Cognitive and Perceptual Deficits

Presented by Diana OGrady Occupational Therapist

Objectives
Review

definitions Review brain function in relation to cognition and perception Review types of stroke and deficits Learn strategies to assist the stroke survivor and yourself

Why are we concerned with cognitive and perceptual deficits?

Because

these invisible barriers have a big impact on every aspect of your patients life Understanding the deficits and knowing what you can do to help is the first step in helping your patient do important activities such as eating and moving and improve their functional outcomes

Definitions
Cognition

- refers to the act or process of knowing information refers to the ability to organize, understand, and interpret sensory information from within our body and from the external environment

Perception

Brain Function Frontal Lobe

-

Key Functions: Memory (for habits and motor activities) Executive functions (task initiation, motivation, planning and self monitoring) Concentration/ reasoning Judgment/ problem solving

Associated Dysfunctions: Inability to attend to task Inability to sequence complex tasks (i.e. getting dressed) Impaired judgment, decreased ability to problem solve

Brain Function Parietal Lobe

Key Functions: Visual attention Touch perception Integration of different sensory input

Associated Dysfunction: Difficulty focusing visual attention or attending to more than one object at a time Inability to perceive objects normally Neglect or inattention to part of body or space Denial of deficits

Brain Function Temporal Lobe

Key Functions: Integration of visual, auditory, and somatic info Memory (storage, retrieval of words, experiences)

Associated Dysfunction: Difficulty recognizing faces Difficulty attending to input Short term memory loss Disturbance of longterm memory

Brain Function Occipital Lobe

Key Function: Vision

Associated Dysfunction: Visual field cuts Diplopia Agnosias inability to recognize familiar objects, words, colours, or movement of an object

Spatial organization and interpretation of visual info Visual reflexes

Type of Stroke Anterior Cerebral Artery (ACA)

Supplies: Medial and superior aspects of frontal and parietal lobes Dysfunction: Cognition - Impaired attention span - Perseveration - Amnesia

Perception - Apraxia

When you walk in the patients room

What you might see is

Strategies for how you can help Apraxia

Physical cues (e.g. label on the back of a shirt) Break the task down into steps Short and simple instructions Verbal cue/instructions instead of demonstration Hand over hand guidance when needed Positive feedback after each step Consistent routine

Type of Stroke Medial Cerebral Artery (MCA)

Supplies: Lateral aspect of frontal and parietal lobe Dysfunction: Cognition - Lack of judgement /poor insight - Perseveration

Perception - Neglect or inattention to body and/or space - Difficulty with spatial relationships - Apraxia

When you walk in the patients room

What you might see is

Strategies for how you can help Visual Neglect

Create

activity/stimulation on the affected side Set up may be required i.e. in bathroom Approach from the unaffected side Positive approach encourage Use visual cues (i.e. red line along side of food tray) and guidance

Type of Stroke Posterior Cerebral Artery (PCA)

Supplies: Medial and inferior aspects of right temporal and occipital lobes Dysfunction: Cognition - Memory impairment

Perception - Impaired right vs. left discrimination - Difficulty with spatial relationships - Visual agnosia

Summary
Cognitive

and perceptual deficits are dependent on the location, type, and severity of stroke Damage to the right hemisphere tends to have a greater impact on cognitive and perceptual abilities

Summary (cont)

Section 7 Cognitive and Perceptual Problems of Tips and Tools binder is a great resource for specific explanations and strategies for assisting your patients When something seems to work, document the triggers and/or successes so other individuals can be consistent with your patient Try to be patient, creative, and consistent

Conclusion
Assessment, observation, and analysis of the information you gather and use of tools and resources will guide you to identifying the Invisible barriers and finding solutions. Good Luck and Thank you