OT Neuro - Perceptual Dysfunctions

-Motor perception disorders •-Body scheme disorders •-Visual spatial disorders •-Visual perception disorders •-Tactile perception disorders

-Adaptive approaches –+Focus is on repetitive practice of tasks that are typically related to ADLs –+Adapting the context and developing strategies • -Remedial approaches –+Practice in tasks that require perceptual skills –+Engagement in occupation to promote remediation of skills

-Disturbance of a complex processing system involving planning and execution • -Inability to perform skilled, purposeful movements in the absence of loss of strength, coordination or sensation • -Can occur as a result of damage to either hemisphere, but may be more frequently seen in left hemisphere lesions

-Impairment in performing motor tasks on command, despite appearing to understand the concept • -Occurs with left hemisphere lesions • -Often retain kinesthetic memory patterns so a person may be able to carry out habitual tasks • -Exhibit errors in motor performance –+Use body parts as objects –+Manipulation of body parts

-Impairment in carrying out complex, sequential motor acts • -Loss of conceptual sequencing that allows one to relate the symbolism of object names and visual imagery to a motor task • -Common errors –+Omit steps of a sequence –+Incomplete sequences –+Inappropriate use of objects –+Move in the wrong plane or wrong direction –+Perseverate motor actions

•Assessment: clinical assessment done through observations of performance of functional tasks • Intervention : –Remedial – provide tactile and kinesthetic input prior to and during a task; minimize verbal input; carry out activities in the best context –Adaptive – determine which type of commands are most effective (sequential or desired action); visualization of desired action

•-Impairment in producing designs in two or three dimensions on command or spontaneously •-Will have difficulty with multi-step, sequential activities such as meal prep • -Occurs with lesions in either hemisphere –+R-sided lesion – visual-spatial dysfunction, such as lack of perspective, figure in space, and analysis of parts in relation to each other –+L-sided lesion – exist with visual field deficits; exhibit a planning problem

-R-sided lesion – very disorganized; heavy lines; poor perspective and spatial relations; models are not usually helpful • -L-sided lesion – very hesitant in drawings; more difficulty in execution; drawings will be more simple; models may be helpful, but will want to overlay on the model

Assessment: –Non-standardized: copying tasks; design tasks –sticks, blocks, peg designs –Standardized – cognitive and neuropsych tests • Intervention : –Remedial – practice producing two and three dimensional designs; use backward chaining; concern exists over transfer of learning to functional tasks –Adaptive – Backward chaining to perform functional tasks such as grooming, meal preparation; number objects to be used in a sequential task

-Inability to dress oneself as a result of body scheme and/or visual spatial relations —-Commonly seen with constructional apraxia •-Seen in inability to orient clothes; will try to put clothes on upside down or backward; will put both legs in one pant leg; arm in wrong sleeve; will only dress half of body •-Errors occur because of incorrect actions or sequencing

•Assessment: non-standardized – have person perform dressing activities and observe •Intervention : –Remedial – Minimal verbal cues; Try global commands, “Get dressed.” Try to use affected extremity. –Adaptive – Note how characteristics may alter performance – one garment at a time versus all garments. Use labels on clothes. Try tactile strategies.

-Dysfunction in the ability to conceive and execute motor actions •-Known as apraxia •-Significant implications for occupational performance •-Types –+Ideational apraxia –+Ideomotor apraxia –+Constructional apraxia –+Dressing apraxia

-Somatognosia –-Finger agnosia –-Unilateral neglect –-Right-left discrimination –-Anosognosia

-Representation of the spatial relations among the parts of the body •-Perception of body position and relationship of the body and its parts •-Guides movement and serves as the foundation for perception of environment •-Seen most often with right hemisphere lesions

-Lack of awareness of body structure and failure to recognize body parts and their relationship to each other •-Person may confuse sides of the body; may not differentiate his or her body from that of another person’s body