PERCEPTUAL DISORDERS

AND ITS MANAGMENT

Dr.A.Kumaresan.MPT(Neuro),
PhD
• PERCEPTION :
As the integration of sensory impression into
information psychologically meaningful.

• SENSATION:
defined as appreciation of stimuli through
special senses, sensory system or internal
receptors
• Disorders:

Body scheme and body image

impairments

Spatial relation disorders

Agnosias

Apraxia
Unilateral neglect:

• Is the inability to register and integrate

stimuli and perceptions from one side of the
body and the environment

• Also called unilateral spatial neglect, hemi-

attention, hemineglect and unilateral visual
inattention

• Personal space
Peripersonal space (within arm distance)
Extrapersonal space (area beyond arm length)
• Lesion area: inferior posterior regions of
right parietal lobe

• Testing:
Behavioral inattention test: ADL and
response to cueing
• Treatment suggestion

Remedial approach:
Stimuli that are specialized for the right side
of brain, such as shapes and blocks.
Simultaneous stimulation of left side of
brain such as letters and numbers should
be minimized
Compensatory approach:
Education about the condition
Various strategies for activities
of daily living encouraged

Red ribbon one corner- scan back to this

point
Addressing patient from unaffected side
Placing alarm bells, phones and other
essentials on unaffected side
Place mirror
• Anosoagnosia

Complete denial and lack of awareness of

the presence or severity of one’s paralysis.

Supramarginal gyrus

Testing: “y r u not able to move your limb”

Treatment :
It spontaneously gets resolved with in 3
months following stroke
• Somatoagnosia:

Is a lack of awareness of the body structure

and relationship of body parts to oneself or
to others

Also called Autopagnosia

Unable to imitate the movements

Dominant parietal lobe

Testing:
• Treatment:
Remedial approach:
Facilitation of body awareness is
accomplished through sensory stimulus
Verbally identifies body parts or points to
picture of them as the therapist touches
them
• Right-left discrimination:

Inability to identify the right and left side of

one’s own body

Difficulty imitating movement when

command includes these terms

Parietal lobe of either hemisphere

Testing: “touch right ear”; “left leg”.

• Treatment:

Compensatory approach:
Avoid using right and left words instead use
pointing or provide cues
Use tapes to mark commonly used objects
• Finger agnosia:

Inability to identify the fingers of owns hand or

hands of the therapist

Parietal region. Angular gyrus on the left

hemisphere

Testing: Sauguet’s test or point the finger

named by the therapist
Treatment:
Remedial approach: touch and pressure are
stimulated
hard cloth used to rub
on finger
pressure on ventral
surface of hand
Agnosia
• Agnosia is the inability to recognize or
make sense of incoming information
despite intact sensory capabilities
• Visual agnosia:

Inability to recognize familiar objects despite

normal function of eyes and optic tracts

Simultanagnosia: Balint’s syndrome is inability to

perceive a visual stimulus as a whole. Lesion in
dominant occipital lobe

Prosopagnosia: inability to recognize familiar

faces

Color agnosia: inability to recognize colors

• Occipito temporo parietal association area
in either hemisphere

• Testing: common objects

• Treatment:
Remedial approach :drills for practicing
discrimination between faces
Easy street environment

Compensatory approach: using touch and

auditory to distinguish people and objects.
• Auditory agnosia:

Inability to recognise non speech sounds or

to discriminate between them

Dominant temporal lobe.

Testing: close the eyes and identify various

sounds

Treatment: drilling the patients on sounds

• Tactile agnosia:

Inability to recognize forms by handling

them, although tactile, proprioceptive, and
thermal sensations being intact.

Parieto-temporo-occipital lobe

Testing: identify objects placed in hand

without visual cues
• Treatment:
Remedial approach: feels various objects,
shapes, textures with vision occluded
followed by looking at the object for
feedback

Compensatory approach: improve cognitive

awareness
Figure ground discrimination
• Inability to visually distinguish a figure from
background in which it is embedded

• This may lead to distractibility, resulting in

shortened attention span, frustration and
decreased independence

• Parieto-occipital lesion of right hemisphere

• Testing: the Ayres Figure Ground test

practical test
• Treatment:
Remedial approach:
Arrange for practice in visually locating objects
in simple array and progress to more difficult
ones

Compensatory approach:
Use of other intact senses like touch
Educated the patient
Relocating objects in same place
Repetition- verbal cues and touch
Form discrimination
• Inability to perceive or attend to subtle
differences in form and shape

• Parieto-occipito- temporal region

• Testing: gather items of similar shape and

size like pen toothbrush, pencil, straw, key,
coins. Each objects in different positions
• Treatment:
Remedial approach:
The patient should practice describing,
identifying, and demonstrating the use of
similarly shaped and sized objects

Compensatory approach:
If patient can read- labeling
Encouraged to use vision, touch
Spatial relations
• Inability to perceive the relationship of one
object in space to another object

• This may lead to problems in constructional

tasks and dressing

• Crossing midline is a major problem

• Parieto-occipito-temporal area of right side of

brain
• Testing:
Rivermead perceptual assessment battery
Arnadottir OT_ADL Neurobehavioural
evaluation
Ask time??

• Treatment:
Remedial approach:
Position the pt against therapist or object (sit
next to me, go behind the table)
Holding dowel with both hands uninvolved side
to involved side
Later manipulating dowel using verbal or visual
cues.
Topographic disorientation
• Refers to difficulty in understanding and
remembering the relationship of one location
to another.

• Right retrosplenial cortex.

• Testing: ask patient to draw the familiar route

or layout of house
• Treatment:
Remedial appraoch:
Practising using verbal cues
Start from simple route and then progress

Compensatory approach:
Frequently travelled routes can be marked with
colored dots. The space bt dots are gradually
icreased (right lesion compensated by left
hemisphere)
Distance and depth perception
• The patient with this disorder of depth and
disorder perception experiences inaccurate
judgment of direction, distance and depth

• Posterior right hemisphere in superior visual

association cortices.

• Testing: pour glass of juice, stair climbing,

holding an object in air
• Treatment:
Remedial approach:
Pt is asked to place foot on spot-gait training
Blocks can be arranged- touch the top with foot

Compensatory approach:
Practice in compensating for disturbances in
distance and depth perception
Vertical disorientation
• Refers to distorted perception of what is
vertical

• Non-dominant parietal lobe

• Testing: cane vertically and horizontally

(luminous rod)- hand it over to the patient
and ask him to get back to original position
• Treatment:
Compensate using touch for sproper self
orientation, especially going through
doorway, elevators and stairs.
 APRAXIA
• Impairment of voluntary skilled learned
movement

• Characterized by an inability to perform

purposeful movements, which cannot be
accounted for inadequate strength, loss of
coordination, sensation, attentional
difficulties, abnormal tone, movement
disorders, intellectual deterioration, poor
comprehension or uncooperativeness
Ideomotor apraxia
• Breakdown between concept and performance

• Disconnection between the idea of a

movement and its motor execution

• It appears that the information cannot be

transferred from conceptualization and motor
execution.

• Difficulty performing many steps

• Cup of coffee table- “please have coffee” – but
without command performs

• Combing hair- pt identifies the comb and even

say the use of it, but when asked to command
he may not do it

• Left dominant hemisphere.

• Goodglass and Kaplan test: blowing, brushing,

hammering ,shaving
• Treatment:
Remedial approach:
Use of short sentences
Once command at a time
Break down the activity into components
Physically guide for completing the task

Compensatory approach:
Strategy training- occupational therapist
Ideational apraxia
• Failure in conceptualization of the task

• Inability to perform a purposeful motor act,

either automatically or on command (pt no
longer understands the overall concept of the
act, cannot retain the idea of task)

• Tooth brush and tooth paste

• Dominant parietal lobe

Buccofacial apraxia
• Involves difficulties performing purposeful
movements with lips, tongue, cheeks.

• “pretend to blow out candle”. Pt performs

automatically but not on command

• Frontal and central opercula, anterior insula

and small area of temporal gyrus.

• Speech- language therapist- strategies.