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INTRODUCTION

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LEARNING OBJECTIVES

  1. Identify the signs of cognitive and perceptual deficits.

  2. Describe how cognitive and perceptual deficits affect a patient's ability to participate in rehabilitation.

  3. Explain how a patient can be assisted to compensate for body scheme and/or body image disorders.

  4. Describe how spatial relations impairments can affect the patient's ability to follow directions.

  5. Compare and contrast the effect of the various agnosias on the patient's ability to recognize stimuli in the environment.

  6. Differentiate between ideomotor and ideational apraxia. Describe how a patient with apraxia might behave in response to different instructional sets commonly employed in rehabilitation.

  7. Identify how the psychological and emotional status of a patient with cognitive and perceptual deficits may affect participation in rehabilitation.

  8. Analyze and interpret patient data, formulate realistic anticipated goals and expected outcomes, and identify appropriate interventions when presented with a clinical case study.

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Cognitive and perceptual deficits are among the chief causes of poor rehabilitation progress for patients who have sustained brain damage, even among those whose motor skills have returned. Cognitive and perceptual deficits are some of the most puzzling and disabling difficulties that a person can experience. Thinking, remembering, reasoning, and making sense of the world around us is fundamental to carrying out daily living activities. When individuals experience problems with these capacities, it can have a devastating effect on their lives and the lives of their family. These people may not be able to live alone, fulfill the responsibilities of paid employment, or sustain a family life and relationships.1 Thus, effective treatment of many patients with brain damage depends on understanding perception and cognition.

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The brain may be damaged through several mechanisms, including infections, such as encephalitis; anoxia, as may occur following near-drowning, cardiopulmonary arrest, or carbon monoxide poisoning; tumors that are benign or malignant; trauma resulting from motor vehicle accidents, falls, or violent incidents (e.g., traumatic sports-related injury, gunshot wound); toxins such as alcohol or substance abuse; and vascular disease, which may produce an infarct or hemorrhagic stroke. The largest two groups of people who acquire cognitive and perceptual impairments following brain damage are persons who experienced stroke and traumatic brain injury (TBI).1 The physical rehabilitation of these patient groups is addressed in Chapter 15, Stroke, and Chapter 19, Traumatic Brain Injury.

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The patient who has sustained an initial cerebral vascular accident (CVA) is thought to have focal or localized damage to discrete areas of the brain, often resulting in discrete cognitive or perceptual deficits. In contrast, patients who have sustained a TBI are presumed to have generalized brain damage resulting in cognitive impairment with generalized deficits in attention, memory, learning, and so forth, rather than specific difficulties in discrete cognitive or perceptual functions. However, elements of both perceptual and cognitive dysfunction may occur in brain damage owing to either CVA or trauma. The distinctions between the two groups of patients become particularly blurred when one considers the patient ...

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