What does neglect look like? - PowerPoint PPT Presentation

Jims
what does neglect look like l.
Skip this Video
Loading SlideShow in 5 Seconds..
What does neglect look like? PowerPoint Presentation
Download Presentation
What does neglect look like?

play fullscreen
1 / 29
Download Presentation
What does neglect look like?
695 Views
Download Presentation

What does neglect look like?

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. What does neglect look like? Allan Funk Occupational Therapist Foothills Medical Centre

  2. glect look like? Funk al Therapist dical Centre

  3. What does neglect look like? Allan Funk Occupational Therapist Foothills Medical Centre

  4. at es lect ok ke? an nk tional apist hills ical tre

  5. Not so neglected • Hot topic • Implications for safety, independence are varied and serious • Many subtypes • Limited understanding – many limitations in assessment and treatment

  6. Impact • Mobility • Driving • ADL • IADL

  7. Neglect • How does it work? • How does it break down?

  8. What process or mechanism is breaking down? • Registration, integration, selection, action • Sensation, perception, cognition, praxis

  9. Sensation • Peripheral or central • Attention

  10. Integration • Coordinate systems – eye-centered, head-centered, body-centered, gravitational • Perceptual fields – relative leftness, environment vs. object • Peri-personal vs. extra-personal • Construction

  11. Selection • Attention • Stimuli – number, structure, contrast, salience, novelty, speed • Recognition • Vigilance – Useful field of view • Central executive

  12. Action • Visual or manual search • Mobility • Writing

  13. Subtypes • Right vs. left • Incidence

  14. Subtypes • Sensory- perceptual mode • Kinaesthetic • Auditory • Visual – spatial • Reading

  15. Subtypes • Useful field of view

  16. Subtypes • Extinction

  17. Fellow travellers • Awareness - anosognosia • Indifference - anosodiaphoria • Sensory loss • Attention • Memory • Motor impairment

  18. Anatomy • inferior parietal, frontal lobe, cingulate cortex, superior colliculus, lateral hypothalamus • anterior (lesion limited to the prefrontal cortex and adjacent white matter); posterior (lesion limited to the retrorolandic cortex, including parietal, but also temporal and/or occipital regions); anteroposterior (lesion involving both prefrontal, rolandic, and posterior regions,); subcortical (lesion limited to subcortical areas, such as internal capsule, centrum semiovale, striatum, or thalamus) • Occipital lobe, anterior limb of the internal capsule, posterior limb of the internal capsule, anterior portion of paraventricular white matter, posterior portion of paraventricular white matter, thalamus

  19. Anatomy II • Top-down • Bottom-up • Posterior parietal cortex, frontal eye fields, cingulate gyrus • Thalamus, striatum, superior colliculus, ascending reticular activating system

  20. Assessment • Pencil and paper or computer-based tasks • Scoring • Sensitivity

  21. Assessment • Cancellation • Bisection • Visual scanning • Construction • Reading

  22. Assessment • Cancellation – visual search pattern is most predictive • Right start >distribution of errors>number of errors • Bisection – placement and length

  23. Assessment • Preponderance of pencil & paper • There is not yet a reliable, sensitive formal test of extra-personal neglect.

  24. Function • Much better sensitivity than pencil and paper • Complexity of enivronment is key • interpretation requires knowledge of subtypes

  25. Treatment • Focus on where the process is breaking down

  26. Treatment • Sensation – use attention to compensate • Use soundbites or acronyms to facilitate acquisition of compensatory strategy • Minimum cueing & fading – ensure the patient is as active as possible in generating the desired behaviour • Target key functional tasks where safety is a particular concern – here you may need to cue more heavily

  27. Treatment • Integration – poorly understood. • Eliminate distractions, try to use the simplest successful tasks/materials/environments.

  28. Treatment • Selection/Attention – treatment may not generalise from one sensory-perceptual mode to another • Amenable to remediation • Delineate relevant subtypes • Manipulate key stimulus variables to grade and progress tasks – number, novelty, structure, salience, speed, contrast

  29. Treatment • Action