1. Perceptual Deficits and visual deficits Janet Ivey Occupational Therapy This is not an Agored Cymru publication. It has been developed by colleagues from Cwm Taf University Health Board and is currently being hosted by Agored Cymru until a more suitable site becomes available.

2. Aims of Session To be able to define perceptionTo be able to define perception To have a basic knowledge of perceptual deficitsTo have a basic knowledge of perceptual deficits To understand and be able to identify potential perceptual problems and how they present in every day activities.To understand and be able to identify potential perceptual problems and how they present in every day activities. To be aware of common visual field deficits and how they affect occupational performance.To be aware of common visual field deficits and how they affect occupational performance.

3. Perception is - The integration and interpretation of sensory impressions into meaningful dataThe integration and interpretation of sensory impressions into meaningful data The interpretation of sensory inputThe interpretation of sensory input Making sense of what you see, hear or touchMaking sense of what you see, hear or touch

5. 4 main areas Body awarenessBody awareness Visual discriminationVisual discrimination ApraxiaApraxia AgnosiaAgnosia

6. Body awareness Made up of body image and body schemeMade up of body image and body scheme Body image is the visual and mental image of one’s body (mental representation)Body image is the visual and mental image of one’s body (mental representation) Body scheme – postural model as to the position of body in space and relationships of body parts to one anotherBody scheme – postural model as to the position of body in space and relationships of body parts to one another

7. Examples of body awareness SomatognosiaSomatognosia - disorder of body scheme and lack of awareness of body structure, failure to recognise body parts and relationships to one a another Unilateral NeglectUnilateral Neglect - failure to respond to stimuli on the side of the body contralateral to the lesion. May ignore 1 side of the body and/or environment Ipsilateral neglectIpsilateral neglect - most common in frontal lobe lesions – ignores the same side of body as the lesion site - most common in frontal lobe lesions – ignores the same side of body as the lesion site

8. AnosognosiaAnosognosia - erson fails to recognise presence or severity of their paralysis. May deny their illness - Person fails to recognise presence or severity of their paralysis. May deny their illness Right/Left discriminationRight/Left discrimination - Inability to use and understand the concepts of right/left Examples of body awareness

9. Visual Discrimination Visual discrimination is the ability to distinguish one object from another; they can be differentiated by colour, size, shape, pattern, foreground to background and position. Form Discrimination deficit is difficulty attending to subtle variations in form e.g. differentiating between a glass, water jug and flower vase.Form Discrimination deficit is difficulty attending to subtle variations in form e.g. differentiating between a glass, water jug and flower vase.

10. Visual Discrimination Depth Perception deficit is difficulty in judging depths and distances, e.g. difficulty navigating stairs and barriers such as walls or doorways or difficulty knowing when a glass is full when filling it with water.Depth Perception deficit is difficulty in judging depths and distances, e.g. difficulty navigating stairs and barriers such as walls or doorways or difficulty knowing when a glass is full when filling it with water. Figure Ground deficit is difficulty distinguishing the foreground from the background, e.g. difficulty finding a white vest or towel on a white sheet or an item of clothes in a cluttered drawerFigure Ground deficit is difficulty distinguishing the foreground from the background, e.g. difficulty finding a white vest or towel on a white sheet or an item of clothes in a cluttered drawer

11. Visual Discrimination Spatial Relations deficit is difficulty perceiving the position of two or more objects in relation to oneself or each other, e.g. difficulty putting food onto a spoon and then into the mouth or difficulty putting a teapot lid on a teapot. It may also be exhibited as difficulty understanding the concepts of in/out, front/behind, up/down etc., e.g. difficulty finding a cup behind a kettle or placing on t-shirt inside out.Spatial Relations deficit is difficulty perceiving the position of two or more objects in relation to oneself or each other, e.g. difficulty putting food onto a spoon and then into the mouth or difficulty putting a teapot lid on a teapot. It may also be exhibited as difficulty understanding the concepts of in/out, front/behind, up/down etc., e.g. difficulty finding a cup behind a kettle or placing on t-shirt inside out. Topographical Disorientation is difficulty in understanding and remembering relationships of places to one another, e.g. difficulty in finding one's way.Topographical Disorientation is difficulty in understanding and remembering relationships of places to one another, e.g. difficulty in finding one's way.

12. Apraxia The ability to perform skilled purposeful movements in the absence of loss of motor power, sensation or co-ordination.The ability to perform skilled purposeful movements in the absence of loss of motor power, sensation or co-ordination.

13. Types of Apraxia Ideational dyspraxiaIdeational dyspraxia Ideomotor dyspraxiaIdeomotor dyspraxia See later lecture

14. Agnosias The ability to recognise familiar objects / people perceived by the senses.The ability to recognise familiar objects / people perceived by the senses.

15. Examples of Agnosia’s Visual object agnosia – inability to recognise objects through visual acuity (recognition of objects by touch etc. is still intact)Visual object agnosia – inability to recognise objects through visual acuity (recognition of objects by touch etc. is still intact) Prosopagnosia – inability to recognise differences in faces. May affect both familiar and unfamiliar faces.Prosopagnosia – inability to recognise differences in faces. May affect both familiar and unfamiliar faces. Colour agnosia – inability to recognise or select colours on command, can often say if a colour is the same in 2 different objects.Colour agnosia – inability to recognise or select colours on command, can often say if a colour is the same in 2 different objects.

16. . Tactile agnosia or astereognosis – inability to recognise objects or forms by handling although sensory and proprioceptive functions are intact.Tactile agnosia or astereognosis – inability to recognise objects or forms by handling although sensory and proprioceptive functions are intact. Auditory agnosia - inability to recognise difference in soundsAuditory agnosia - inability to recognise difference in sounds Examples of Agnosia

17. Visual deficits Visual impairment is common following stroke and includes problems such as blurred vision double vision field of vision loss wobbling vision and many others. Referral to an Orthoptist is essential for accurate diagnosis and help – –These symptoms can be addressed in a variety of ways such as with targeted treatment, advice, compensatory strategies and so on. This is important as visual impairment impacts on mobility, rehabilitation, driving, reading and general activities of daily living (Rowe F. 2012 UK Stroke conference)

18. Visual deficits Visual deficits -Incidence 67-71% of stroke patients have visual impairments post stroke 52% Visual field loss 50% have blurred vision but within this cohort 71% of these patients recover within 2-3 weeks 20% have visual perception problems but this is probably underestimated due lack of detection (Rowe F. 2012 UK Stroke conference)

20. Visual deficits Right homonymous hemianopia – due to lesion of left parietal or temporal lobes with pressure on left optic nerveRight homonymous hemianopia – due to lesion of left parietal or temporal lobes with pressure on left optic nerve Right Homonymous inferior quadrantanopia – due to partial involvement of optic radiations ( upper portion of optic radiation in this case)Right Homonymous inferior quadrantanopia – due to partial involvement of optic radiations ( upper portion of optic radiation in this case)

21. Hemianopia Slides downloaded from www.strokecorecompetencies.org/ courtesy of NHS Scotland, NHS Education for Scotland, Chest Heart & Stroke Scotland, University of Edinburgh.www.strokecorecompetencies.org/

22. Diplopia Slides downloaded from www.strokecorecompetencies.org/ courtesy of NHS Scotland, NHS Education for Scotland, Chest Heart & Stroke Scotland, University of Edinburgh.www.strokecorecompetencies.org/

23. Occulomotor & visual acuity Visual acuity – glasses, what they can see, read etcVisual acuity – glasses, what they can see, read etc Occulomotor – Tracking, saccades, converge/divergeOcculomotor – Tracking, saccades, converge/diverge

24. QUESTIONS?