrimination

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

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

clinical example of form discrimination

the pt may confuse a pen with a toothbrush, a vase with a water pitcher, a cane with a crutch and so forth

spatial relations disorder

inability to perceive the relationship of one object in space to another object, or to oneself

clinical examples of spatial relations disorder

pt may find it difficult to place the cutlery, plate and spoon in the proper position when setting a table

the pt may be unable to tell the time from an analog clock because of difficulty in perceiving the relative positions of the hands

the pt may have difficulty learning to position his or her arms, legs and trunk in relation to the WC to prepare for transferring

position in space impairment

inability to perceive and to interpret spatial concepts such as up, down, under, over, in, out, in front of, and behind

clinical examples of position in space impairment

if a pt is asked to raise the arm above the head during ROM activities or is asked to place the feet on the footrests, the pt may behave as if he or she does not know what to do

topographical disorientation

difficulty in understanding and remembering the relationship of one location to another

as a result, the pt is unable to get from one place to another with or without a map

clinical examples of topographical disorientation

the pt cannot find the way from his or her room to the physical therapy clinic, despite being shown repeatedly

the pt cannot describe the spatial characteristics of familiar surroundings, such as the layout of his or her bedroom at home

depth and distance perception disorder

experiences inaccurate judgement of direction, distance, and depth

clinical example of depth and distance perception disorder

the pt may have difficulty navigating stairs, may miss the chair when attempting to sit, or may continue pouring juice once a glass is filled

vertical disorientation

distorted perception of what is vertical

clinical example of vertical disorientation

views the world differently and this may affect upright posture

agnosia

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

visual agnosias

most common form of agnosia

inability to recognize familiar objects despite normal function of the eyes and optic tracts

simultanagnosia (Balint's syndrome)

inability to perceive a visual stimulus as a whole

the pt perceives an entire array one part at a time

prosopanosia

inability to recognize familiar faces

related to visually ambiquous stimulus, the recognition depends on evoking a memory context such as different species of bird or different cars

color agnosia

inability to recognize colors; it is not color blindness

the pt is unable to identify or name colors on command, although color chips can be correctly paired

pt no longer associates a duckling as yellow or the sea as blue

auditory agnosia

inability to recognize nonspeech sounds or to discriminate between them

examples of auditory agnosia

cannot tell the difference between the ring of a doorbell and that of a telephone, or between a dog barking and thunder

tactile agnosia or asterognosis

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

example of tactile agnosia

if a pt is handed a familiar object (key, comb, safety pin) with vision occluded, he or she will fail to recognize it

apraxia

inability to perform purposeful movements

ideomotor apraxia

breakdown between concept and performance

disconnection between the idea of movement and its motor execution

pts can carry out habitual tasks automatically and describe how they are done, but are unable to imitate gestures or perform on command

examples of ideomotor apraxia

pt is unable to "blow" on command however, if presented with a bubble wand, the pt will spontaneously blow bubbles

ideational apraxia

failure in the conceptualization of a task. inability to preform a purposeful motor act, either automatically or on command, bc the pt no longer understands the overall concept of the act, cannot retain the idea of the task, or cannot formulate the motor patterns required

examples of ideational apraxia

when presented with a toothbrush and toothpaste and told to brush the teeth, the pt may put the tube of toothpaste in the mouth or try to put toothpaste on the toothbrush without removing the cap

buccofacial apraxia or oral apraxia

difficulties with performing purposeful movements with the lips, tongue, cheeks, larynx, and pharynx on command

clinical example of buccofacial apraxia

a pt may have difficulty responding to the command "pretend to blow out a candle" or "blow a kiss"