1. PERCEPTION
Dr. Fernandez OTR 615

2. Key to Success Identify the Root of the problem
Is the problem a auditory processing disorder
Is the problem a visual processing disorder
Is the problem a timing, concentration/motor processing disorder

3. Visual Attention Deficit
Decrease ability to attend to , focus or discriminate for detail
Focus on tangential elements of a task rather than on the main elements or goal

4. Functional treatment for Visual Attention Deficits
Work in a quiet area and start having them focus for short periods of time.
Have patient set goals of time if possible
Start with patient attending to large objects first, then add on, moving to smaller and increase numbers of items to work with
Add variables of color, size, speed

6. Visual Tracking Deficit
Decrease ability to read without skipping lines and losing ones place.
Squinting, rubbing eye
Double vision
Difficulty tracking moving objects
Writes crooked or poorly spaced
Avoidance of reading.

7. Functional treatments for Visual Tracking Deficits
Vision therapy
Eye exercises/orthoptics/visual training
Utilize the Amsler Grid
Vision tracking Goggles (Visagraph II)
Symmetrical pursuit training

8. Unilateral Neglect Inferior parietal lobe/no dominant hemisphere
Inability to integrate sensory input from one side of the body (usually the left) and from one side of the environment
Patient neglects to wash one side of the body/shave/eat food from one half of his plate
Reading from the middle of the line/article
Bumping into furniture on one side
Applies make-up on one side of the face combs, hair on one side only

10. Functional Treatment for Unilateral Neglect
Activities to stimulate the neglected side(brushing, rubbing, ice, vibration) while patient watching
Movement of neglected side(while patient watches) either actively or passively
Activities that force the patient to look to the neglected side
For the patient having trouble reading/writing utilize a red line down the side of the page on the neglected side as a cue
Teaching the patient to monitor visually both the position and movement of the neglected side

11. Continued…Unilateral Neglect
For the patient that turns to the uninvolved side when operating a wheelchair, placement of a tape on the floor as a guide
For the patient who has not yet learned to compensate for his deficits, placement of food, telephone, call light, etc. On the uninvolved side
Keep the affected side in visual field,
Lap tray/pillow

12. Body Scheme Deficits (somatognosia)
Parietal lobe/dominant hemisphere
Lack of awareness of body structure
Patient fails to recognize his/her own body parts
Inability to recognize the relations between his/her body parts
Difficulty in orientation of his body to the environment to the outside world
Confusion to his /her side of the body
Difficulty in contra lateral movements
Inability to distinguish between the therapist extremities and his own

14. Functional treatment for Body Scheme Deficits
Practice of activities that require patient to name body parts
Practice of activities that require patient to explore the relations between body parts( eg., puzzles of human body, imitating postures)
Reinforcement of awareness of body parts by having patient tactilely stimulate parts of the body as they are named by the therapist(e.g., patient rubs, brushes, strokes , or washes part named by the therapist

15. Do you guys remember this…I still can not find the witch…

16. Figure Ground Deficit Parietal lobe
Difficulty in differentiating foreground from back ground
Difficulty finding items/ things in especially cluttered areas
Difficulty in finding sleeves/opening in sleeve or leg opening in pants
Difficulty finding the brakes on the wheelchair/difference finding the wheels from the arm rest
Difficulty finding hidden pictures, picking one line of prints from another while reading

19. Functional Treatment for Figure Ground Deficits
Color cues to outline/highlight the object9e.g., ribbon around brake of wheelchair, colored tape/tread around sleeve of shirt or pant leg.
Adaptation of the environment to make it simple and uncluttered
Use of dividers to separate items in drawers
Placement of only a few things on bedside table
Organization of meal tray so that it has only a few items on it(I.e, meals served in courses
Compensation for deficits by very systematic examination of each small area, both visually and tactilely
Practice of functional activity until the patient can do the automatically
Random scattering of a few objects for patient to name

21. Depth Perception Deficit
Parietal lobe of either hemisphere
Difficulty in perceiving spatial relationships between objects or between objects and self

22. Functional Treatment of Depth Perception Deficits
Have patient practice functional tasks that require him/her to judge distance and depth(e.g., walking up and down steps of varying height, walking through a furniture maze
Have patient try to determine distance to objects visually and verify his judgment by pacing out distance to see which objects actually are farther away or closer
Have patient verify visual space determinations by tactile sensation(e.g., pour a cup of water to what seems full and verify by putting his finger inside the top of the glass
Have patient follow maps to navigate between points A and B

24. Form Constancy Deficit
Parietal lobe lesion
Inability to attend to subtle variation in form: inability to differentiate objects of similar shapes(water pitcher/urinal)
Difficulty sorting task
Difficulty sorting right from Left sleeve

25. Functional treatment of Form Constancy
Matching activities, sorting activities, and activities to duplicate printed patterns
Presentation of an object in various position and sizes for patient to identify it.

27. Position in Space Deficit
Parietal lobe non-dominant hemisphere
Difficulty in interpreting position in space (up-down, in-out, front- behind)
Difficulty in navigating both in w/c and upright
Failure to look under or behind
Decrease midline orientation

28. Functional treatments for Position in Space Deficits
Practice of functional tasks that require the patient to use the concept of position in space (e.g., stacking cans, organizing food pantry,organizing closets)
Work with building blocks, following verbal or written instructions
Obstacle courses, maze

29. Spatial Relationship Deficit
Parietal lobe non-dominant hemisphere
Problems perceiving the position of two or more objects in relations with self
Problems perceiving the position of two objects in relations to each other
Difficulty in processing mirror images
Difficulty in judging the relative position of one object to another(directionality) and the internal awareness of the two sides of the body(laterality.)

31. Functional Treatments for Spatial Relationship Deficits
Practice of task in which patient must orient himself in space (e.g., navigating around furniture, maze) either following verbal instructions or following a map
Practice of task in which patient must orient object to object (e.g., copying tasks, making blocks and peg boards designs, connecting dots, converting 2D drawings to 3D ones with blocks

32. Visual Discrimination Deficit Left-Right
Inability to differentiate between Right-Left sides of the body either own body or another persons
Decrease ability to differentiate between two similar objects ( letter m/n)

33. Functional treatments for Visual Discrimination Deficits
Giving on side of the body augmented tactile and proprioceptive input (e.g., have patient wear weighted cuff on one side extremities
Quizzing patient on right versus left discrimination (e.g., show me your right hand)
Including the terms right and left when practicing functional skills (e.g., you are putting on your right shoe, you wear your watch on your left arm)

34. Visual Closure Deficit
Decrease ability to visualize the whole of something when only part of it is visible
Difficulties in recognizing a picture of someone with a facial feature covered

35. Functional Treatments for Visual Closure Deficits
Provide matching pictures/items labeled
Review whole picture vs incomplete labeled
Puzzles of various items
Newspaper clipping of item match with name of item
Cut pictures of items in half and match halves together

36. Visual Memory Deficit Problems in remembering objects
Unable to store visual material
Unable to recall visually presented material Simultaneously or sequential
Individual can not retrieve the mental representation of the object being viewed or make a connection between the mental representation and the object itself
Unable to recall and use visual information from the past

37. Functional Treatment for Visual Memory Deficits
Utilize techniques of repetition
Utilize pictures of family/pets/home
Utilize memory book with familiar items titled
Have familiar items of ADL labeled with picture/ have the sort/categorize items
Behavior compensation using external aids
Repeat, Repeat, Repeat

38. Topographical Orientation Deficit
Occipital parietal lobe non-dominant hemisphere
Difficulty understanding the relationship of places to one another
Difficulty finding way in space
Unreliable in transporting self to and from treatment or from room to room or around house

39. Functional Treatments for Topographical Orientation
Use of markers (e.g., colored dots) to mark the patient’s route between locations, gradual removal of cues
Practice of tasks in which patient must go from one place to another
Review local maps/ facility map and location

40. APRAXIA
Caused by a lesion in the neural pathways of the brain that contain the learned patterns of movement

41. Motor Apraxia
Loss of kinesthetic memory pattern so that purposeful movement patterns so that purposeful movement cannot be achieved, even though the idea and purpose of the task is understood
Defect in execution
Inability to carry out a complicated sequence, although simple tasks performed automatically

42. BEST MOTOR PLANNING IN TOWN

43. Constructional Apraxia
Difficulty in producing 2D or 3D designs by coping, drawing, or constructing, both on command or spontaneously.
Difficulty in performing purposeful acts while using objects in his environment
Affects person’s ability to draw or copy simple diagrams or to construct simple figures

45. Ideomotor Apraxia
Inability to imitate features or perform a purposeful motor task on command, even though the patient understands the idea or concepts of the task
Retained ability to carry out old habitual tasks automatically
Motor planning problems
Loss of skilled sequence of movement
Perseveration of movement

46. Ideational Apraxia Conceptual
Since aphasia can occur concomitantly with apraxia it may be necessary to give short directions and to speak slowly and clearly
Component parts of tasks to be taught separately then slowly combined
Inability to create a plan for a specific movement
Loss of knowledge about the idea of the movements
Arteriosclerosis