Impact on Activities of Daily Living

Cognition, Perception & Vision Station

Stroke Annual Review 2018Ipshitha 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

on 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