6
- Visual, auditory, tactile
- Unable to process sensory input
- Lesion area: parietal, temporal and/or occipital lobe
Agnosia
Language disorder:
Fluent, receptive
Wernicke's
Language disorder:
Receptive and expressive
Global
- Treatment for diplopia
- Refract light and focus it on the same place in both the retinas
- Helps the brain to produce a single image leading to clearer vision
- Changes the way light enters the eye and brain, therefore affecting the nervous system
- can start with tape on glasses before getting glasses
Prism glasses
- Acute hemiparesis rapidly progressing to tetraplegia and lower bulbar paralysis - the patient cannot move or speak but remains alert and oriented
- Horizontal eye movements are impaired but vertical eye movements and blinking remain intact
- Occlusion of the vertebrobasilar system
- Patients can demonstrate some improvements over time
Locked in syndrome
Language disorder:
Non-fluent, expressive
Broca's
- Ideomotor, ideational, buccofacial
- Unable to complete motor task on command
- Lesion area: frontal and parietal
Apraxia
- Lesion in posterior portion first temporal gyrus (L hemisphere)
Wernicke's aphasia
Problem with visual information processing
Visual field cut
- Sits or stands asymmetrically
- Most of the weight shifted toward the weaker side
- Uses the stronger UE or LE to push over to the weaker side, leads to instability and falls
Patient observation in pusher syndrome
Language disorder:
Repetition
Conduction
- Figure-ground discrimination, form discrimination, spatial relations, position in space, topographical disorientation, depth and distance perception, vertical disorientation
- Lesion area: parietal, occipital, temporal
Spatial relations disorder
Intact comprehension of oral and written language with difficulty producing speech, articulating, naming and writing; limited vocabulary
- Lesion: anterior lesions, third frontal convolution (L hemisphere)
Broca aphasia
How do we treat visual field cuts and neglect?
Compensatory scanning **
- Treat from hemiparetic side
- Stabilize hemi leg
- Tone management and weight bearing
- forced use
Treatment for typical stroke
Describes severe aphasia that involves loss of production and comprehension of language including writing; usually results from a large MCA infarct
- Lesion: anterior lesions, third frontal convolution (L hemisphere)
Global aphasia
Fluent speech with difficulty naming, repeating words while retaining written and oral comprehension
- Either fluent or non-fluent
Conduction aphasia
Dysfunction in supplementary motor areas, retaining verbal and written comprehension; but characteristic difficulty repeating words or phrases
- Lesion: anterior lesions, third frontal convolution (L hemisphere)
Transcortical motor aphasia
- Behavior phenomenon
- Leaning and active pushing toward the hemiplegic side in all positions using the nonparetic arm and leg
- Resistance to any attempt at passive correction of posture towards midline or across the body toward the nonaffected side
- 80% R brain lesions
- Involvement of the thalamus
- Recovery process slow
- Graviceptive neglect
Pusher syndrome
- Patient will push more forcefully if therapist tries to passively correct posture
- Training needs to emphasize upright positions with active movement shifts toward the stronger side
- Environmental prompts
- Use visual cues and cognitive strategies
Considerations for treatment in pusher syndrome
- Diplopia, monocular blindness, cortical blindness
- Visual field cut/loss: hemianopia, quadrantanopia
- Lesion area: along the visual pathway
Vision deficits
- Problem with awareness
- Scanning (to increase attention)
- Moving involved side arm/leg within neglected environment
Neglect
- Problem with visual information processing
Treatment ideas
- Scanning in the direction of the loss
- Oculomotor exercises
- Field expanders/prisms
- Prism glasses (for tx of diplopia)
Visual field loss
- Treat from front and progress to hemi side
- use of mirrors to engage hemi side
- stabilize hemi leg
- tone management and weight bearing
- forced use
Treatment for hemineglect
- Treat from front
- Stabilizing force from front, back or circumferentially
- Use of vertical cue (wall, door frame)
- Use of physical cue (wall, person)
- Remove pushing ability or use it to your advantage (self tone management)
Treatment for pusher syndrome