Impact on Activities of Daily Living Cognition, Perception & - - PowerPoint PPT Presentation

Impact on Activities of Daily Living

Cognition, Perception & Vision Station Stroke Annual Review 2018

Ipshitha Anand, Shelia Boatman, Brenda Dorey, Natalie Hayworth & Emily Palmer

• Review the case scenario
• Apraxia
• Definition and presentation
• Homonymous hemianopsia
• Definition and presentation
• What can we do?
• Take Home Messages
• Questions

• Manuel is a 56 year old man
• Manuel was assessed by OT and he presents with

ideational apraxia when completing bathing, showering and grooming

• He also has difficulties with fully scanning his

environment due to right homonymous hemianopia

• Inability to perform purposeful movements
• Deficit with accessing the motor plans
• Often presents in combination with aphasia
• It is most beneficial to patients to assess and

practice tasks in context

• Breakdown of knowledge of what is to be done to

perform the task, including lack of knowledge regarding object use and errors in sequencing

• Loss of the movement memory pattern so that

movement cannot be produced

• Difficulty with how to perform a task
• Movements may be produced spontaneously with

difficulty performing same movement when asked

Ideational Apraxia Ideomotor Apraxia

• Tool misuse (i.e. using a

toothbrush to brush hair)

• Sequencing errors (i.e. putting
• n shoes and then socks)
• Perseveration (i.e. washing hair

repetitively without moving on to the rest of the body)

• Performance latency (i.e.

standing in shower without initiating washing)

• Clumsiness
• Awkward grasp on objects
• Difficulty with transfers

• Routine
• Use of pictures
• Cues
• Consider environment set-up
• Keep tasks in context
• Provide education for patients and families
• Talk with the occupational therapist about patient specific

strategies

• Also known as a field cut
• Loss of half of the visual field in both eyes
• Injury location will determine how much vision is

lost and location of vision loss

• Difficulty or inability to read and/or write
• Decreased safety, independence and confidence with

mobility

• Increased feelings of anxiety, especially in busy settings
• Misidentification of details on the affected side
• Slow visual scanning

(Warren, M (2010): Evaluation and Intervention for Visual Processing Deficits in Adult Acquired Brain Injury Part I: Visabilities Rehab Services Inc.)

• Encourage patient to scan their environment
• Utilize visual anchor
• Environmental set-up
• Give patients extra time
• Educate family members and visitors
• Talk with the occupational therapist about patient

specific strategies

• Both apraxia and visual field cuts can significantly

impact an individuals ability to manage basic ADLs

• There are things we can do to help!

• Gillen G (2008): Cognitive and Perceptual Rehabilitation:

Optimizing Function. St. Louis: Elsevier/Mosby

• Warren, M (2010): Evaluation and Intervention for Visual Processing

Deficits in Adult Acquired Brain Injury Part I: Visabilities Rehab Services Inc.)

• Zoltan, B (1996): Vision, Perception and Cognition: A manual for the

evaluation and treatment of the neurologically impaired adult (third edition). Thorofare, New Jersey: SLACK Incorporated