How can you assess if your pt has any form of neglect?
- observation of pt in their env't
- use assessment tools
What should you observe when you assess pts neglect?
- the position of the pt in bed, or chair with head and eyes to ipsilateral side - usually the right, arm and leg may dangle off the bed, tilted or crooked in bed
- when approached from the left may bizarrely orient and reply to the right, away from the person addressing them
- walk, navigate wheelchair in a rightward biased manner or alternately collide with objects, doorframes on the left
What are the assessment tools for neglect?
- MMSE for cognition
- clock drawing, line cancellation, copying diagrams, coin selection, menu selection, room observationm figure puzzles, reading tasks
- all tests should be presented in front of the pts midline with therapist seated directly opposite. No time limit is imposed
What are the behavioural tasks you can assess?
- telephone dialing
- article reading
- telling and setting the time
- coin sorting
- address and sentence copying
- map navigation
- card sorting
Personal tasks you can use to assess pt with neglect?
- hair combing
- using razor or makeup
- using glasses
What are some extra personal tasks you can use to assess ur pts neglect?
- serving tea
- descriptioon of envt
- card dealing
How are the behavioural tasks, personal tasks and extra personal tasks?
- scored based on symmetry of performance
What is the clock drawing test used for?
- assess cognitive impairement and neglect
- adds merit in that is evaluates executive, visuoperceptual and constructional dysfunction
- has sensitivity of 83% and specificity of 72% for cognitive imapirment
- not helpful in determining between dementia types
- usually with MMSE
What are the instructions you give to ur pt for clock drawing test?
- draw the outline of a clock face
- put in all the numbers
- set the hands at ten past 11
The scoring process for CDT is on pg 55
What are the treatments of neglect?
- envt modification
What are the aims of the treatment of neglect?
- is to expand the attention window
What is the scanning treatment technique for neglect?
- searching for random targets etc
- place a target on left side to serve as an anchor
- moving from relatively few many stimuli
- pacing the patient
- track target around perimeter
- search random targets
- cancellation tasks
- reading tasks
- use lighthouse strategy when walking: reduce bumping into things- move head left to right while scanning, emphasize imagery of lighthouse beam
- reminders to look left
- external stimulation: left neck vibration, caloric stimulation, prism glasses, transcranial magnetic stimulation
How can you treat object- centred neglect?
- large and small stimli
- embed target within larger stimulus
- include irrelevant items on left- shift attention toward midline or left of midline
- name objects that span the midline- symmetrical vs asymmetrical pictures, read words that span the midline, count or describe intersecting or joined objects
- outline items with finer to establish boundaries, right, left, alternating
How can you modify the environment to help treat neglect?
- orientate pts bedroom leftwards and hence make the pt percieve his left side
- verbal/ visual cueing/ tactile cueing
- motor bias- a form of CIT to encourage the use of the affectedlimb in the left hemisphere
Saftey you need to be aware of for pts with neglect
- need to monitor pt as they are likely to have falls, left sided collisions, falling out of bed
- consdier external envt and family education for community reintegration
What is a type of severe perceptual dysfunction?
- the pusher
What are some management strategies for the pusher?
- relaxation of unaffected side- selective trunck activation on affected side, positioning, hanlidng, verbal cues to relax unaffected side/and stim mm activation
- regain central alignment- in lying, sitting and standing
- use of external/ environmental cues to orient the pt in space- these may be used in sitting, standing, during transfers and walking, use of a table, box or rail alongside the pts affected sid, may also use another object in front to 'box' them in
- use of automatic activites to promote weight shift- reaching to unaffected side and forwards, produce self initated displacement
- maintin range, flexibility on both sides, esp overactive side
What are the specific training strategies for sitting?
- awareness of upright (mirror may or may not work)
- try to relax the unaffected side by placing hand in lap or in therapist hand, foot on therapists foot
- internal displacement- particular reaching forward and to unaffected side and then progres to reaching forwards and to the affected side
What are the specific training strategies for a pusher in standing?
- structure the envt eg plinth, bars, table, wall
- verbal cues eg "move your right hip forward to the bar"
- visaul cues (mirror/ video feedback may or may not work)
- careful handling: do not handle the unafected side too much esp much especially the shoulder of the pt will push more. Handle at the hip and knee and encourage activation of affected leg mm. Apply compression down through knee and ankle to hold foot on ground during standing up
- weight shifting tasks to left and right
- may initially splint affected knee to allow for better weight bearing