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Case #1

A) Figure ground visual deficits

B) Bell's Test screens for spatial neglect

C) Motor Free Visual Perception Test, Occupational Therapy Adult Perceptual Screening Test (OT-APST), Star Cancellation Test

D)

Identifying ingredients in fridge/cabinet space for meal preparation

Identifying appropriate clothing to wear

Social interaction with family/grandchildren because he is having difficulty finding/seeing things on the floor, tables, beds, etc.

bathing and feeding because like colored foods would be difficult for him to discriminate between

It would be difficult for him to be safely functionally mobile because he is not able to see objects in a cluttered space or against similar colored backgrounds

E) Intervention to work on this deficit using a remediation or compensatory approach

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Case 1

1. Visual perceptual deficit: figure ground, visual neglect, form constancy

2. What does the test screen for? Figure ground → suspected of having attentional deficit

3. Choose 3 assessments to utilize?

1. Motor free Visual Perception Test

2. Occupational Therapy Adult Perceptual Screening Test (OT-APST)

3. Star Cancellation Test

4. BEERY VMI

4. Other impacted occupations

1. Meal prep

2. Driving

3. Item retrieval for occupations

5. Intervention

1. Locate various objects in his pantry

1. Grade up: smaller items, like colors, more items, multiple shelves

2. Grade down: focusing on one shelf, less objects on shelf, easier objects to find (more obvious)

Case 2

1. Visual perception deficit

1. Form constancy: unable to identify sauce and her son in different clothing

2. Ideational apraxia: difficulty with recipe cards

2. Assessments

1. Beery VMI

2. Test of visual perceptual skills

3. Rivermead perceptual assessment battery

1. Assesses form constancy, sequencing, object comparison figure ground perception

3. Goal : Client will correctly identify at least 3 ingredients for a recipe from the pantry with verbal cues within 1 week to address meal preparation

4. 2 Interventions CPT code

1. 97535 - ADL / IADL training

1. Identifying different tomato sauces that match her recipe

2. 97129 - sequencing tasks

1. Identifying correct steps for completing selected recipe

Case 3 ----------

Case 4
left hemi neglect
score: 30/30 severe neglect
After scoring a 30/30 on the CBS this is identified as having a severe neglect. This can be the cause of the difficulty you have experienced when completing your daily routine. This means that you are not fully addressing both sides of your body or incorporating them into daily tasks. But, good thing is that since in therapy we are able to incorporate activities to address this.

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Case #2:

A)

Form Constancy: tomato sauce and not being able recognize her son when he is wearing different clothes

Visual Discrimination: difficulty telling the difference of details on the recipe cards

B) Mini Mental Exam,  Occupational Therapy Adult Perceptual Screening Test (OT-APST), Barthel Index, possibly  Motor Free Visual Perception Test (MVPT-3)

C) STG: Client will make a sandwich by following a 3 step recipe with minimal assistance within 1 week.
D)

Client will participate in simple meal preparation activity with provided verbal cues and pictured examples/directions

Client will engage in identifying various household items and provide a short description what its used for

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Case 3

1. Somatognosia

2. Point to RUE, ask to point to her nose w/ RUE and ask where UE is/ proprioception and/or kinematics assessment

3. Clock diagrams

1. Constructional apraxia

2. Visuospatial deficit

3. L Hemineglect

4. Perseveration (trouble terminating), cognition impaired

5. Stimulus bound response and difficulty encoding

4. Writing numbers in pre drawn clock has more to do with visual perception, whereas drawing from scratch has more to w/ cognition.

5. OT APST -> for presence of impairment in visual perception across each of major constructs (perception and praxis)

Case 1

1. Figure ground (identifying something from background)

2. Bell’s test, looks at visual neglect

1. Results scored 31/35, 1 left omission and 3 omissions on right

2. No impairments found

3. Assessments

1. OTAPST assessment

2. Test of everyday attention (TEA)

3. COPM

4. SLUMS

4. Occupations impacted: meal prep, dressing, home management and maintenance, and medication management

5. Labels -> grade up: general label categories/grade down -> categorize color code

Case 4

1. L hemineglect since he is only shaving right side of face and only eating contents on right side of plate.

2. Pt presents with severe R hemi neglect based off the catherine bergego scale getting a score 30/30

Case 2

1. Prosopagnosia - can not recognize sons face

2. assessments

1. OTAPST

2. Minimental

3. TUG

3. Goal

1. Client will perform 5-step sandwich preparatory task with set up assistance using 2 verbal cues while standing with rolling walker in 2 weeks

4. Interventions

1. Following a recipe in a cookbook with pictures

1. Grade up: use a cookbook with less/no pictures

2. Grade down: set up all the materials or use a cookbook with more pics

2. Watch an instructional video

1. Grade up: watch the video once

2. Grade down: watch the video in increment

5. CPT codes:

1.  97129 - Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes

2. 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes

3. 97535 Self-care/home management training (e.g., activities of daily living [ADLs] and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment), direct one-on-one contact, each 15 minutes

4. 97167 Occupational therapy evaluation, high complexity

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case 2:
A. - form constancy : prosopagnosia
- ideomotor - apraxia
B. -apraxia screen for tulia
- barthel
c.
client will perform meal with min assist with 25%  verbal and tactile cues in 2 weeks
d.
1. declutter and label tomato sauce (contexual cues) color code, practice feeling diff. type of jars, store pasta next to sauce jars

case 3:
A. somatoagnosia
B.
1. ask her to open toothpaste
2. ask to clap her hands
3. ask her to perform brushing her hair
c. adult perception screening test

Case 1:
A. -figure ground (sort)
- visual closure (toys)
- form constancy ( match socks)
B. visuual neglect - results no attentional deficits present on left.
c. Slums
comp
contrast sensitivity
d. dressing, meal prep, hygiene, grooming and cleaning
e. decluttering the area, labeling/dividers in drawers

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Form Constancy

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Anosognosia
Ask patient to show you her affected UE, shake hands with her affected UE and ask her whose hand she is shaking
1.Constructional apraxia (mild)
2.Visual Spatial disorganization
3.Unilateral neglect
4.Perseveration
5. Stimulus bound

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Figure Ground
Bells-Test( cancellation test)
Unilateral spatial neglect in the near extra personal space
Used for CVA patients.
Different versions can pick up on perceptual attention deficits.