Transcript Dalita Meyer Presentation

Presented By: Dalita Meyer, OTR/L
Avera St. Luke’s
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Its performance tends to degrade gracefully under
partial damage
In contrast, most programs and engineered systems
are brittle: if you remove some arbitrary parts, very
likely the whole will cease to function
It can learn (reorganize itself) from experience
This means that partial recovery from damage is
possible if healthy units can learn to take over the
functions previously carried out by the damaged
areas
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It performs massively parallel computations
extremely efficiently
For example, complex visual perception occurs
within less than 100 ms, that is, 10 processing steps
It supports our intelligence and self-awareness
Nobody knows yet how this occurs
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A transient ischemic attack (also called TIA or “mini stroke”) is one of the
most important warning signs of future stroke
A TIA occurs when a blood clot blocks an artery that supplies blood to
the brain
The symptoms of a TIA, which are temporary and may last a few minutes
or a few hours, can occur alone or in combination
A TIA is a medical emergency, since it is impossible to predict if it will
progress into a major stroke
If you or someone you know experiences these symptoms, get
emergency help
Immediate treatment can save your life or increase your chance of a full
recovery
Age: Over 55 years of age
High levels of cholesterol in blood test
Smoking
High blood pressure (hypertension)
Diabetes
Obesity
Sedentary lifestyle
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Injury caused by trauma to the skull or brain
Caused by accidents, falls, assaults, traffic accidents
Adults obtain TBI’s more frequently than any other
age group
Children experience TBI’s due to accidental falls and
intentional abuse
More likely to develop Alzheimer’s and Parkinson’s
later in life
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Visual attention
Oculomotor contol
- Provides perceptual stability
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Visual Acuity
- Provides clarity – ability to see details
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Visual Field
- Provides awareness of objects
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Acuity
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Ocular Motor Control
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Visual Field Deficit
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Unilateral Spatial Neglect
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Ability to see detail and color
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Acuity Tests
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Contrast Tests
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Reading Acuity Tests
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Task Analysis
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Corrective lenses
Increase contrast – bright tape, paint bright labels, ligh walls
w/dark furniture, contrast light switches and electrical
outlets
Solid colors for rugs, bedspreads, dishes, countertops
Decrease clutter
Bold tip pens, bold line paper
Magnifiers
Motion lights
Teach compensatory skills with other senses
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Subjective complaints – Interview
Observe head and eyes
Eye dominance
Eye movements
Task Analysis
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Controlled and stabilized eye movement
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Essential for near vision
Complaint fatigue with reading, writing or close
work
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Saccadic
- Change the line of sight
- Activated by attention
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Rapid eye movements that change the line of sight
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Patient calling out or point to letters from two
columns printed on opposite sides of page
Provide vestibular movements in conjunction with
demands of saccadic skills
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Provide anchoring during reading tasks
Control the density of the visual information being
presented
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Body parts
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Right/left discrimination
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Provide tactile input – patient rub arm with rough
cloth while name the body part
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Practice particular tasks that reinforce body parts
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Bilateral activities
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Educate patient and family and train family how to
assist with affected side
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Changes in visual search caused by visual
inattention
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Prisms have improved this however there needs to
be more studies if there is a carry over for ADL’s
Patching
Flashing lights versus static stimuli
Verbal, auditory and tactile cueing
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Education for patient and family
Compensatory strategies
Educate on scanning with head and eye movements by
progression
- Movements leading the eye from attended to
unattended space
- Eye movements into the unattended space
- Eye movements without the use of head
movements
Place all items for functional independence within the
patient’s field of vision
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Area of visual world that can be seen when looking
straight ahead
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Place objects commonly used on the side of the
patient effected side
Provide verbal auditory and tactile cues to
encourage patient to look to the affected
Practice worksheets as a treatment for scanning
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Place items for functional independence within the
patient’s field of vision
Educate patient and family about field loss –
especially related to safety
Work on compensation techniques – i.e. tape,
finger
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Adopt a narrow search pattern confined to midline
and sound side
Person scans very slowly towards deficit side
Missing and/or “misidentifying” visual detail on the
“blind” side
Reduced visual monitoring of the hand
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The dog ran quickly to his master.
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Viewer-based:
ckly to his master.
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Object-based:
he og an ickly
o
is
ster.
Delicious
Eight
licious
Fight
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Reading Task
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Scan Course
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Telephone Number copy
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Compensation requires conscious cognitive strategy
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Must believe vision cannot be trusted on deficit
side
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Awareness allows client to develop “intellectual
over-ride”
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Left to right, clockwise counterclockwise
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Develop strategies with the patient on how to take
in visual information in an organized manner
Complete treatment activities such as crossing out
target letters, mazes, puzzles, solitare card game
Locate items in a store found on a list
Locate names, items and prices in the newspaper
Locate names, number in a phone book
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Anchoring or cueing the patients to where to begin
the visual search – tape marker
Pacing or cueing the patient about the speed of
response – for impulsive or erratic scanning
Control the density or spacing of objects
Stack clothing in a consistent order
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These patients have deficits in their ability to plan or
complete motor actions that rely on semantic memory. They
are able to explain how to perform an action, but unable to
"imagine" or act out a movement such as "pretend to brush
your teeth" or "pucker as though you bit into a sour lemon."
The ability to perform an action automatically when cued,
however, remains intact. This is known as automaticvoluntary dissociation. For example, they may not be able to
pick up a phone when asked to do so, but can perform the
action without thinking when the phone rings.
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Patients have an inability to conceptualize a task and
impaired ability to complete multistep actions. Consists of
an inability to select and carry out an appropriate motor
program. For example, the patient may complete actions in
incorrect orders, such as buttering bread before putting it in
the toaster, or putting on shoes before putting on socks.
There is also a loss of ability to voluntarily perform a learned
task when given the necessary objects or tools. For instance,
if given a screwdriver, the patient may try to write with it as
if it were a pen, or try to comb one's hair with a toothbrush.
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Dressing apraxia is the inability to dress
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Dressing apraxia can be due to ideomotor or
ideational apraxia
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The patient may not cognitively understand the
demands of the dressing task (ideational) or has
lost the appropriate motor plan to complete the
task (ideomotor) or maintains the appropriate
motor plan but is unable to access it (ideomotor)
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For example, a patient with ideomotor apraxia
understands that trousers are worn over their legs
but cannot access the appropriate motor plan and
therefore may put their arms through the legs
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(from Greek praxis, an act, work, or deed) is the
inability to execute learned purposeful movements,
despite having the desire and the physical capacity
to perform the movements. Apraxia is an acquired
disorder of motor planning, but is not caused by
incoordination, sensory loss, or failure to
comprehend simple commands (which can be
tested by asking the person to recognize the correct
movement from a series). It is caused by damage
to specific areas of the cerebrum.
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Apraxia should not be confused with ataxia, a lack
of coordination of movements; aphasia, an inability
to produce and/or comprehend language; abulia,
the lack of desire to carry out an action; or
allochiria, in which patients perceive stimuli to one
side of the body as occurring on the other.
Developmental coordination disorder (DCD) is the
developmental disorder of motor planning.
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Non-verbal oral or buccofacial ideomotor apraxia
resulting in difficulty carrying out movements of the
face on demand. For example, an inability to lick
one's lips or whistle.
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The inability to draw or construct simple
configurations, such as intersecting pentagons.
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The loss of ability to have normal function of the
lower limbs such as walking. This is not due to loss
of motor or sensory functions.
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Difficulty making precise movements with an arm
or leg.
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Difficulty moving the eye, especially with saccade
movements that direct the gaze to targets
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Difficulty planning and coordinating the movements
necessary for speech.
Questions???