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What does neglect look like?. Allan Funk Occupational Therapist Foothills Medical Centre. glect look like?. Funk al Therapist dical Centre. What does neglect look like?. Allan Funk Occupational Therapist

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what does neglect look like

What does neglect look like?

Allan Funk

Occupational Therapist

Foothills Medical Centre

glect look like

glect look like?

Funk

al Therapist

dical Centre

what does neglect look like3

What does neglect look like?

Allan Funk

Occupational Therapist

Foothills Medical Centre

at es lect ok ke

at es lect ok ke?

an nk

tional apist

hills ical tre

not so neglected
Not so neglected
  • Hot topic
  • Implications for safety, independence are varied and serious
  • Many subtypes
  • Limited understanding – many limitations in assessment and treatment
impact
Impact
  • Mobility
  • Driving
  • ADL
  • IADL
neglect
Neglect
  • How does it work?
  • How does it break down?
slide8
What process or mechanism is breaking down?
  • Registration, integration, selection, action
  • Sensation, perception, cognition, praxis
sensation
Sensation
  • Peripheral or central
  • Attention
integration
Integration
  • Coordinate systems – eye-centered, head-centered, body-centered, gravitational
  • Perceptual fields – relative leftness, environment vs. object
  • Peri-personal vs. extra-personal
  • Construction
selection
Selection
  • Attention
  • Stimuli – number, structure, contrast, salience, novelty, speed
  • Recognition
  • Vigilance – Useful field of view
  • Central executive
action
Action
  • Visual or manual search
  • Mobility
  • Writing
subtypes
Subtypes
  • Right vs. left
  • Incidence
subtypes14
Subtypes
  • Sensory- perceptual mode
  • Kinaesthetic
  • Auditory
  • Visual – spatial
  • Reading
subtypes15
Subtypes
  • Useful field of view
subtypes16
Subtypes
  • Extinction
fellow travellers
Fellow travellers
  • Awareness - anosognosia
  • Indifference - anosodiaphoria
  • Sensory loss
  • Attention
  • Memory
  • Motor impairment
anatomy
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
anatomy ii
Anatomy II
  • Top-down
  • Bottom-up
  • Posterior parietal cortex, frontal eye fields, cingulate gyrus
  • Thalamus, striatum, superior colliculus, ascending reticular activating system
assessment
Assessment
  • Pencil and paper or computer-based tasks
  • Scoring
  • Sensitivity
assessment21
Assessment
  • Cancellation
  • Bisection
  • Visual scanning
  • Construction
  • Reading
assessment22
Assessment
  • Cancellation – visual search pattern is most predictive
    • Right start >distribution of errors>number of errors
  • Bisection – placement and length
assessment23
Assessment
  • Preponderance of pencil & paper
  • There is not yet a reliable, sensitive formal test of extra-personal neglect.
function
Function
  • Much better sensitivity than pencil and paper
  • Complexity of enivronment is key
  • interpretation requires knowledge of subtypes
treatment
Treatment
  • Focus on where the process is breaking down
treatment26
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
treatment27
Treatment
  • Integration – poorly understood.
    • Eliminate distractions, try to use the simplest successful tasks/materials/environments.
treatment28
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
treatment29
Treatment
  • Action