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By Manasi Kulkarni
Shyamli Kulkarni
CONTENTS Cognition List of Cognitive problems Perception List of Perceptual problems Attention deficit Memory deficit Impairment of executive functions Body scheme and body image impairment Spatial relation impairment Agnosia Apraxia
Cognition The mental action or process of acquiring
knowledge and understanding through thought, experience and the senses.
Encompasses the processes such as Attention, Memory, Judgment, Reasoning ,Computation.
Cognitive ProblemsAttention –there are 4 types of attentions
1.Sustained
2.Selective
3.Divided
4.Alternating
Memory-three types of memory
1.Immediate memory
2.Short term memory
3.Long term memory
Impairment of executive function
1.Volition
2.Planning
3.Purposive action
4.Effective performance
PerceptionPerception is defined in several ways
It is organization identification and interpretation of sensory information in order to represent and understand the environment. Or
Perception is defined as integration of sensory impressions into information that is psychologically meaningful.
Perceptual problemsThere are 4 areas of perception which are
mostly affected in the brain lesions.
1.Body scheme and imaging
2.Agnosia
3.Apraxia
4.Spatial relation disorder
Attention Deficit ATTENTION is the ability to select and attend to a specific
stimulus while simultaneously suppressing extraneous stimuli.
SUSTAINED ATTENTION: it is capacity to attend to relevant information during activity.
SELECTIVE ATTENTION : it is capacity to attend to a task despite environmental visual or auditory stimuli.
DIVIDED ATTENTION : it is capacity to respond simultaneously to two or more tasks or stimuli when all stimuli are relevant.
ALTERNATNG ATTENTION: it is capacity to move flexibly between tasks and respond appropriately to the demands of each tasks.
Memory deficit MEMORY is the mental process allows the individual
store experiences perceptions for recall at a later time .
Memory comprises :
Learning/ acquisition
Storage/ retention
Recall /retrival
Levels of memory IMMIDIATE : it involves retention of information that
has been stored for a few second .
SHORT TERM : it involves retention of events and learning that has taken place within a few minutes, hours and days.
LONG TERM : it involves retention of early experience and information acquired over a period of years.
• Mainly the frontal lobe lesion affects the memory.patients who do not have long term memory are often described as having Amnesia.
Impairment of executive function It consist of those capacities that enable a person
to engage successfully in independent,purposive,self serving behaviour.
VOLITION- Encompasses a future realization of one’s need and wants
PLANNING-Identification and organization of steps and elements needed to carry out an intention or achieve a goal.
PURPOSIVE ACTION-Includes productivity and self regulation which encompasses the ability to initiate ,maintain ,switch and stop complex action sequences in an orderly manner to realize a goal.
EFFECTIVE PERFORMANCE- Capacity for quality control, including the ability to self monitor and self correct one’s behaviour.
Body scheme and body image impairment
BODY SCHEME : postural models of body including the relationship of body to the environment
BODY IMAGES : visual and mental images of ones body that include feeling about ones body especially in relation of health and disease.
Impairments of body images and scheme Unilateral neglect
Somatognosia
Rt and Lt discrimination
Finger agnosia
Anosognosia
UNILATERAL NEGLECT : inability to register and integrate stimuli and perception from one side of the body and environment or hemispace, which is not due to the sensory loss.
Unilateral Neglect can be referred as-
Unilateral spatial neglect
Hemi neglect
Unilateral visual inattention
ANOSOGNOSIA : severe condition
Includes denial and lack of awareness or presence or severity of ones paralysis.
SOMATOGNOSIA : also known as AUTOPAGNOSIA or BODY AGNOSIA
Impairment in body scheme, lack of awareness of the body parts to oneself or to others.
Rt.AND lt.DISCRIMINATION : inability to identify
Rt & Lt sides of own body or that of the examiner.
Inability to execute the movement in response to verbal commands that include the term Rt and lt.
FINGER AGNOSIA : inability to identify the fingers of ones own hands or of the hands of the examiner.
Testing of finger agnosia
Spatial relation disorder Difficulty in perceiving the relationship between the
self and two or more objects.
Spatial relation disorder :
Figure ground discrimination
Form discrimination
Spatial relations
Position in space
Topographical disorientation
Depth and distance perception
Vertical disorientation
FIGURE GROUND DISCRIMINATION : inability to visually distinguish figure from the background in which it is embedded.
FORM DISCRIMINATION : inability to perceive or attend to subtle differences in form and shape.
SPATIAL RELATIONS : inability to perceive the relationship of one object in space to another object or to oneself.
Ex. Figure ground discrimination
POSITION IN SPACE : inability to perceive and to interpret spatial concepts such as up, down, under, over, in, out, infront of and behind.
TOPOGRAPHICAL DISORIENTATION : difficulty in understanding and remembering locations the relationship of one location to another.
DEPTH AND DISTANCE PERCEPTION : inaccurate judgement of direction, distance and depth.
Faulty distance perception.
VERTICAL DISORIENTATION : distorted perception of what is vertical.
Displacement of vertical position can contribute to disturbance of motor performances both in posture and in gait.
VerticalDisorientation
Agnosia Inability to recognize or make sense of incoming
information despite intact sensory capacities.
AGNOSIAS are :
Visual objects
Auditory
Tactile
VISUAL OBJECT : inability to recognize familiar objects despite normal function of the eye and optic tracts.
AUDITORY: Inability to recognize nonspeech sounds / to discriminate between them.
TACTILE : ASTERIOGNOSIS
Inability to recognize form by handling them although tactile, proprioceptive and thermal sensations are intact.
Apraxia Impairment of voluntary skilled learned movements.
Inability to perform purposeful movements which can not be accounted for by :
Inadequate strength
Loss of coordination
Abnormal tone
Movement disorder
Intellectual disorientation
Poor comprehension
Uncooperativeness
APRAXIAS are:
Ideomotor apraxia
Ideational apraxia
Buccofacial apraxia
IDEOMOTOR : breakdown between concept and performance disconnection between idea of movement and its motor execution.
IDEATIONAL : failure in the conceptualization of the task.
Inability to perform a purposeful motor act either automatically or on command.
BUCCOFACIAL : difficulties with performing purposeful movement with the lips, tongue, cheek, larynx, pharynx, on commands.