Among the chief causes of poor rehabilitation progress for pts who havr sustained brain damage, even among those whose motor skills have returned

Brain may be damaged through several mechanisms

Inflammation of brain

Deprived of oxygen

Act or process of knowing

Knowledge of situation and facts

Thinking in a logical and sensible way

Making sensible conclusions

Ability to understand something immediately

Strong in remembering information

Cognitive functions

Integration of sensory impressions into formation that is psychologically meaningful

Ability to select those stimuli that require attention and action, to integrate thos stimuli with each other and with prior info, and finally to interpet them

The resulting awareness of objects and experiences within the environment enables the individual to make sense out of a complex and constantly changing internal and external sensory environment

Appreciation of stimuli through organs of special sense, peripheral cutaneous, sensory system, or internal receptors

The term perception and sensation are often confused with each other

Cognitive deficits do not lie in the sensory ability itself but rather with the individual’s ability to interpret sensation accurately and therefore respond appropriately

Five approaches of therapy

Focuses on remediation of underlying skills the patient has lost

Transfer of training approach

Based on the assumption that a disruption in one brain region can have a negative impact on brain functioning as a whole

Premise that practice in one task with particular cognitive or perceptual requirements will enhance performance in other tasks with similar particular demands

Explain the relationship bet functioning and the behavior of children with sensorimotor or learning prob

Describes normal sensory intergrative development and functioning, defines patterns of sensory intergrative dysfunction, and suggests treatment techniques

Assumed that the production of an adaptive response facilitates sensory integration, which in turn enhances the ability to produce higher level adaptive behaviors

Rood’s sensorimotor technique is used

Some of the treatment modalities employed include rubbing or icing to provide sensory input, resistance and weight bearing to impart proprioceptive input, and the yse of spinning or rocking to provide vestibular input

Different types of sensory stimuli which can facilitate or inhibit an action

Assumes that patient with acquired brain injury must practice every activity in its true context in order to recover function

Focuses on retraining real world skills rather than on retraining specific cognitive and perceptual processes

Rehabilitative or compensatory

Most commonly used in PT clinics

Most widely used approach in treating perceptual deficits which offers a great deal of practical support for the physical therapist

Direct repetitive practice of specific functional skills that are impaired is an efficient means of enhancing the patient’s independence in those specific tasks

Favor addressing the functional problem over and above the treatment of its underlying cause when working with an adult posttroke population

Therapy is viewed as learning that takes into consideration the unique strengths and limitations of the individual patient

Complementary components of functional approach

Changes that need to be made in the patient’s approach to tasks

Alterations that need to be made in the human or social and physical environment in order to facilitate relearning of skills

Functional approach: to compensate for the disability, the patient first has to be made aware of deficiencies and must then be taught how to circumvent them using intact sensations and perceptual skills

General suggestions when teaching compensatory techniques:

Focuses on training individuals with brain injury to structure and organize information

Addresses memory, high language disorders and perceptual dysfunction under one umbrella

Cognitive rehab addresses memory, high language disorders and perceptual dysfunction under one umbrella:

Research has demonstrated that even in a non brain injured population, skills learned in one task do not automatically transfer to other tasks

Can be used to facilitate the carryover of skills learned in therapy to functional activities

Learning can be conceptualized as a dynamic interplay between:

Cognitive rehab proposes a number of strategies relevant to PT practice

Interactive rehab that provides a holistic perspective for the management of stroke, TBI, brain tumors, cerebral palsy and other neurological conditions

Based on the idea that therapist can apply both micro and macro perspectives for evaluation and treatment, which is an assumption shared by many OT who work in this field

Holistic or humanistic and provides guidelines for the management of functional performance and real life occupations

Characteristics of client in macro perspective

Functional or top down in focus

take note

take note

More remedial in focus and provides guidelines for the management of performance components or subskills

Micro perspective evaluation and treatment is based in these theories:

Micro persopective: Changes in clients are further influenced by these factors

One of the most common forms of sensory loss affecting pt with hemiplegia

Commonly encountered visual impairment by pt with hemiplegia

Loss of peripheral vision

Double vision often present following brain damage

Patient sees two of the entire environment

Usually the result of defective function of extraocular muscles in which noth eyes are open but not in conjunction with the other

Horizontal

Vertical

Treatment for diplopia

Most common visual deficit affecting patients with hemiplegia

Lesion interrupts inflow to the optic pathways on one side of the brain

Loss of outer half of visual field from one eye and inner half of visual field of the other eye

Loss of incoming info from half of visual environment contralateral to the side of lesion

Testing procedures of hemianopsia

Confrontation method

take note

Common in patients who have had a stroke

Eye movements, which are controlled by the ________ muscles are used to detect, identify, and derive meaning from objects and environment

They allow person to become oriented to and explore the critical visual aspects of the environment

Two types of eye movements are important to examine

Allows patient to maintain focus on an object as it is brought nearer or farther away

Enable the eyes to follow a moving object and visuallt scan the environment

Often the eyes will follow a moving object visually, although the patient seems aware of the presence of that object and can locate it if asked

Visual scanning test

Pencil topper in visual scanning test

One that has a uniform procedure to administer and score, provides operational definition for all germs, is norm-referenced, and has information available concerning its reliability and validity

Results can be communicated to other therapists who will share an understanding of patient’s capacities or abilities

Can be administered at both admission and discharge to provide therapist with reliable and valid measure of the outcome of therapy

Read standardized tests page 35-37 on ppt

The patient’s own feedback is always accurate because they owe the perceptual and cognitive dysfunctions

Information regarding whether or not the patient attained the correct outcome

Information regarding the manner in which the task was accomplished

Form in which feedback is delivered

When involving the patient in educ sessions, the patient must be addressed as a competent adult and not patronized

Physical therapists must be regarded as the principal participants in the rehab process

In situation in which the perceptual deficit does not interfere with assimilation of info, patients should have the minor role in decision making process regarding the goals of therapy

Three point approach

Pressure to discharge patients quickly, possibly before the full extent of cognitive and perceptual deficits has been revealed, means that the patients may be discharged to potentially hazardous situations at home

Therapists need to do an initial screening of all patients with brain damage to determine potential problems as early as possible and ensure that patients are diacharged to a safe environment

Changing the environment or strategy for task completion so that the patient can be safe and independent as quickly as possible

Focus on patient’s deficits and attempt to improve functional ability by retraining specific perceptual components of behavior

Bottom up approach