cognitive-perceptual impacts on motor control

perception

integration of sensory impressions (peripheral sensory/afferent info) into psychologically meaningful info (higher level processing at cortex, interpretation and meaning to incoming afferent info)

cognition

ability to process, sort, retrieve and manipulate info

orientation & memory

attention, reasoning, planning, problem solving

motivation, emotional aspects

critical for goal directed movements

perception and cognition

both are required for successful movement within the environment

deficits in either=often major barrier/s to successful rehabilitation

information processing

the CNS must identify and perceive sensory inputs contribution to

individual must determine useful actions

individual must execute action w/ correct movement sequencing, timing, coordination

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

3 core components of executive function

behavioral inhibition (self control), working memory, cognitive flexibility (set shifting)

together they allow for reasoning, problem solving, and planning

executive functioning areas of the brain

frontal lobe and related networks play critical role

DLPFC: dorsolateral prefrontal cortex

cingulate cortex

limbic system

association areas

association areas

multimodal, motor, and sensory

parts of cognition

processes that contribute to establishing goals or intent of movement

orientation

memory

attention

reasoning

problem solving

planning

motivation

emotional aspects

types of attention

focused, selective, sustained, alternating, divided

focused attention

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

selective attention

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

sustained attention

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

alternating attention

shift focus of attention and move btwn tasks having different cognitive requirements

divided attention

highest level of attention and refers to ability to respond simultaneously to multiple tasks or multiple task demands

attention impairment

inability to follow directions

orientation impairment

disoriented

memory impairment

appears disoriented, wil forget names, schedules, etc. and decr ability to learn

problem solving impairments

difficulty with ADLs, sociallly inappropriate, inability to recognize threats to safety

higher level processing

receiving info about the environment and state of the body through somatosensation, visual, vestibular system (peripheral sensory mechanisms from the environment)

perceptual impairments

body scheme: awareness of body parts, position of body

R/L discrimination: ability to understand R/L

body part indentification: ability to identify body parts

anosognosia: unawareness or denial of deficits

unilateral neglect: neglect of 1 side of body/space

position in space: ability to understand concepts like over, under, around, above , below

spatial relations: ability to perceive self in relation to other objects

topographic orientation: ability to find one’s way from one place to another

figure ground perception: ability to distinguish foreground from background

limb apraxia: inability to carry out purposeful movement in the presence of intact sensation

constructional apraxia: deficits in constructional activities

dressing apraxia: inability to dress oneself

praxis

ability to perform a learned skilled movement

apraxia

inability to perform a learned movement that cannot be accounted for by weakness, in coordination, sensory loss or incomprehension or inattention

agnosia

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

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

perceptual deficit

damage typically to post parietal and occipital temporal cortex

perception, avoidance, confidence

perception infl how individuals conceptualize their movement

perception infl what activities individuals participate in

all congruent with actual abilities normally

standardized outcome measures for cognition

mini-mental state exam (MMSE) C&P

slu mental status exam (SLUMS)

montreal cognitive assessment (MOCA)

minicog P

clock drawing test

quick assessment of cognition (executive function)/perception (visuospatial relationships)

screens for attentional and executive dysfunctions (cognition) and apraxia or neglect (perception)

instruct pt to draw numbers to make circle look like face of clock, then draw the hands of the clock to read 10 after 11

score 1-6 with 1=perfect and 6=no representation of a clock

avoidance measures

fear avoidance beliefs questionnaire (FABQ): impact on PA & work

fear of falling avoidance behavior question (FFABQ)

activities specific balance confidence scale (ABC)

kinesiophobia scales

pt specific functional scale with avoidance