Impact of Impact of NeurobehavioralNeurobehavioral

Deficits on Deficits on Activities of Daily Activities of Daily

LivingLiving

► ⅠⅠ. Activities of Daily Living. Activities of Daily Living► ⅡⅡ. Neurobehavior : The process of linking . Neurobehavior : The process of linking

occupation to neuronal activityoccupation to neuronal activity►ⅢⅢ. Theoretical relationship between . Theoretical relationship between

occupational performance and occupational performance and neurobehaviorneurobehavior

►ⅣⅣ. Detecting the effect of neurobehavioral . Detecting the effect of neurobehavioral deficits on activity performancedeficits on activity performance

►ⅤⅤ. Processing during task performance. Processing during task performance ►ⅥⅥ. Dysfunction of the activities of daily . Dysfunction of the activities of daily

living area of occupation as a result of living area of occupation as a result of cerebrovascular accidentscerebrovascular accidents

►ⅦⅦ. Patterns of impairments resulting from . Patterns of impairments resulting from cerebrovascular accidentscerebrovascular accidents

chapter objectiveschapter objectives

1. Establish a relationship between neurobehavioral 1. Establish a relationship between neurobehavioral concepts and activity performance.concepts and activity performance.

2. Apply the theory on which the A-ONE is based as 2. Apply the theory on which the A-ONE is based as a structure for clinical observations of stroke a structure for clinical observations of stroke patients.patients.

3. Provide conceptual and operational definitions for 3. Provide conceptual and operational definitions for neurobehavioral impairments and disability.neurobehavioral impairments and disability.

4. Apply clinical reasoning skills based on the A-ONE 4. Apply clinical reasoning skills based on the A-ONE theory for hypothesis testing.theory for hypothesis testing.

5. Relate the ICF and the Occupational Therapy 5. Relate the ICF and the Occupational Therapy Practice Framework to the A-ONE theory and Practice Framework to the A-ONE theory and neurobehavioral concepts.neurobehavioral concepts.

6. Provide examples of how strokes can cause 6. Provide examples of how strokes can cause different patterns of impairments affecting task different patterns of impairments affecting task performance.performance.

ⅠⅠ. Activities of Daily Living. Activities of Daily Living

* Basic or personal activities of daily living* Basic or personal activities of daily living · oriented toward taking care of one's own body· oriented toward taking care of one's own body · bathing, showering, bowel and bladder · bathing, showering, bowel and bladder

management, dressing, eating, feeding, functional management, dressing, eating, feeding, functional mobility, personal device care, personal hygiene, mobility, personal device care, personal hygiene, grooming, sexual activity, sleep/rest, toilet hygienegrooming, sexual activity, sleep/rest, toilet hygiene

* Instrumental activities of daily living* Instrumental activities of daily living · education, work, play, leisure, social participation · education, work, play, leisure, social participation * Performance contexts* Performance contexts · cultural, physical, social, personal, spiritual, · cultural, physical, social, personal, spiritual,

temporal, curtual conditionstemporal, curtual conditions · · Table 18-1Table 18-1 : relates the Frameworks terminology to : relates the Frameworks terminology to

the classification systems of the ICF and A-ONE.the classification systems of the ICF and A-ONE.

* Summary* Summary

·· Occupational performance : the ability of an Occupational performance : the ability of an individual to accomplish activities by interaction of individual to accomplish activities by interaction of client factors, performance skills, performance client factors, performance skills, performance patterns, and context of that individual.patterns, and context of that individual.

ⅡⅡ. Neurobehavior : The . Neurobehavior : The process of linking occupation process of linking occupation

to neuronal activityto neuronal activity* Neurobehavior* Neurobehavior ·· behavior based on neurological function behavior based on neurological function ·· different tasks → different types of sensory stimuli different tasks → different types of sensory stimuli

→ different mechanisms of the central nervous → different mechanisms of the central nervous system → behavioral responses → feedback → new system → behavioral responses → feedback → new sensory stimulisensory stimuli

·· Fig. 18-1Fig. 18-1 : illustrates the elements : illustrates the elements* Neurobehavioral deficit* Neurobehavioral deficit ·· A functional impairment manifested as defective A functional impairment manifested as defective

task performance resulting from a neurologic task performance resulting from a neurologic processing dysfunction.processing dysfunction.

·· affects client factors (affect, body scheme, affects client factors (affect, body scheme, cognition, emotion, gnosis, language, memory, cognition, emotion, gnosis, language, memory, motor movement, perception, personality, praxis, motor movement, perception, personality, praxis, sensory awareness, spatial relatioins, visuospatial sensory awareness, spatial relatioins, visuospatial skills) skills)

ⅢⅢ. Theoretical relationship . Theoretical relationship between occupational between occupational

performance and performance and neurobehaviorneurobehavior

* A-ONE theory * A-ONE theory

· the ability to perform daily activities, · the ability to perform daily activities, neurobehavioral impairments, and the CNS origin of neurobehavioral impairments, and the CNS origin of the neurobehavioral dysfunctionthe neurobehavioral dysfunction

ⅣⅣ. Detecting the effect of . Detecting the effect of neurobehavioral deficits on neurobehavioral deficits on

activity performanceactivity performance

* A systematic analysis of occupational * A systematic analysis of occupational performanceperformance

·· help therapists assess functional help therapists assess functional independence related to task performanceindependence related to task performance

·· detect dysfunctional neurologic client detect dysfunctional neurologic client factorsfactors

  

* Activity analysis* Activity analysis ① ① task - focusedtask - focused ·· the range of skills and components needed to the range of skills and components needed to perform the activity, typical performance perform the activity, typical performance

methods, methods, performance context, cultural meaning of the performance context, cultural meaning of the activityactivity ② ② theory - focusedtheory - focused ·· performed with intervention potential in mind performed with intervention potential in mind ·· focused performance problems based on focused performance problems based on definitions of function and dysfunctiondefinitions of function and dysfunction ③ ③ individual - focused individual - focused ·· focused on client focused on client ·· integrated with the client's goal integrated with the client's goal

* Activity analysis in the A-ONE* Activity analysis in the A-ONE · to identify different client factors and possible · to identify different client factors and possible

manifestations of CNS dysfunction during ADL manifestations of CNS dysfunction during ADL performanceperformance

·· Therapist keeps in mind different possible Therapist keeps in mind different possible neurologic factors and impairments and the neurologic factors and impairments and the theoretical definitions of functional and theoretical definitions of functional and dysfunctional behavior dysfunctional behavior

·· meaningful task meaningful task

·· Fig. 18-2Fig. 18-2

ⅰⅰ. Function of the Cerebral Cortex : The . Function of the Cerebral Cortex : The Foundation of Task PerformanceFoundation of Task Performance

·· detect the type and degree of severity of detect the type and degree of severity of neurobehavioral impairments that interfere with neurobehavioral impairments that interfere with activity performanceactivity performance

·· body factors are based on neurologic function, body factors are based on neurologic function, which takes place at different levels of the CNSwhich takes place at different levels of the CNS

·· three levels of functional complexity in the three levels of functional complexity in the cortex based on Luria's theories cortex based on Luria's theories

- primary, secondary, tertiary cortical zones or - primary, secondary, tertiary cortical zones or projection areasprojection areas

ⅱⅱ. Functional Localization for Neurologic . Functional Localization for Neurologic Processing of Client Body FactorsProcessing of Client Body Factors

* primary areas* primary areas ․ ․ direct processing of primary sensory and motor direct processing of primary sensory and motor informationinformation ․ ․ include the primary somesthetic sensory cortex in include the primary somesthetic sensory cortex in the postcentral gyrus of the parietal lobethe postcentral gyrus of the parietal lobe ․ ․ the primary visual cortex around the calcarine the primary visual cortex around the calcarine

fissure fissure on the medial side of the occipital lobeon the medial side of the occipital lobe ․ ․ the primary auditory cortex in the superior the primary auditory cortex in the superior

themporal themporal gyrus of the temporal lobegyrus of the temporal lobe ․ ․ the primary motor cortex in the precentral gyrus the primary motor cortex in the precentral gyrus

of of the frontal lobethe frontal lobe

* cortical areas* cortical areas ․ ․ The primary association areas that ( except for The primary association areas that ( except for

the motor association cortex) receive information the motor association cortex) receive information from the primary areas and integrate it with from the primary areas and integrate it with information from other areasinformation from other areas

․ ․ The secondary association areas are adjacent to The secondary association areas are adjacent to and connected with primary cortical areas.and connected with primary cortical areas.

․ ․ a single sensory or motor functiona single sensory or motor function ․ ․ include the visual association cortex surrounding include the visual association cortex surrounding

the primary visual cortex in the occipital lobe, the the primary visual cortex in the occipital lobe, the auditory association cortex in the temporal lobe, auditory association cortex in the temporal lobe, the somatosensory association area in the the somatosensory association area in the superior parietal lobule, and the premotor cortex superior parietal lobule, and the premotor cortex in the frontal lobein the frontal lobe

* Association areas* Association areas ․ ․ involved in complex integration of information from involved in complex integration of information from many different cortical areasmany different cortical areas ① ① prefrontal cortexprefrontal cortex ․ ․ dorsolateral prefrontal cortex : involve in complex dorsolateral prefrontal cortex : involve in complex motor functions, concept formation, abstraction, motor functions, concept formation, abstraction, intelligence, judgement, attention, intention, intelligence, judgement, attention, intention, sequencing, and timing and organization of sequencing, and timing and organization of

activity activity steps and behavior as well as emotional steps and behavior as well as emotional

processingprocessing ② ② limbic cortexlimbic cortex ․ ․ limbic association cortex : includes the limbic association cortex : includes the orbitofrontal part of the prefrontal cortex, the orbitofrontal part of the prefrontal cortex, the temporal pole, and the parahippocampal temporal pole, and the parahippocampal gyrus on the medial aspects of the temporal lobes gyrus on the medial aspects of the temporal lobes and the cingulate gyrus of the cortex concerned and the cingulate gyrus of the cortex concerned with memory and with motivation and emotional with memory and with motivation and emotional aspectsaspects

③ ③ parietotemporaloccipital cortexparietotemporaloccipital cortex ․ ․ parietotemporo-occipital cortex : complex sensory parietotemporo-occipital cortex : complex sensory functions based on information from two or more functions based on information from two or more of the socondary association areas of the three of the socondary association areas of the three posterior lobesposterior lobes ․․ Fig. 18-3Fig. 18-3 : illustrates functional organization of the : illustrates functional organization of the cerebral cortexcerebral cortex ․ ․ plasticity permits deviations from the usual plasticity permits deviations from the usual localization sites under certain conditions such as localization sites under certain conditions such as injury or developmental abnormalityinjury or developmental abnormality* Summary* Summary ․ ․ Table 18-2Table 18-2

  

ⅲⅲ. Processing of Praxis. Processing of Praxis - several CNS areas help process particular - several CNS areas help process particular

neurologic body functionsneurologic body functions* the processing model for the praxis* the processing model for the praxis ․ ․ 2 steps2 steps ① ① ideationideation ․ ․ refer to concept formation related to an activityrefer to concept formation related to an activity ․ ․ requires function of the frontal lobes (prefrontal requires function of the frontal lobes (prefrontal and premotor areas) and of areas around the and premotor areas) and of areas around the lateral fissurelateral fissure ② ② planning and programming of movementplanning and programming of movement ․ ․ result of praxis is motor executionresult of praxis is motor execution ․ ․ visuokinesthetic motor engrams or memory visuokinesthetic motor engrams or memory molecules for movementmolecules for movement ․ ․ stored in the left inferior part of the parietal stored in the left inferior part of the parietal

lobelobe․ ․ Fig. 18-4Fig. 18-4

ⅤⅤ. Processing during task . Processing during task performanceperformance

* Motor praxis * Motor praxis  ․  ․ only one type of neurologic body function related to only one type of neurologic body function related to

neurobehavior neurobehavior  ․  ․ client factor and the degree depend on the task to client factor and the degree depend on the task to

be performed be performed  ․  ․ several processing mechanisms involved the several processing mechanisms involved the

performance of a particular activity performance of a particular activity

* Ex. brushing hair * Ex. brushing hair         · visual : information travels through the visual · visual : information travels through the visual pathway to the primary visual cortex pathway to the primary visual cortex       · memories and ideational processes : gets the idea · memories and ideational processes : gets the idea to want to brush the hair to want to brush the hair         · verbal : travels over the auditory pathway to the · verbal : travels over the auditory pathway to the primary auditory area of the cortex in the temporal primary auditory area of the cortex in the temporal lobe where it is processed by the association areas lobe where it is processed by the association areas         · somesthetic : recieces tactile and proprioceptive · somesthetic : recieces tactile and proprioceptive information is analyzed by association areas and information is analyzed by association areas and integrated with prior experiences integrated with prior experiences * ideation : intent to perform an action, and * ideation : intent to perform an action, and

preparation of a sequenced plan of action occur preparation of a sequenced plan of action occur * * Fig. 18-5Fig. 18-5 : illustrates some of the processing : illustrates some of the processing

components that take place during the activity of components that take place during the activity of brushing hair brushing hair

ⅥⅥ. Dysfunction of the . Dysfunction of the activities of daily living area of activities of daily living area of

occupation as a result of occupation as a result of cerebrovascular accidentscerebrovascular accidents

* neurologic body functions * neurologic body functions   ①   ① neuromuscular funcitons neuromuscular funcitons   ②   ② sensory functions and pain sensory functions and pain   ③   ③ mental functions mental functions   ④   ④ voice and speech functions voice and speech functions * related Table 18-2 * related Table 18-2 * conceptual definitions : generalized and abstract * conceptual definitions : generalized and abstract * operational definitions : how particular concepts are * operational definitions : how particular concepts are

measured and observed measured and observed

ⅰⅰ. Conceptual definitions of terms. Conceptual definitions of terms

* frontal lobes process functions related to * frontal lobes process functions related to neuromusculoskeletal and movement-related neuromusculoskeletal and movement-related client factor functions including muscle and client factor functions including muscle and movement functions movement functions

* dysfunction of the frontal lobes * dysfunction of the frontal lobes   ․ ․ affect neuromusculoskeletal body functions affect neuromusculoskeletal body functions

processed in the primary motor and premotor processed in the primary motor and premotor areas areas

  ․ ․ the distribution of impairments is related to lesion the distribution of impairments is related to lesion localization in the primary motor cortex localization in the primary motor cortex

  ․ ․ Table 18-3 : includes definitions of impairments or Table 18-3 : includes definitions of impairments or dysfunction of neurologic client factors and dysfunction of neurologic client factors and relates these to different cerebral lobe relates these to different cerebral lobe

* Parietal lobe * Parietal lobe  ․  ․ process somatosensory and complex sensory process somatosensory and complex sensory

information from multimodal stimuli information from multimodal stimuli  ․  ․ related to dysfunctions of client factors, in related to dysfunctions of client factors, in

particular somesthetic sensory functions and particular somesthetic sensory functions and specific mental functions specific mental functions

 ․  ․ dysfunction of the inferior parietal lobe : related dysfunction of the inferior parietal lobe : related to perceptural and motor processing of client to perceptural and motor processing of client factors, in particular specific mental functions factors, in particular specific mental functions related to sequencing of complex movement, related to sequencing of complex movement, memory, and perception memory, and perception

* Occipital lobe * Occipital lobe  ․  ․ primary and secondary processing areas for visual primary and secondary processing areas for visual

information information  ․  ․ visual processing is located mainly in the inferior visual processing is located mainly in the inferior

parietal lobe parietal lobe  ․  ․ dysfunction : impairments are related to visual dysfunction : impairments are related to visual

sensory functions and specific mental functions sensory functions and specific mental functions related to perception of visual information related to perception of visual information referring to the Framework classification of client referring to the Framework classification of client factors factors

 ․  ․ lesions of the association areas : ex. visual lesions of the association areas : ex. visual agnosia agnosia

* Temporal lobes * Temporal lobes   ․ ․ two types of processing - auditory and limbic two types of processing - auditory and limbic   ․ ․ related to sensory functions of hearing, voice and related to sensory functions of hearing, voice and

speech functions. global mental functions of speech functions. global mental functions of temperament and personality, and specific temperament and personality, and specific mental functions of memory, perception of mental functions of memory, perception of hearing, and emotional fucntions hearing, and emotional fucntions

  ․ ․ lateral sides of the hemisphereslateral sides of the hemispheres   : primary and : primary and secondary processing sites for auditory stimuli secondary processing sites for auditory stimuli and perceptual processing of such information and perceptual processing of such information

  ․ ․ Ex. anomia Ex. anomia

ⅱⅱ. Manifestation of Neurobehavioral . Manifestation of Neurobehavioral impairments during task performance : impairments during task performance : operational definitions of conceptsoperational definitions of concepts

* operational definitions * operational definitions  ․  ․ how concepts are measured and observed how concepts are measured and observed  ․  ․ based on A-ONE based on A-ONE  ․  ․ For successful completion of each of the tasks, For successful completion of each of the tasks,

involvement of several neurologic client factors in involvement of several neurologic client factors in necessary necessary

 ․  ․ The following examples indicate the effect of The following examples indicate the effect of different impairments on task performance in the different impairments on task performance in the various performance areas various performance areas

 ․  ․ Some impairments affect specific ADL areas Some impairments affect specific ADL areas  ․  ․ Other impairments are more pervasive and may Other impairments are more pervasive and may

appear in any ADL performance area or may need appear in any ADL performance area or may need to be addressed specifically to be addressed specifically

- Personal Hygiene and Grooming - Personal Hygiene and Grooming Performance AreaPerformance Area

* hygiene and grooming domain of the A-ONE * hygiene and grooming domain of the A-ONE   ․   ․ personal hygiene and grooming, toilet hygiene, personal hygiene and grooming, toilet hygiene,

and bathing or showering and bathing or showering   ․   ․ washing the face and body and bathing or washing the face and body and bathing or

showering showering   ․   ․ oral hygiene (including brushing teeth) oral hygiene (including brushing teeth)   ․   ․ combing hair, shaving, applying cosmetics, combing hair, shaving, applying cosmetics,

deodorants, or perfumes, and performing toilet deodorants, or perfumes, and performing toilet hygiene hygiene

* Dysfunction of neuromusculoskeletal and * Dysfunction of neuromusculoskeletal and movement-related functions movement-related functions

  ․   ․ Fig. 18-6Fig. 18-6

* Dysfunction of sensory functions * Dysfunction of sensory functions   ․   ․ impaired tactile and proprioceptive sensation, impaired tactile and proprioceptive sensation,

astereognosis, or hemianopsia with a loss of a astereognosis, or hemianopsia with a loss of a visual field, or a loss of part of a visual field may visual field, or a loss of part of a visual field may be present be present

  ․   ․ affect object manipulation affect object manipulation   ․   ․ suffer from inattention or neglect will be aware of suffer from inattention or neglect will be aware of

the impairment and attempt to compensate for it the impairment and attempt to compensate for it (ex. by using vision for sensory feedback) (ex. by using vision for sensory feedback)

* Dysfunction of the client factor of sequencing * Dysfunction of the client factor of sequencing complex movement complex movement

  ․   ․ Fig. 18-6, BFig. 18-6, B   ․   ․ require sequencing and planning of fine finger require sequencing and planning of fine finger

and wrist movements so that the razer is turned and wrist movements so that the razer is turned toward the face for effective use toward the face for effective use

  ․   ․ motor apraxia may influence the ability to comb motor apraxia may influence the ability to comb or brush hair or brush hair

* Premotor perseveration : manifested as repetition * Premotor perseveration : manifested as repetition of the movements of washing the face of the movements of washing the face

* Prefrontal perseveration : perseveration of whole * Prefrontal perseveration : perseveration of whole acts acts

  ․   ․ Fig. 18-6, CFig. 18-6, C * Dysfunction of the perceptual processing * Dysfunction of the perceptual processing   ․   ․ If the perceptual processing is present, a spatial If the perceptual processing is present, a spatial

relation disorder, difficulty with left-right relation disorder, difficulty with left-right discrimination, unilateral body inattention or discrimination, unilateral body inattention or neglect, unilateral visual inattention or neglect, neglect, unilateral visual inattention or neglect, anosognosia, or somatoagnosia may be expected. anosognosia, or somatoagnosia may be expected.

  ․   ․ Fig. 18-6, DFig. 18-6, D * Impairments related to neglect or inattention * Impairments related to neglect or inattention   ․   ․ result from dysfunction of the specific mental result from dysfunction of the specific mental

function factor of perception or attention function factor of perception or attention   ․   ․ not use the affected limb according to available not use the affected limb according to available

control   ․ control   ․ Fig. 18-6, EFig. 18-6, E

* Somatoagnosia * Somatoagnosia   ․   ․ differentiate between the mirror image and self differentiate between the mirror image and self   ․   ․ Fig. 18-6, FFig. 18-6, F   ․   ․ defined in the A-ONE as severe dysfunction that defined in the A-ONE as severe dysfunction that

usually is accompanied by ideational apraxia and usually is accompanied by ideational apraxia and often by spatial relation disorders often by spatial relation disorders

* Dysfunctions of global and specific mental * Dysfunctions of global and specific mental function function

  ․   ․ effect on grooming and hygiene tasks include effect on grooming and hygiene tasks include ideational apraxia, organization and sequencing ideational apraxia, organization and sequencing problems related to activity steps, impaired problems related to activity steps, impaired judgement, decreased level of arousal, lack of judgement, decreased level of arousal, lack of attention, distraction, field dependency, impaired attention, distraction, field dependency, impaired memory, and impaired intention memory, and impaired intention

  ․   ․ Ideational apraxia appear during grooming and Ideational apraxia appear during grooming and hygiene activities. hygiene activities.

  ․   ․ Fig. 18-6, GFig. 18-6, G

* Lack of judgement * Lack of judgement   ․   ․ appear as an inability to make realistic decisions appear as an inability to make realistic decisions

based on environmental information, providing based on environmental information, providing that perception of those impulses is adequate. that perception of those impulses is adequate.

  ․   ․ Fig. 18-6, HFig. 18-6, H * Field dependency * Field dependency   ․   ․ attention component and a perseveration attention component and a perseveration

component component   ․   ․ dysfunction : distracted from performing a dysfunction : distracted from performing a

particular task by specific stimuli that they are particular task by specific stimuli that they are compelled to act on or incorporate into the compelled to act on or incorporate into the previous activity previous activity

* Short-term memory problems * Short-term memory problems   ․   ․ not remember the sequence of activity steps or not remember the sequence of activity steps or

instructions throughout activity performance instructions throughout activity performance   ․   ․ have to remind an individual several times to have to remind an individual several times to

comb the hair, even though the individual does comb the hair, even though the individual does not have comprehension problems not have comprehension problems

* Lack of initiation * Lack of initiation

  ․   ․ occur during performance of grooming and hygiene occur during performance of grooming and hygiene tasks tasks

  ․   ․ The individual has a plan of action but cannot start The individual has a plan of action but cannot start the plan. the plan.

  ․   ․ associated with ideational problems as well associated with ideational problems as well

- Dressing Performance Area- Dressing Performance Area ► Fig. 18-7 . . Fig. 18-7 . .

- Functional Mobility Performance Area- Functional Mobility Performance Area ► Fig. 18-8 Fig. 18-8

- Eating Performance Area - Eating Performance Area

* Fig. 18-9 * Fig. 18-9

ⅦⅦ. Patterns of impairments . Patterns of impairments resulting from cerebrovascular resulting from cerebrovascular

accidentsaccidents

* cerebral blood supply depends on three arteries in * cerebral blood supply depends on three arteries in each hemisphere each hemisphere

  ․   ․ the middle and anterior cerebral arteries (branches the middle and anterior cerebral arteries (branches of the internal carotid artery) of the internal carotid artery)

  ․   ․ the posterior cerebral artery (branch of the basilar the posterior cerebral artery (branch of the basilar artery) artery)

  ․   ․ vertebral arteries vertebral arteries

* two major types of cerebrovascular dysfunction * two major types of cerebrovascular dysfunction cause neurologic lesions cause neurologic lesions

  ①   ① ischemia ischemia     ․     ․ insufficient blood supply to the brain insufficient blood supply to the brain     ․     ․ responsible for 70~80% of all strokes responsible for 70~80% of all strokes     ․     ․ subdivided into thrombosis, or blood flow subdivided into thrombosis, or blood flow

obstruction caused by a local process in one or obstruction caused by a local process in one or more blood vessels more blood vessels

  ②   ② hemorrhage hemorrhage     ․     ․ bleeding, caused by a ruptured blood vessel bleeding, caused by a ruptured blood vessel     ․     ․ accounts for the remaining 15~20% of strokes accounts for the remaining 15~20% of strokes     ․     ․ results in swelling and compression of brain results in swelling and compression of brain

tissue tissue     ․     ․ subdivided into subarachnoid hemorrhage, subdivided into subarachnoid hemorrhage,

intraparenchymal hemorrhage, or bleeding in the intraparenchymal hemorrhage, or bleeding in the cerebral tissue cerebral tissue

* * Table 18-4, 18-5Table 18-4, 18-5 : indicate patterns of : indicate patterns of impairments as they relate to dysfunction of impairments as they relate to dysfunction of different cerebral arteries and different CNS areas different cerebral arteries and different CNS areas as a result of various vascular pathologic as a result of various vascular pathologic

conditionsconditions

Thank you.Thank you.