Impact of Neurobehavioral  Deficits on Activities of Daily Living
<ul><li>Ⅰ . Activities of Daily Living </li></ul><ul><li>Ⅱ . Neurobehavior : The process of linking occupation to neuronal...
chapter objectives <ul><li>1. Establish a relationship between neurobehavioral concepts and activity performance. </li></u...
Ⅰ . Activities of Daily Living <ul><li>* Basic or personal activities of daily living </li></ul><ul><li>· oriented toward ...
<ul><li>* Summary </li></ul><ul><li>·  Occupational performance : the ability of an individual to accomplish activities by...
Ⅱ . Neurobehavior : The process of linking occupation to neuronal activity <ul><li>* Neurobehavior </li></ul><ul><li>·  be...
 
Ⅲ . Theoretical relationship between occupational performance and neurobehavior <ul><li>* A-ONE theory  </li></ul><ul><li>...
Ⅳ . Detecting the effect of neurobehavioral deficits on activity performance <ul><li>* A systematic analysis of occupation...
<ul><li>* Activity analysis </li></ul><ul><li>①  task - focused </li></ul><ul><li>·  the range of skills and components ne...
<ul><li>* Activity analysis in the A-ONE </li></ul><ul><li>· to identify different client factors and possible manifestati...
<ul><li>ⅰ . Function of the Cerebral Cortex : The Foundation of Task Performance </li></ul><ul><li>·  detect the type and ...
<ul><li>ⅱ . Functional Localization for Neurologic Processing of Client Body Factors </li></ul><ul><li>* primary areas </l...
<ul><li>* cortical areas </li></ul><ul><li>․  The primary association areas that ( except for the motor association cortex...
<ul><li>* Association areas </li></ul><ul><li>․  involved in complex integration of information from  </li></ul><ul><li>ma...
<ul><li>③  parietotemporaloccipital cortex </li></ul><ul><li>․  parietotemporo-occipital cortex : complex sensory  </li></...
<ul><li>ⅲ . Processing of Praxis </li></ul><ul><li>- several CNS areas help process particular neurologic body functions <...
Ⅴ . Processing during task performance   <ul><li>* Motor praxis  </li></ul><ul><li> ․  only one type of neurologic body fu...
<ul><li>* Ex. brushing hair  </li></ul><ul><li>     · visual : information travels through the visual  </li></ul><ul><li>p...
Ⅵ . Dysfunction of the activities of daily living area of occupation as a result of cerebrovascular accidents   <ul><li>* ...
<ul><li>ⅰ . Conceptual definitions of terms   </li></ul><ul><li>* frontal lobes process functions related to neuromusculos...
<ul><li>* Parietal lobe  </li></ul><ul><li> ․  process somatosensory and complex sensory information from multimodal stimu...
<ul><li>* Occipital lobe  </li></ul><ul><li> ․  primary and secondary processing areas for visual information  </li></ul><...
<ul><li>* Temporal lobes  </li></ul><ul><li>  ․  two types of processing - auditory and limbic  </li></ul><ul><li>  ․  rel...
<ul><li>ⅱ . Manifestation of Neurobehavioral impairments during task performance : operational definitions of concepts   <...
<ul><li>- Personal Hygiene and Grooming Performance Area   </li></ul><ul><li>* hygiene and grooming domain of the A-ONE  <...
<ul><li>* Dysfunction of sensory functions  </li></ul><ul><li>  ․  impaired tactile and proprioceptive sensation, astereog...
<ul><li>* Premotor perseveration : manifested as repetition of the movements of washing the face  </li></ul><ul><li>* Pref...
<ul><li>* Somatoagnosia  </li></ul><ul><li>  ․  differentiate between the mirror image and self  </li></ul><ul><li>  ․  Fi...
<ul><li>* Lack of judgement  </li></ul><ul><li>  ․  appear as an inability to make realistic decisions based on environmen...
<ul><li>* Lack of initiation  </li></ul><ul><li>  ․  occur during performance of grooming and hygiene tasks  </li></ul><ul...
<ul><li>- Dressing Performance Area   </li></ul><ul><li>Fig. 18-7    .   .   </li></ul><ul><li>- Functional Mobility Perfo...
Ⅶ . Patterns of impairments resulting from cerebrovascular accidents   <ul><li>* cerebral blood supply depends on three ar...
<ul><li>* two major types of cerebrovascular dysfunction cause neurologic lesions  </li></ul><ul><li>  ①  ischemia  </li><...
<ul><li>*  Table   18-4 ,  18-5   : indicate patterns of impairments as they relate to dysfunction of different cerebral a...
<ul><li>Thank you. </li></ul>
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Deficits on ADL

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Deficits on ADL

  1. 1. Impact of Neurobehavioral Deficits on Activities of Daily Living
  2. 2. <ul><li>Ⅰ . Activities of Daily Living </li></ul><ul><li>Ⅱ . Neurobehavior : The process of linking occupation to neuronal activity </li></ul><ul><li>Ⅲ . Theoretical relationship between occupational performance and neurobehavior </li></ul><ul><li>Ⅳ . Detecting the effect of neurobehavioral deficits on activity performance </li></ul><ul><li>Ⅴ . Processing during task performance </li></ul><ul><li>Ⅵ . Dysfunction of the activities of daily living area of occupation as a result of cerebrovascular accidents </li></ul><ul><li>Ⅶ . Patterns of impairments resulting from cerebrovascular accidents </li></ul>
  3. 3. chapter objectives <ul><li>1. Establish a relationship between neurobehavioral concepts and activity performance. </li></ul><ul><li>2. Apply the theory on which the A-ONE is based as a structure for clinical observations of stroke patients. </li></ul><ul><li>3. Provide conceptual and operational definitions for neurobehavioral impairments and disability. </li></ul><ul><li>4. Apply clinical reasoning skills based on the A-ONE theory for hypothesis testing. </li></ul><ul><li>5. Relate the ICF and the Occupational Therapy Practice Framework to the A-ONE theory and neurobehavioral concepts. </li></ul><ul><li>6. Provide examples of how strokes can cause different patterns of impairments affecting task performance. </li></ul>
  4. 4. Ⅰ . Activities of Daily Living <ul><li>* Basic or personal activities of daily living </li></ul><ul><li>· oriented toward taking care of one's own body </li></ul><ul><li>· bathing, showering, bowel and bladder management, dressing, eating, feeding, functional mobility, personal device care, personal hygiene, grooming, sexual activity, sleep/rest, toilet hygiene </li></ul><ul><li>* Instrumental activities of daily living </li></ul><ul><li>· education, work, play, leisure, social participation </li></ul><ul><li>* Performance contexts </li></ul><ul><li>· cultural, physical, social, personal, spiritual, temporal, curtual conditions </li></ul><ul><li>· Table 18-1 : relates the Frameworks terminology to the classification systems of the ICF and A-ONE. </li></ul>
  5. 5. <ul><li>* Summary </li></ul><ul><li>· Occupational performance : the ability of an individual to accomplish activities by interaction of client factors, performance skills, performance patterns, and context of that individual. </li></ul>
  6. 6. Ⅱ . Neurobehavior : The process of linking occupation to neuronal activity <ul><li>* Neurobehavior </li></ul><ul><li>· behavior based on neurological function </li></ul><ul><li>· different tasks -> different types of sensory stimuli -> different mechanisms of the central nervous system -> behavioral responses -> feedback -> new sensory stimuli </li></ul><ul><li>· Fig. 18-1 : illustrates the elements </li></ul><ul><li>* Neurobehavioral deficit </li></ul><ul><li>· A functional impairment manifested as defective task performance resulting from a neurologic processing dysfunction. </li></ul><ul><li>· affects client factors (affect, body scheme, cognition, emotion, gnosis, language, memory, motor movement, perception, personality, praxis, sensory awareness, spatial relatioins, visuospatial skills) </li></ul>
  7. 8. Ⅲ . Theoretical relationship between occupational performance and neurobehavior <ul><li>* A-ONE theory </li></ul><ul><li>· the ability to perform daily activities, neurobehavioral impairments, and the CNS origin of the neurobehavioral dysfunction </li></ul>
  8. 9. Ⅳ . Detecting the effect of neurobehavioral deficits on activity performance <ul><li>* A systematic analysis of occupational performance </li></ul><ul><li>· help therapists assess functional independence related to task performance </li></ul><ul><li>· detect dysfunctional neurologic client factors </li></ul><ul><li>  </li></ul>
  9. 10. <ul><li>* Activity analysis </li></ul><ul><li>① task - focused </li></ul><ul><li>· the range of skills and components needed to </li></ul><ul><li>perform the activity, typical performance methods, </li></ul><ul><li>performance context, cultural meaning of the </li></ul><ul><li>activity </li></ul><ul><li>② theory - focused </li></ul><ul><li>· performed with intervention potential in mind </li></ul><ul><li>· focused performance problems based on </li></ul><ul><li>definitions of function and dysfunction </li></ul><ul><li>③ individual - focused </li></ul><ul><li>· focused on client </li></ul><ul><li>· integrated with the client's goal </li></ul>
  10. 11. <ul><li>* Activity analysis in the A-ONE </li></ul><ul><li>· to identify different client factors and possible manifestations of CNS dysfunction during ADL performance </li></ul><ul><li>· Therapist keeps in mind different possible neurologic factors and impairments and the theoretical definitions of functional and dysfunctional behavior </li></ul><ul><li>· meaningful task </li></ul><ul><li>· Fig. 18-2 </li></ul>
  11. 12. <ul><li>ⅰ . Function of the Cerebral Cortex : The Foundation of Task Performance </li></ul><ul><li>· detect the type and degree of severity of neurobehavioral impairments that interfere with activity performance </li></ul><ul><li>· body factors are based on neurologic function, which takes place at different levels of the CNS </li></ul><ul><li>· three levels of functional complexity in the cortex based on Luria's theories </li></ul><ul><li>- primary, secondary, tertiary cortical zones or </li></ul><ul><li>projection areas </li></ul>
  12. 13. <ul><li>ⅱ . Functional Localization for Neurologic Processing of Client Body Factors </li></ul><ul><li>* primary areas </li></ul><ul><li>․ direct processing of primary sensory and motor </li></ul><ul><li>information </li></ul><ul><li>․ include the primary somesthetic sensory cortex in </li></ul><ul><li>the postcentral gyrus of the parietal lobe </li></ul><ul><li>․ the primary visual cortex around the calcarine fissure </li></ul><ul><li>on the medial side of the occipital lobe </li></ul><ul><li>․ the primary auditory cortex in the superior themporal </li></ul><ul><li>gyrus of the temporal lobe </li></ul><ul><li>․ the primary motor cortex in the precentral gyrus of </li></ul><ul><li>the frontal lobe </li></ul>
  13. 14. <ul><li>* cortical areas </li></ul><ul><li>․ The primary association areas that ( except for the motor association cortex) receive information from the primary areas and integrate it with information from other areas </li></ul><ul><li>․ The secondary association areas are adjacent to and connected with primary cortical areas. </li></ul><ul><li>․ a single sensory or motor function </li></ul><ul><li>․ include the visual association cortex surrounding the primary visual cortex in the occipital lobe, the auditory association cortex in the temporal lobe, the somatosensory association area in the superior parietal lobule, and the premotor cortex in the frontal lobe </li></ul>
  14. 15. <ul><li>* Association areas </li></ul><ul><li>․ involved in complex integration of information from </li></ul><ul><li>many different cortical areas </li></ul><ul><li>① prefrontal cortex </li></ul><ul><li>․ dorsolateral prefrontal cortex : involve in complex </li></ul><ul><li>motor functions, concept formation, abstraction, </li></ul><ul><li>intelligence, judgement, attention, intention, </li></ul><ul><li>sequencing, and timing and organization of activity </li></ul><ul><li>steps and behavior as well as emotional processing </li></ul><ul><li>② limbic cortex </li></ul><ul><li>․ limbic association cortex : includes the </li></ul><ul><li>orbitofrontal part of the prefrontal cortex, the </li></ul><ul><li>temporal pole, and the parahippocampal </li></ul><ul><li>gyrus on the medial aspects of the temporal lobes </li></ul><ul><li>and the cingulate gyrus of the cortex concerned </li></ul><ul><li>with memory and with motivation and emotional </li></ul><ul><li>aspects </li></ul>
  15. 16. <ul><li>③ parietotemporaloccipital cortex </li></ul><ul><li>․ parietotemporo-occipital cortex : complex sensory </li></ul><ul><li>functions based on information from two or more </li></ul><ul><li>of the socondary association areas of the three </li></ul><ul><li>posterior lobes </li></ul><ul><li>․ Fig. 18-3 : illustrates functional organization of the </li></ul><ul><li>cerebral cortex </li></ul><ul><li>․ plasticity permits deviations from the usual </li></ul><ul><li>localization sites under certain conditions such as </li></ul><ul><li>injury or developmental abnormality </li></ul><ul><li>* Summary </li></ul><ul><li>․ Table 18-2 </li></ul><ul><li>  </li></ul>
  16. 17. <ul><li>ⅲ . Processing of Praxis </li></ul><ul><li>- several CNS areas help process particular neurologic body functions </li></ul><ul><li>* the processing model for the praxis </li></ul><ul><li>․ 2 steps </li></ul><ul><li>① ideation </li></ul><ul><li>․ refer to concept formation related to an activity </li></ul><ul><li>․ requires function of the frontal lobes (prefrontal </li></ul><ul><li>and premotor areas) and of areas around the </li></ul><ul><li>lateral fissure </li></ul><ul><li>② planning and programming of movement </li></ul><ul><li>․ result of praxis is motor execution </li></ul><ul><li>․ visuokinesthetic motor engrams or memory </li></ul><ul><li>molecules for movement </li></ul><ul><li>․ stored in the left inferior part of the parietal lobe </li></ul><ul><li>․ Fig. 18-4 </li></ul>
  17. 18. Ⅴ . Processing during task performance <ul><li>* Motor praxis </li></ul><ul><li> ․ only one type of neurologic body function related to neurobehavior </li></ul><ul><li> ․ client factor and the degree depend on the task to be performed </li></ul><ul><li> ․ several processing mechanisms involved the performance of a particular activity </li></ul>
  18. 19. <ul><li>* Ex. brushing hair </li></ul><ul><li>     · visual : information travels through the visual </li></ul><ul><li>pathway to the primary visual cortex </li></ul><ul><li>   · memories and ideational processes : gets the idea </li></ul><ul><li>to want to brush the hair </li></ul><ul><li>    · verbal : travels over the auditory pathway to the </li></ul><ul><li>primary auditory area of the cortex in the temporal </li></ul><ul><li>lobe where it is processed by the association areas </li></ul><ul><li>    · somesthetic : recieces tactile and proprioceptive </li></ul><ul><li>information is analyzed by association areas and </li></ul><ul><li>integrated with prior experiences </li></ul><ul><li>* ideation : intent to perform an action, and preparation of a sequenced plan of action occur </li></ul><ul><li>* Fig. 18-5 : illustrates some of the processing components that take place during the activity of brushing hair </li></ul>
  19. 20. Ⅵ . Dysfunction of the activities of daily living area of occupation as a result of cerebrovascular accidents <ul><li>* neurologic body functions </li></ul><ul><li>  ① neuromuscular funcitons </li></ul><ul><li>  ② sensory functions and pain </li></ul><ul><li>  ③ mental functions </li></ul><ul><li>  ④ voice and speech functions </li></ul><ul><li>* related Table 18-2 </li></ul><ul><li>* conceptual definitions : generalized and abstract </li></ul><ul><li>* operational definitions : how particular concepts are measured and observed </li></ul>
  20. 21. <ul><li>ⅰ . Conceptual definitions of terms </li></ul><ul><li>* frontal lobes process functions related to neuromusculoskeletal and movement-related client factor functions including muscle and movement functions </li></ul><ul><li>* dysfunction of the frontal lobes </li></ul><ul><li>  ․ affect neuromusculoskeletal body functions processed in the primary motor and premotor areas </li></ul><ul><li>  ․ the distribution of impairments is related to lesion localization in the primary motor cortex </li></ul><ul><li>  ․ Table 18-3 : includes definitions of impairments or dysfunction of neurologic client factors and relates these to different cerebral lobe </li></ul>
  21. 22. <ul><li>* Parietal lobe </li></ul><ul><li> ․ process somatosensory and complex sensory information from multimodal stimuli </li></ul><ul><li> ․ related to dysfunctions of client factors, in particular somesthetic sensory functions and specific mental functions </li></ul><ul><li> ․ dysfunction of the inferior parietal lobe : related to perceptural and motor processing of client factors, in particular specific mental functions related to sequencing of complex movement, memory, and perception </li></ul>
  22. 23. <ul><li>* Occipital lobe </li></ul><ul><li> ․ primary and secondary processing areas for visual information </li></ul><ul><li> ․ visual processing is located mainly in the inferior parietal lobe </li></ul><ul><li> ․ dysfunction : impairments are related to visual sensory functions and specific mental functions related to perception of visual information referring to the Framework classification of client factors </li></ul><ul><li> ․ lesions of the association areas : ex. visual agnosia </li></ul>
  23. 24. <ul><li>* Temporal lobes </li></ul><ul><li>  ․ two types of processing - auditory and limbic </li></ul><ul><li>  ․ related to sensory functions of hearing, voice and speech functions. global mental functions of temperament and personality, and specific mental functions of memory, perception of hearing, and emotional fucntions </li></ul><ul><li>  ․ lateral sides of the hemispheres   : primary and secondary processing sites for auditory stimuli and perceptual processing of such information </li></ul><ul><li>  ․ Ex. anomia </li></ul>
  24. 25. <ul><li>ⅱ . Manifestation of Neurobehavioral impairments during task performance : operational definitions of concepts </li></ul><ul><li>* operational definitions </li></ul><ul><li> ․ how concepts are measured and observed </li></ul><ul><li> ․ based on A-ONE </li></ul><ul><li> ․ For successful completion of each of the tasks, involvement of several neurologic client factors in necessary </li></ul><ul><li> ․ The following examples indicate the effect of different impairments on task performance in the various performance areas </li></ul><ul><li> ․ Some impairments affect specific ADL areas </li></ul><ul><li> ․ Other impairments are more pervasive and may appear in any ADL performance area or may need to be addressed specifically </li></ul>
  25. 26. <ul><li>- Personal Hygiene and Grooming Performance Area </li></ul><ul><li>* hygiene and grooming domain of the A-ONE </li></ul><ul><li>  ․ personal hygiene and grooming, toilet hygiene, and bathing or showering </li></ul><ul><li>  ․ washing the face and body and bathing or showering </li></ul><ul><li>  ․ oral hygiene (including brushing teeth) </li></ul><ul><li>  ․ combing hair, shaving, applying cosmetics, deodorants, or perfumes, and performing toilet hygiene </li></ul><ul><li>* Dysfunction of neuromusculoskeletal and movement-related functions </li></ul><ul><li>  ․ Fig. 18-6 </li></ul>
  26. 27. <ul><li>* Dysfunction of sensory functions </li></ul><ul><li>  ․ impaired tactile and proprioceptive sensation, astereognosis, or hemianopsia with a loss of a visual field, or a loss of part of a visual field may be present </li></ul><ul><li>  ․ affect object manipulation </li></ul><ul><li>  ․ suffer from inattention or neglect will be aware of the impairment and attempt to compensate for it (ex. by using vision for sensory feedback) </li></ul><ul><li>* Dysfunction of the client factor of sequencing complex movement </li></ul><ul><li>  ․ Fig. 18-6, B </li></ul><ul><li>  ․ require sequencing and planning of fine finger and wrist movements so that the razer is turned toward the face for effective use </li></ul><ul><li>  ․ motor apraxia may influence the ability to comb or brush hair </li></ul>
  27. 28. <ul><li>* Premotor perseveration : manifested as repetition of the movements of washing the face </li></ul><ul><li>* Prefrontal perseveration : perseveration of whole acts </li></ul><ul><li>  ․ Fig. 18-6, C </li></ul><ul><li>* Dysfunction of the perceptual processing </li></ul><ul><li>  ․ If the perceptual processing is present, a spatial relation disorder, difficulty with left-right discrimination, unilateral body inattention or neglect, unilateral visual inattention or neglect, anosognosia, or somatoagnosia may be expected. </li></ul><ul><li>  ․ Fig. 18-6, D </li></ul><ul><li>* Impairments related to neglect or inattention </li></ul><ul><li>  ․ result from dysfunction of the specific mental function factor of perception or attention </li></ul><ul><li>  ․ not use the affected limb according to available control   ․ Fig. 18-6, E </li></ul>
  28. 29. <ul><li>* Somatoagnosia </li></ul><ul><li>  ․ differentiate between the mirror image and self </li></ul><ul><li>  ․ Fig. 18-6, F </li></ul><ul><li>  ․ defined in the A-ONE as severe dysfunction that usually is accompanied by ideational apraxia and often by spatial relation disorders </li></ul><ul><li>* Dysfunctions of global and specific mental function </li></ul><ul><li>  ․ effect on grooming and hygiene tasks include ideational apraxia, organization and sequencing problems related to activity steps, impaired judgement, decreased level of arousal, lack of attention, distraction, field dependency, impaired memory, and impaired intention </li></ul><ul><li>  ․ Ideational apraxia appear during grooming and hygiene activities. </li></ul><ul><li>  ․ Fig. 18-6, G </li></ul>
  29. 30. <ul><li>* Lack of judgement </li></ul><ul><li>  ․ appear as an inability to make realistic decisions based on environmental information, providing that perception of those impulses is adequate. </li></ul><ul><li>  ․ Fig. 18-6, H </li></ul><ul><li>* Field dependency </li></ul><ul><li>  ․ attention component and a perseveration component </li></ul><ul><li>  ․ dysfunction : distracted from performing a particular task by specific stimuli that they are compelled to act on or incorporate into the previous activity </li></ul><ul><li>* Short-term memory problems </li></ul><ul><li>  ․ not remember the sequence of activity steps or instructions throughout activity performance </li></ul><ul><li>  ․ have to remind an individual several times to comb the hair, even though the individual does not have comprehension problems </li></ul>
  30. 31. <ul><li>* Lack of initiation </li></ul><ul><li>  ․ occur during performance of grooming and hygiene tasks </li></ul><ul><li>  ․ The individual has a plan of action but cannot start the plan. </li></ul><ul><li>  ․ associated with ideational problems as well </li></ul>
  31. 32. <ul><li>- Dressing Performance Area </li></ul><ul><li>Fig. 18-7 . . </li></ul><ul><li>- Functional Mobility Performance Area </li></ul><ul><li>Fig. 18-8 </li></ul><ul><li>- Eating Performance Area </li></ul><ul><li>* Fig. 18-9 </li></ul>
  32. 33. Ⅶ . Patterns of impairments resulting from cerebrovascular accidents <ul><li>* cerebral blood supply depends on three arteries in each hemisphere </li></ul><ul><li>  ․ the middle and anterior cerebral arteries (branches of the internal carotid artery) </li></ul><ul><li>  ․ the posterior cerebral artery (branch of the basilar artery) </li></ul><ul><li>  ․ vertebral arteries </li></ul>
  33. 34. <ul><li>* two major types of cerebrovascular dysfunction cause neurologic lesions </li></ul><ul><li>  ① ischemia </li></ul><ul><li>    ․ insufficient blood supply to the brain </li></ul><ul><li>    ․ responsible for 70~80% of all strokes </li></ul><ul><li>    ․ subdivided into thrombosis, or blood flow obstruction caused by a local process in one or more blood vessels </li></ul><ul><li>  ② hemorrhage </li></ul><ul><li>    ․ bleeding, caused by a ruptured blood vessel </li></ul><ul><li>    ․ accounts for the remaining 15~20% of strokes </li></ul><ul><li>    ․ results in swelling and compression of brain tissue </li></ul><ul><li>    ․ subdivided into subarachnoid hemorrhage, intraparenchymal hemorrhage, or bleeding in the cerebral tissue </li></ul>
  34. 35. <ul><li>* Table 18-4 , 18-5 : indicate patterns of impairments as they relate to dysfunction of different cerebral arteries and different CNS areas as a result of various vascular pathologic conditions </li></ul>
  35. 36. <ul><li>Thank you. </li></ul>

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