Perception testing and training
- 1. PERCEPTION TESTING AND TRAINING PRESENTATION BY: DR. VAIBHAVI PARMAR 2ND YEAR MPT 4TH AUG 2017
- 2. Definition: Lezak defines perception as the integration of sensory impressions into information that is psychologically meaningful. The terms perception and sensation are often confused with each other.
- 3. ■ CLINICAL INDICATORS Inability to do simple tasks independently or safely, Difficulty in initiating or completing a task, Difficulty in switching from one task to the next, Diminished capacity to locate visually or to identify objects that seem obviously necessary for task completion.
- 4. In addition, unable to follow simple one-step commands. Make the same mistakes over and over. Hesitate many times, appear distracted and frustrated, and exhibit poor planning.
- 5. COMMON TESTS FOR PERCEPTION 1) Structured Observational Test of Function Consists of a screening test, neuropsychological checklist, and four ADL scales (eating from a bowl, pouring a drink and drinking, putting on an upper body garment, and washing and drying hands). 2) Allen Cognitive Level Test to gain information concerning the client’s educational and work background, the client is observed performing the visuomotor task of leather lacing.
- 6. 3) The Behavioural Inattention Test (unilateral visual neglect) To check client’s ability to perform everyday occupations. It consists of 9 activity-based subtests and 6 pen & paper subtests. 4) Rivermead Perceptual Assessment Battery (TBI) To examine visual perceptual impairments. 16 performance tests that examine form discrimination, colour constancy, sequencing, object completion, figure–ground discrimination, body image, inattention, and spatial awareness. 5) Rivermead Behavioural Memory Test To examine everyday memory abilities. To check client’s memory function, an indication of appropriate areas for treatment, and enables the therapist to monitor memory skills throughout the treatment program.
- 7. PERCEPTUALIMPAIRMENTS: 1)Body scheme/body image impairments • Unilateral neglect • Anosognosia • Somatoagnosia • Right–left discrimination • Finger agnosia 2)Spatial relation impairments (complex perception) • Figure–ground discrimination • Form discrimination • Spatial relations • Position in space • Topographical disorientation • Depth and distance perception • Vertical disorientation
- 8. 3) Agnosia • Visual object agnosia • Auditory agnosia • Tactile agnosia 4) Apraxia • Ideomotor apraxia • Ideational apraxia • Buccofacial apraxia
- 9. PERCEPTUAL DISORDERS BODY SCHEME BODY IMAGE Visual & mental image of one’s body Postural model of body including that includes Feeling about one’s body. relationship of body parts to each other Esp Health & Disease & environment.
- 10. 1) UNILATERAL NEGLECT Inability to register and integrate stimuli and perceptions from one side of the body. According to distribution: Personal & Spatial (contralat body) ( contralat space) According to modality: Motor & Sensory (stimuli to which (visual, auditory, person aware) somatosensory)
- 11. Clinical exp: Patient ignore left half of body when dressing, shaving, left food in plate on one side. Lesion: inferior–posterior regions of the Rt) parietal lobe. Testing: a) The Behavioural Inattention Test which examine BADL & IADLs. b) Ask to do any task eg make a drawing, writing Treatment: Use verbal instructions minimal Encourage to turn head to neglect side & attention driven. Can use eye patch or prism glasses. Teach strategies to assist in ADLs Encourage to give demonstration with affected side
- 13. 2) SOMATOAGNOSIA • Lack of awareness of the body structure and the relationship of body parts to oneself or to others. ( autopagnosia or simply body agnosia) •Clinical exp: difficulty performing transfer activities difficulty following instructions, imitate therapist’s movements. Lesion: dominant parietal lobe Testing: Ask to point body parts name by therapist on himself or chart Ask to imitate movements of therapist Ask to ans the que in relationship to his body. e.g are your knees below your head?
- 14. Management: facilitation of body awareness through sensory stimulation to the body part affected. E.g Rub body part with rough surface as therapist name or points on it.
- 15. 3) ANOSOGNOSIA • Lack of awareness of the presence or severity of one’s paralysis. • Clinical Ex: patient maintains that there is nothing wrong and refuse to accept responsibility for them. •Lesion: supramarginal gyrus •Testing: asked what happened to the arm or leg, whether he or she is paralyzed, how the limb feels, and why it cannot be moved Patient deny paralysis. •Treatment: it resolves spontaneously in the first 3 months following stroke, if persists long term safety is importance in the treatment.
- 16. 4) RIGHT LEFT DISCRIMINATION •inability to identify the right and left sides of one’s own body or of that of the examiner. •Clinical Exa: patient cannot tell the therapist which is the right arm and which is the left, unable to follow instructions using the concept of right–left, such as “turn right at the corner.” •Lesion: parietal lobe of either hemisphere •Testing.The patient is asked to point to body parts on command, such as right ear, left foot, right arm, and so forth. •Treatment: for compensation when giving instructions to the patient, the words “right” and “left” should be avoided. Instead, pointing or providing cues using distinguishing features of the limb may be more effective (e.g., “the arm with the watch”)
- 17. 5) FINGER AGNOSIA •inability to identify the fingers of one’s own hands or of the hands of the examiner. •Clinical Exa: difficulty in naming the fingers on command, identifying which finger was touched, mimicking finger movements. •Lesion: parietal lobe •Testing: asking the patient to move or point to his or her finger when named by the therapist, 10 times (own) 10 times ( therapist) 10 times (chart). •Treatment: rough cloth can be used to rub the dorsal surface of the more affected arm, hand, and fingers, and the ventral surface of the more affected fingers. Pressure can be applied to the ventral surface of the hand.
- 18. SPATIAL RELATION DISORDERS Impairments that have in common a difficulty in perceiving the relationship between the self and two or more objects. 1) FIGURE GROUND DISCRIMINATION •Impairment in visual figure–ground discrimination is the inability to visually distinguish a figure from the background in which it is embedded. •Clinical Exa: The patient 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. •Lesion: Parieto-occipital lesions of the right hemisphere and less frequently the left hemisphere.
- 19. •Testing: 1) Ayres Figure–Ground Test 2) Function-based Test •Treatment: therapist should arrange for practice in visually locating objects in a simple array. For Compensation taught to become aware of the existence and nature of the deficit. examine objects slowly and instructed to use other, intact senses. (e.g., touch)
- 20. 2) SPATIAL RELATIONS 3) FORM DISCRIMINATION Inability to perceive the relationship of one object in space to another object, or to oneself. Clinical Exa: difficult to place the cutlery, plate, and spoon in the proper position when setting the table. Lesion: inferior parietal lobe or rt) parieto-occipital-temporal junction. Testing:Rivermead Perceptual Assessment Battery Inability to perceive or attend to subtle differences in form and shape. Clinical Exa: confuse a pen with a toothbrush, a cane with a crutch Lesion: parieto-temporo-occipital region of no dominant hemisphere Testing: asked to identify items similar in shape and different size.
- 21. Treatment: In form discrimination should practice describing, identifying, and demonstrating the use of similarly shaped and sized objects. In spatial relations orient by giving the patient instructions to position himself or herself in relation to the therapist or another object. E.g “Sit next to me,” “Go behind the table”
- 22. 4) DEPTH AND DISTANCE PERCEPTION •Patient experiences inaccurate judgment of direction, distance, and depth. • Clinical Exa: Difficulty navigating stairs, may miss the chair when attempting to sit. •Testing: functional test ( ask to grasp an object from table) (asked to fill a glass of water) •Treatment: aware of the deficit while gait training ask to walk on spots teach compensatory strategies ( ask to hold armrests of a chair to assist with sitting)
- 24. AGNOSIAS Visual • inability to recognize familiar objects Auditory • inability to recognize non speech sounds or to discriminate between them Tactile • inability to recognize forms by handling them, although tactile, proprioceptive, and thermal sensations may be intact
- 25. Visual agnosia
- 26. Testing: Patient is asked to name the familiar objects, to point to an object named by the therapist. (visual) Patient is asked to close the eyes and to identify the source of various sounds. The therapist rings a bell, honks a horn, rings a telephone.(auditory) asked to identify objects placed in the hand by examining them manually without visual cues. (tactile) Treatment: compensation
- 27. APRAXIA: inability to perform purposeful movements, which cannot be accounted for by inadequate strength, loss of coordination, impaired sensation, attentional difficulties, abnormal tone, movement disorders, intellectual deterioration, poor comprehension, or uncooperativeness. • able to carry out habitual tasks automatically and describe how they are done but is unable to imitate gestures or perform on command Ideomotor • inability to perform a purposeful act, automatically or on command, because the patient no longer understands concept of the act, can’t retain the idea of the task Ideational • difficulties with performing purposeful movements with the lips, tongue, cheeks, larynx, and pharynx on command. Buccofacial
- 28. Treatment: therapist should speak slowly and use the shortest possible sentences for verbal commands. When teaching a new task break the task and then ask to do.
- 29. EVIDENCES: 1) Combining neck vibration and prism adaptation produces additive therapeutic effects in unilateral neglect. Neuropsychol Rehabil 2010 By: Árni Kristjánsson; Ulrike Halsband 3 groups 1) neck vibration 2) prism adaptation 3) combination of both Findings for both groups indicated improved visual search following intervention, but the patients that underwent the combined intervention (NVPA) showed clear improvements on visual search based paper and pencil neglect tests unlike the NV-only group.
- 30. 2) Efficacy of strategy training in left hemisphere stroke patients with apraxia:A randomised clinical trial By: Joost Dekker & G. Deelman Neuropsychological rehabilitation, 2001 113 left hemisphere stroke patients with apraxia were randomly assigned to two treatment groups. 1) strategy training + occupation therapy 2) OT only Duration: 8 weeks Measures: ADL activities observation & barthel index They found only short-term effectiveness of strategy training in left hemisphere stroke patients with apraxia.
- 31. 3)Occupational therapy treatment with right half-field eye-patching for patients with subacute stroke and unilateral neglect:A randomized controlled trial. Disability and Rehabilitation, Tsang, M. H., Sze, K. H., & Fong, K. N. K. (2008) They randomly allocated in 2 groups 1) OT without Eye patch 2) OT with eye patch Duration: 4 weeks Measures: BIT & FIM study indicates that right half-field eye-patching techniques improved impairment & in ADL function.
- 32. REFERENCES: 1) Physical Rehabilitation Susan B O’Sullivan Thomas j Schmitz ( 6th edition) 2) Motor control theory and practical application – anne shumway –cook and wallacott 2nd ediation
- 33. THANK YOU!