cognitive and perceptual problems in stroke

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.