exam 3

individual
task
environment

what 3 factors influence movement?

cognition
perception
action

what are 3 characteristics of the individual that influence movement?

perception

integration of sensory impressions into psychologically meaningful information

-based on sensory info coming in

cognition

ability to process, sort, retrieve and manipulate information

-Critical for goal directed movements

cognition

the following are (cognition/perception)

•Orientation & Memory
•Attention, Reasoning, Planning, Problem solving
•Motivation, Emotional aspects

both

(cognition/perception/both) are required for successful movement within the environment

goal directed movement

(Cognition is vital for us to be able to direct movement and actions so they have meaning behind them)

cognition is critical for _____ _____ movement

•The CNS must 1-identify and 2-perceive sensory input
•The individual must determine useful action(s)
•The individual must execute action with the correct movement sequencing, timing, and coordination

what 3 things need to happen for information processing for a person to perform a skilled task?

identify
perceive

in order to perform a skilled movement the CNS must ____ and _____ sensory input

reaction time

the time between preparation and initiation

-represents the lag between sensory input and initial piece of motor output

executive function

A variety of higher cognitive processes that use and modify information from many cortical sensory systems to modulate and produce behavior

-Necessary for effective, goal directed actions and for the control of attentional resources

goal directed actions

attentional resources

executive function is necessary for effective, ______ ______ actions and for the control of ______resources

1.Behavioral inhibition (self-control)
2.Working memory
3.Cognitive flexibility (set shifting)

what are the 3 core components of executive function?

•Reasoning
•Problem solving
•Planning

together the 3 components of executive function allow for what 3 things?

frontal lobes

(related networks= Dorsolateral prefrontal cortex (DLPFC)
Cingulate cortex
Limbic system
Association areas)

•The ______ _____ and related networks play a critical role in executive function

Dorsolateral prefrontal cortex (DLPFC)
Cingulate cortex
Limbic system
Association areas

what related networks work with frontal lobe to play a critical role in executive function?

cognition

the following are all examples of what?

•Orientation
•Memory
•Attention
•Reasoning
•Problem solving
•Planning
•Motivation
•Emotional aspects

goals
intent

cognition= Processes that contribute to establishing _______ or _____ of movement

decreased

As skill of learner is improved, cognitive effort is _________

attention

information processing capacity of an individual

capacity

(and performing a task requires a given portion of capacity)

Attention is limited, _______

deteriorates

•If 2 tasks are performed together and they require more than the total capacity of attention, the performance on either or both of the tasks ________

capacity sharing theories
time sharing hypotheses
cross talk model
bottleneck theories

what are some dual task theories?

bottleneck theory of attention

suggests that individuals have a limited amount of attentional resources that they can use at one time.

Therefore, information and stimuli are 'filtered' somehow so that only the most salient and important information is perceived

cross talk theory

theory of attention/dual tasks:

-like serial processing

-we have two inputs to our system that demand attention- our brain says two things are not alike to each other so I cant capacity share them together

It can respond to one task and during execution of 1st task have response selection of the second task

*One task is processed and selected before other one is selected*

focused attention

type of attention:

the ability to respond discretely to specific visual, auditory, or tactile stimuli

selective attention

type of attention:

the ability to maintain behavioral or cogntiive set in in the face of distracting or competing stimuli

sustained attention

type of attention:

the ability to maintain a consistent behavioral response during continuous and repetitive activity

alternating attention

type of attention:

shift focus of attention and move betwen tasks having different cogntitive requirements

divided attention

this is the highest level fo attention and it refers to the ability to respond simultaneously to multiple tasks or multiple task demands

attention
orientation
memory
problem solving

what are the different things we can have cognitive impairments involving?

memory

_______ impacts the way we select what we are doing

inability to follow directions

what are some functional effects that may be seen from cognitive impairments impacting attention?

disoriented

what are some functional effects that may be seen from cognitive impairments impacting orientation?

appears disoriented
will forget names, schedules, etc
decreased ability to learn

what are some functional effects that may be seen from cognitive impairments impacting memory?

difficulty with ADLs
socially inappropriate
inability to recognize threats to safety

what are some functional effects that may be seen from cognitive impairments impacting problem solving?

mini cog

reliable, quick, and easily available instrument to screen for cognitive impairment in otherwise healthy older adults.

consists of a 3-item recall test (memory) and a clock-drawing test (visual spatial info and processing)

cognitive motor interference

possible outcome when a cognitive task and a motor task are performed simultaneously

in healthy adults:
•Limited by ability to process information. i.e., "attentional capacity:
•System requires switching attention to the most task-relevant information

task-relevant

with CMI System requires switching attention to the most _______-______ information

decreased

allocation of attention

CMI with neurologic disease:
1.Capacity available for attention to task may be ______
2.Executive function deficits may result in incorrect ______ of _______

reaction time

movement sequence

with cognitive motor interference:

May see movement deficits in ______ _______ (preparation - initiation) and/or in ______ _______ (initiation- execution - termination)

switched
allocated

to perform dual tasks Attention must be able to be appropriately ______ and _______

•Stimuli may be conflicting and numerous

divided
alternating
selective

what types of attention are used in cognitive motor interference?

executive function

Pathology may affect capacity of ______ ______such that attention is not allocated properly

ex. Parkinson's disease - cortical changes in frontal lobe, in connections between basal ganglia and prefrontal cortex linked to attention allocation deficit

speed of processing

Pathology may affect capacity of ______ of _______ available for attention to task

ex. Multiple sclerosis - number and extent of cortical lesions in grey matter of frontal and superior parietal lobes associated with cognitive impairments (decreased information processing and attentional deficits)

executive control + selective attention (inhibition)

switching + divided attention (shifting)

what cognitive domains are most affected in people with PD who freeze?

motor-motor
cognitive-motor

what are 2 types of dual tasks?

motor-motor

what type of dual task if riding a unicycle and juggling?

cognitive-motor

what type of dual task is walking and reading?

perception

Integration of sensory impressions into psychologically meaningful information

Comes from all sensory inputs up and goes to higher level processing centers to make it meaningful

peripheral sensory/afferent info

higher level processing (cortex)- Interpretation and meaning to incoming afferent information

what are 2 parts of perception?

•Retina (eye)- optic n.
•Macula & Cupula (inner ear) - vestibulocochlear n.
•Muscle spindles, GTO, ruffini's endings, paciniform corpuscles - dorsal columns [gracilis (LE); cuneatus (UE)]

what are some receptors/places in the body we receive afferent information to go on and send to higher regions for perception?

•Occipital temporal region
•Vestibular cortex
•Posterior parietal cortex

what are some higher level processing centers that allow for perception of afferent information and allow the individual to act effectively within an environment in a meaningful way?

environment

body

the process of perception starts by Receiving information about the _______ and state of the _____

dorsal/where stream

visual processing stream

-for spatial processing
-from occipital --> parietal --> frontal

-location, movement, spatial transformations, spatial relations

ventral/what stream

visual processing stream:

-for object processing

occipital --> temporal--> frontal

-color, texture, pictoral detail, shape, size

difficulty wiht dressing, transfers, mobility, following directions that include right/left

what might some functional effects of right-left discrimination be?

ADLS limited to one half of body
transfers and mobility unsafe

what might some functional effects of unilateral neglect be?

ADL affected due to difficulty in using objects

what might some functional effects of limb apraxia be?

multidimensional
complex

Chronic pain is ______ and _______

perception
emotional response

Pain is a _______ and the _______ response to that

false (it is perceived not sensed)

T/F: pain is a sensory thing

perceived

pain is _______ meaning it is not a message that the brain receives coming in as pain- it receives a message does some work with it and then decides that means pain

structural

(there are major changes in the frontal lobe)

______ changes happen overtime with chronic pain

pain matrix

encompasses brain structures that process and regulate pain information

- part of decision making tree that goes back and sees if it is pain or something else you deal with differently

emotional/motivational aspects

the following areas of the brain are involved with which part of the pain matrix?

-insular cortex
-anterior cingulate cortex
-dorsomedial nucleus thalamus
-amygdala

(just recognize these are in pain matrix)

sensory aspects

the following areas of the brain are involved with which part of the pain matrix?

-VPL nucleus thalamus
-primary somatosensory cortex
-somatosensory association cortex

(just recognize these are in pain matrix)

cognitive aspects

the following areas of the brain are involved with which part of the pain matrix?

prefrontal cortex

(just recognize these are in pain matrix)

increase in pain

decrease in pain

what is pro-nociception?

what is anti-nociception?

dual tasking

•the concurrent performance of 2 tasks that CAN be performed independently, measured separately, and have distinct goals"

1. can be performed independently
2. measured separately
3. have distinct goals

what 3 characteristics do dual tasks have to meet?

complex task
complex task
dual task
dual task

match the following with either (dual task/complex task):

Walking while carrying a glass of water=

Walking with crutches=

Standing on one foot while saying the alphabet (alternating letters - ie A, C, E)=

Juggling while counting backwards by 3's=

complexity

task _________=related to number of task components and attentional demands

novelty

task _______=related to performer experience

complexity
novelty

dual task performance depends in part on task _______ and task ________

all are dual motor-motor tasks

what type of task are these?

drinking a cup of water while writing a note with the other hand=

walking while texting on the phone=

tapping the foot as fast as possible while drawing a 6 pointed star=

novelty

_______ matters for dual tasking because it drives attentional demands because brain doesn't have ready made program for the task that is new

•Task specific interference
motor OR cognitive
•Automaticity
motor AND cognitive
•Task prioritization
Attention allocation

what are some measures of dual task performance?

automaticity

overall effect/combined effect of dual task
-how well does the brain automatically perform the task?

(DT-ST)/ST x 100

what is the formula for a motor dual task effect or for cognitive dual task effect?

motor priority trade off

what task prioritization category is the following?

+ motor DTE
- cognitive DTE

motor better (+), cognitive worse (-)

cognitive priority trade off

what task prioritization category is the following?

- motor DTE
+ cognitive DTE

motor worse (-), cognitive better (+)

mutual interference

(both are negative)

what task prioritization category is the following?

- motor DTE
- cognitive DTE

both worse (-)

mutual facilitation (both are positive)

what task prioritization category is the following?

+ motor DTE
+ cognitive DTE

both better (+)

motor DTE - cognitive DTE

(+= motor priority, 0= no priority, -= cognitive priority)

what is the formula for modified attention allocation index?

+= motor priority
0= no priority
-= cognitive priority

what do the following scores for modified attention allocation index (mAAI) mean?

positive (+) score=
0=
negative (-) score=

((motor DT x cog DT) - (motor ST x cog ST))/ (motor ST x cog ST)

what is the formula for the combined DTE?

+ if the performance improved

- if the performance got worse

how do we know what sign to make the answer for DTE?

+

-

•If performance is better during TUGc ((↓ time) then the DTE is described as (+/-)?

•If performance is worse during TUGc (↑ time) then the DTE is describe as (+/-)?

•Cognitive task must be continuous
•Cognitive task must be completed using the same method but different specific responses (ie if serial subtraction - subtract by the same number but start at a different number)
•Do not provide number until you are ready to begin the motor task

what are some considerations to remember about the cognitive task when making a dual motor-cognitive task/measuring the effects?

MOST CLINICALLY RELEVANT PIECE WE HAVE TALKED ABOUT WITH DUAL TASKING BC IT'S A SAFETY MECHANISM- if focus on cognitive task and find out they are falling multiple times a week we see their attention is diverted away from motor task at hand so not using balance strategies appropriately

why does task prioritization matter for us as clinicians?

Need to make sure not to bias pt with our instructions on how to do the task

ex. as PTs we tend to tell them to focus on motor even If we don't mean to and don't give good cognitive instructions

Walk as quickly as you can safely while also counting as quickly as you can accurately- BALANCE INSTRUCTIONS- then we can see what brain does to prioritize without our bias

what do we need to think about when providing instructions before a dual task?

what is the single cutoff for mini-mental state exam for abnormal?

dementia

the mini mental state exam is meant for what?

(dementia/mild cognitive impairment)

dementia

= cognitive impairment sufficient to interfere with performance of ADLs

- we care about this bc we care about ADLs and their performance

-orientation
-short term immediate recall
-attention and basic problem solving
-long term recall
-language
-perception: praxis

what are the cognitive domains that the mini mental assesses?

praxis

ability to perform a learned skilled movement

apraxia

= inability to perform a learned movement that can not be accounted for by weakness, incoordination, sensory loss or incomprehension or inattention
-NOT accounted for in a mechanical way

agnosia

= inability to recognize and identify objects, persons, or sounds using one or more of their senses despite otherwise normally functioning senses.

• The deficit cannot be explained by memory, attention, language problems, or unfamiliarity to the stimuli.

posterior parietal
occipital temporal cortex

where is the damage typically in someone with agnosia?