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13 Cards in this Set
- Front
- Back
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Left Neglect Summary
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Reduced responsivity toward leftward info and movement toward the left as defined by the body midline, the coordinates of the environment, and/or the stimuli within the environment.
Neglect is dynamic, not static, and shifts with the focus of attention and the amount of effort required to disengage and move attention in the leftward direction. Left neglect can occur in the auditory, tactile, olfactory, and visual modalities. Left neglect can occur in motor performance either by inhibiting leftward movements or by reducing movements of the left limb. Neglect is a negative predictor for recovery of independence in ADLs. Patients with left neglect often have unconcious perception of left-sided input, in that they are aware of, but fail to fully process neglected info. Patients with left neglect deny the deficit and may deny ownership of the left-sided body parts. Lesion sites associated with left neglect include areas of the frontal and parietal cortex, the basal ganglia, internal capsule, and thalamus. Some tests of visual neglect are line bisection, cancellation, drawing, reading, and writing. Two fundamentals important to remember are: 1. neglect is a subjective experience that occurs inside the mind of the neglector, 2. the concept of space is a mental or psychological construct. |
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Right CVA: things you may see
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Decent language
Paralysis on the left Sometimes don't believe paralyzed body part is theirs Fluent Memory might be pretty good Flat affect Impulsive Distractable/Fidgety Poor eye contact Poor comprehension of time (internal clock is off) Left neglect |
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Strokes vs. TBI
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Strokes:
Focal damage Language affected Age is usually older adults Better awareness TBI: Diffuse damage Age of patient usually younger Not as aware |
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Where do you start for TBI patient?
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1. Glascow Coma Scale
Used initially in hospital by doctors to rate patients Score from 3-15 (severe to mild) 2. Rancho Los Amigos Scale of Cognitive Functioning Used by anyone in hospital 3. Low levels of RLA are 1-3 A. Educate the family First 6 months are most critical for recovery Stair step pattern Inconsistencies Provide written info Model what you want them to do B. Western Neurosensory Stimulation Profile Evaluates patients abilities to use their 5 senses Doris likes the purple beads in olivia's princess tiara (to remember how to set the stage) Stimulation/Interaction Program a. Provide orientation b. Tasks similar to the WNSSP |
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Dora likes the purple beads in olivia's princess tiara
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D=Door (get rid of distractions)
L=Lights (turn them on) T=Touch (lightly shake them or put hand on their arm) P=Positioning (move feet up, etc.) B=Bed (elevate if possible) I=Ice (use if necessary to wake up) O=Orientation (talking to patient and providing info on where they are, etc.) P=PROM (passive range of motion) T=Thermal Tactile Stim (lemon swabs or something really cold) |
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Level 4 (Confused/Agitated)
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A. Family Education
B. You can record abilities in terms of: increased behaviors length of attention to task improved attention with less structure amount of frustration outbursts amount of hitting C. Behaviors |
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TBI Behaviors
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Motor restlessness
Irritability Reduced frustration tolerance Reduced tolerance to stimulation Increased anxiety Perseveration Lability Reduced awareness/denial Altered sleep/wake cycle Reduced inhibitions Inappropriateness Impulsive Reduced length of attention to task Distractibility Reduced memory Reduced organization Confabulation Egocentric Reduced patience Reduced awareness to most saliant/relevant info Inflexible Reduced abstract thought Reduced topic maintenance Tangential Flat affect |
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Cognitive areas for TBI
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Attention: structure the environment
Memory/Orientation |
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Level 5 (Confused/Appropriate)
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Family Ed
Cognitive Abilities |
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Level 5 Cognitive Abilities for TBI
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1. Attention/Concetration
Span Length of attention to task Distractibility 2. Memory Orientation Oriented x4 (time, place, self, reason/purpose) 3. Recent Memory 4. Long Term Memory 5. Reasoning |
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Memory (Immediate, recent and long-term)
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Immediate: The capacity to retain and recall new information after several minutes.
Recent: The capacity to retain and recall new information over a period of hours or days. Long-Term: The capacity to retain and recall information from the past. |
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Long-Term Memory Strategy
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A. Day planners
Why? Memory, reasoning/organization, landmarks for improvement for patient and family, impulsivity, place to keep behavior program) |
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Common Changes After a Right Hemisphere Stroke
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Inattention
Short Term Memory Deficits Disorientation Confusion or Disorganized Thinking Decreased Perception and/or Processing Left Neglect Impaired Executive Functioning Impulsivity Reduced Initiation and/or Delayed Processing |
