Perceptual dysfunction.pdf

Perceptual Dysfunction JILL SEALE, PT, P hD, NCS Management Strategies: Unilateral Spatial Neglect Mix of restorative strategies, compensatory strategies and environmental/task adaptation ◦ Increase stimulation to neglected side ◦ Increase attention to neglected side ◦ Verbal cueing ◦ Scanning train...

Perceptual Dysfunction JILL SEALE, PT, P hD, NCS Management Strategies: Unilateral Spatial Neglect Mix of restorative strategies, compensatory strategies and environmental/task adaptation ◦ Increase stimulation to neglected side ◦ Increase attention to neglected side ◦ Verbal cueing ◦ Scanning training ◦ Bilateral movements or weightbearing ◦ Active movement of the affected side upper extremity ◦ Adapt environment for safety Management Strategies: Other Body Scheme/Body Image Disorders Anosognosia ◦ Supervision ◦ environmental modifications, repetition R/L discrimination: ◦ repetition/practice ◦ Demonstration/imitation ◦ visual cue such as watch on L Management Strategies: Visual Discrimination Decrease clutter Visual scanning Slowing down Repeated practice Amplify stimulation (tape on step edges for example) Adapt environment to avoid Management Strategies: Apraxia Keep verbal commands to a minimum, put task at subcortical level, physically guide, visualize the task. Performance can improve with imitation and repetition Use simple or isolated tasks The more familiar and typical the surroundings the better (environment and context specific) Management Strategies: Agnosia Use real objects Physical guidance Practice discrimination between objects Compensate with other sensory modalities In Summary Perception is the interpretation of what we take in from senses Normal perception is needed for normal movement and function (just like normal sensory, normal motor) Perceptual dysfunctions can have significant impact on movement, function, safety, ability to live independently Management strategies utilize a combination of restorative and compensatory/adaptation approaches Perceptual Dysfunction JILL SEALE, PT, P hD, NCS Objectives Describe perception and the neuroanatomy of perception Describe methods for screening/examination of perception Describe most common perceptual dysfunctions ◦ ◦ ◦ ◦ Body image/body scheme Visual discrimination Apraxia Agnosia Compare/contrast common perceptual dysfunctions Identify strategies for management of common perceptual dysfunctions Perception Use or integration of sensory information into “meaningful information” – Shumway-Cook, 2017 Allows us to understand the relationships between our bodies and the environment Normal perception requires intact sensation Neuroanatomy review Parietal lobe most responsible for perception Perceptual dysfunction can occur with infarcts of the ACA, MCA or PCA Importance of Perception Deficits may increase risk for injury May impair/impact motor function Impacts motor learning Impact prognosis and plan of care What does a perceptual problem look like? Pt has difficulty carrying out simple tasks, but is strong enough and has good sensation Difficulty initiating or completing a task Difficulty shifting from one task to another Problems following one step commands even when comprehension seems fine Takes a LONG time to do things or is impulsive Video Examples Unilateral Spatial Neglect: https://www.youtube.com/watch?v=vuhCjQpPzdc Visual Agnosia: https://www.youtube.com/watch?v=ze8VVtBgK7A&t=133s Apraxia (Ideomotor): https://www.youtube.com/watch?v=EvOYeqM-6CE Apraxia (dressing): https://www.youtube.com/watch?v=xjm0AAvEOUs Apraxia: https://www.youtube.com/watch?v=44fGSw7QFLc&t=4s Screening/Examination First step is to determine that sensory function is intact ◦ Visual fields, visual acuity ◦ Hearing ◦ Somatosensory and vestibular ◦ Cortical sensations Good observation Tests and Measures Referral to OT for further testing Tests and Measures Unilateral Spatial Neglect ◦ Albert’s Cancellation Test ◦ Draw an Item Body Scheme ◦ Point to body parts (or imitate body part pointing) ◦ Draw a man test Right/Left Discrimination ◦ Point to body part, specifying side