tests for how to examine perception and its training

1. PERCEPTION TESTING
AND TRAINING
PRESENTATION BY: DR. VAIBHAVI PARMAR
2ND YEAR MPT
4TH AUG 2017

2. Definition:
 Lezak defines perception as the integration of sensory impressions into
information that is psychologically meaningful.
 The terms perception and sensation are often confused with each other.

3. ■ CLINICAL INDICATORS
 Inability to do simple tasks independently or safely,
 Difficulty in initiating or completing a task,
 Difficulty in switching from one task to the next,
 Diminished capacity to locate visually or to identify objects that seem obviously
necessary for task completion.

4.  In addition, unable to follow simple one-step commands.
Make the same mistakes over and over.
Hesitate many times, appear distracted and frustrated, and exhibit poor planning.

5. COMMON TESTS FOR PERCEPTION
1) Structured
Observational
Test of
Function
Consists of a screening test, neuropsychological checklist, and
four ADL scales (eating from a bowl, pouring a drink and
drinking, putting on an upper body garment, and washing and
drying hands).
2) Allen
Cognitive Level
Test
to gain information concerning the client’s educational and
work background, the client is observed performing the
visuomotor task of leather lacing.

6. 3) The Behavioural
Inattention Test
(unilateral visual
neglect)
To check client’s ability to perform everyday
occupations. It consists of 9 activity-based subtests and
6 pen & paper subtests.
4) Rivermead
Perceptual
Assessment Battery
(TBI)
To examine visual perceptual impairments. 16
performance tests that examine form discrimination,
colour constancy, sequencing, object completion,
figure–ground discrimination, body image, inattention,
and spatial awareness.
5) Rivermead
Behavioural
Memory Test
To examine everyday memory abilities. To check
client’s memory function, an indication of appropriate
areas for treatment, and enables the therapist to monitor
memory skills throughout the treatment program.

7. PERCEPTUALIMPAIRMENTS:
1)Body scheme/body image
impairments
• Unilateral neglect
• Anosognosia
• Somatoagnosia
• Right–left discrimination
• Finger agnosia
2)Spatial relation impairments
(complex perception)
• Figure–ground discrimination
• Form discrimination
• Spatial relations
• Position in space
• Topographical disorientation
• Depth and distance perception
• Vertical disorientation

8. 3) Agnosia • Visual object agnosia
• Auditory agnosia
• Tactile agnosia
4) Apraxia • Ideomotor apraxia
• Ideational apraxia
• Buccofacial apraxia

9. PERCEPTUAL DISORDERS
BODY SCHEME BODY IMAGE
Visual & mental image of one’s body Postural model of body including
that includes Feeling about one’s body. relationship of body parts to each other
Esp Health & Disease & environment.

10. 1) UNILATERAL NEGLECT
Inability to register and integrate stimuli and perceptions from one side of the
body.
According to distribution: Personal & Spatial
(contralat body) ( contralat space)
According to modality: Motor & Sensory
(stimuli to which (visual, auditory,
person aware) somatosensory)

11. Clinical exp: Patient ignore left half of body when dressing, shaving, left food in plate on
one side.
Lesion: inferior–posterior regions of the Rt) parietal lobe.
Testing: a) The Behavioural Inattention Test which examine BADL & IADLs.
b) Ask to do any task eg make a drawing, writing
Treatment: Use verbal instructions minimal
Encourage to turn head to neglect side &
attention driven.
Can use eye patch or prism glasses.
Teach strategies to assist in ADLs
Encourage to give demonstration with affected
side

13. 2) SOMATOAGNOSIA
• Lack of awareness of the body structure and the relationship of body parts to
oneself or to others. ( autopagnosia or simply body agnosia)
•Clinical exp: difficulty performing transfer activities
difficulty following instructions, imitate therapist’s movements.
Lesion: dominant parietal lobe
Testing: Ask to point body parts name by therapist on himself or chart
Ask to imitate movements of therapist
Ask to ans the que in relationship to his body.
e.g are your knees below your head?

14. Management: facilitation of body awareness through sensory stimulation to the
body part affected.
E.g Rub body part with rough surface as therapist name or points on it.

15. 3) ANOSOGNOSIA
• Lack of awareness of the presence or severity of one’s paralysis.
• Clinical Ex: patient maintains that there is nothing wrong and refuse to accept
responsibility for them.
•Lesion: supramarginal gyrus
•Testing: asked what happened to the arm or leg, whether he or she is paralyzed,
how the limb feels, and why it cannot be moved Patient deny paralysis.
•Treatment: it resolves spontaneously in the first 3 months following stroke, if
persists long term safety is importance in the treatment.

16. 4) RIGHT LEFT DISCRIMINATION
•inability to identify the right and left sides of one’s own body or of that of the
examiner.
•Clinical Exa: patient cannot tell the therapist which is the right arm and which is
the left, unable to follow instructions using the concept of right–left, such as
“turn right at the corner.”
•Lesion: parietal lobe of either hemisphere
•Testing.The patient is asked to point to body parts on command, such as right ear,
left foot, right arm, and so forth.
•Treatment: for compensation when giving instructions to the patient, the words
“right” and “left” should be avoided. Instead, pointing or providing cues using
distinguishing features of the limb may be more effective (e.g., “the arm with the
watch”)

17. 5) FINGER AGNOSIA
•inability to identify the fingers of one’s own hands or of the hands of the examiner.
•Clinical Exa: difficulty in naming the fingers on command, identifying which finger
was touched, mimicking finger movements.
•Lesion: parietal lobe
•Testing: asking the patient to move or point to his or her finger when named by the
therapist, 10 times (own) 10 times ( therapist) 10 times (chart).
•Treatment: rough cloth can be used to rub the dorsal surface of the more affected arm,
hand, and fingers, and the ventral surface of the more affected fingers. Pressure can be
applied to the ventral surface of the hand.

18. SPATIAL RELATION DISORDERS
Impairments that have in common a difficulty in perceiving the relationship between
the self and two or more objects.
1) FIGURE GROUND DISCRIMINATION
•Impairment in visual figure–ground discrimination is the inability to visually
distinguish a figure from the background in which it is embedded.
•Clinical Exa: The patient cannot locate items in a pocketbook or drawer, locate
buttons on a shirt, or distinguish the armhole from the remainder of a solid-
colored shirt.
•Lesion: Parieto-occipital lesions of the right hemisphere and less frequently the
left hemisphere.

19. •Testing: 1) Ayres Figure–Ground Test
2) Function-based Test
•Treatment: therapist should arrange for practice
in visually locating objects in a simple array.
For Compensation taught to become aware
of the existence and nature of the deficit.
examine objects slowly and instructed to
use other, intact senses.
(e.g., touch)

20. 2) SPATIAL RELATIONS 3) FORM DISCRIMINATION
Inability to perceive the relationship of
one object in space to another object,
or to oneself.
Clinical Exa: difficult to place the
cutlery, plate, and spoon in the proper
position when setting the table.
Lesion: inferior parietal lobe or rt)
parieto-occipital-temporal junction.
Testing:Rivermead Perceptual
Assessment Battery
Inability to perceive or attend to subtle
differences in form and shape.
Clinical Exa: confuse a pen with a
toothbrush, a cane with a crutch
Lesion: parieto-temporo-occipital
region of no dominant hemisphere
Testing: asked to identify items similar
in shape and different size.

21. Treatment: In form discrimination should practice describing, identifying, and
demonstrating the use of similarly shaped and sized objects.
In spatial relations orient by giving the patient instructions to position himself or
herself in relation to the therapist or another object.
E.g “Sit next to me,” “Go behind the table”

22. 4) DEPTH AND DISTANCE PERCEPTION
•Patient experiences inaccurate judgment of direction, distance, and depth.
• Clinical Exa: Difficulty navigating stairs, may miss the chair when attempting
to sit.
•Testing: functional test ( ask to grasp an object from table)
(asked to fill a glass of water)
•Treatment: aware of the deficit
while gait training ask to walk on spots
teach compensatory strategies ( ask to hold armrests of a chair to
assist with sitting)

23. DISTANCE PERCEPTION

24. AGNOSIAS
Visual • inability to recognize familiar objects
Auditory
• inability to recognize non speech sounds or to
discriminate between them
Tactile
• inability to recognize forms by handling them,
although tactile, proprioceptive, and thermal
sensations may be intact

25. Visual agnosia

26. Testing: Patient is asked to name the familiar objects, to point to an object named
by the therapist. (visual)
Patient is asked to close the eyes and to identify the source of various sounds.
The therapist rings a bell, honks a horn, rings a telephone.(auditory)
asked to identify objects placed in the hand by examining them manually without
visual cues. (tactile)
Treatment: compensation

27. APRAXIA: inability to perform purposeful movements, which cannot be accounted for by
inadequate strength, loss of coordination, impaired sensation, attentional difficulties,
abnormal tone, movement disorders, intellectual deterioration, poor comprehension, or
uncooperativeness.
• able to carry out habitual tasks automatically
and describe how they are done but is unable
to imitate gestures or perform on command
Ideomotor
• inability to perform a purposeful act,
automatically or on command, because the
patient no longer understands concept of the
act, can’t retain the idea of the task
Ideational
• difficulties with performing purposeful
movements with the lips, tongue, cheeks,
larynx, and pharynx on command.
Buccofacial

28. Treatment: therapist should speak slowly and use the shortest possible sentences
for verbal commands.
When teaching a new task break the task and then ask to do.

29. EVIDENCES:
1) Combining neck vibration and prism adaptation produces additive therapeutic
effects in unilateral neglect.
Neuropsychol Rehabil 2010
By: Árni Kristjánsson; Ulrike Halsband
3 groups 1) neck vibration
2) prism adaptation
3) combination of both
Findings for both groups indicated improved visual search following
intervention, but the patients that underwent the combined intervention (NVPA)
showed clear improvements on visual search based paper and pencil neglect tests
unlike the NV-only group.

30. 2) Efficacy of strategy training in left hemisphere stroke patients with apraxia:A
randomised clinical trial
By: Joost Dekker & G. Deelman
Neuropsychological rehabilitation, 2001
113 left hemisphere stroke patients with apraxia were randomly assigned to two
treatment groups. 1) strategy training + occupation therapy
2) OT only
Duration: 8 weeks
Measures: ADL activities observation & barthel index
They found only short-term effectiveness of strategy training in left hemisphere
stroke patients with apraxia.

31. 3)Occupational therapy treatment with right half-field eye-patching for patients with
subacute stroke and unilateral neglect:A randomized controlled trial.
Disability and Rehabilitation,
Tsang, M. H., Sze, K. H., & Fong, K. N. K. (2008)
They randomly allocated in 2 groups 1) OT without Eye patch
2) OT with eye patch
Duration: 4 weeks
Measures: BIT & FIM
study indicates that right half-field eye-patching techniques
improved impairment & in ADL function.

32. REFERENCES:
1) Physical Rehabilitation Susan B O’Sullivan Thomas j Schmitz ( 6th edition)
2) Motor control theory and practical application – anne shumway –cook and
wallacott 2nd ediation

33. THANK YOU!