Occupational Therapy Interventions

Few individuals with agnosia regain sensory functioning but most make gains within the first few months or year of diagnosis (Rogers, n.d.). There is no specific treatment of agnosia but when possible, the cause of the agnosia is often treated. In other words, damage to regions of the affected cerebrum is treated (e.g., surgery for a stroke). However, most of the time because there is damaged to the brain, there is not much medicinal treatment to be done, especially when the damage is irreversible. Interventions tend to focus on helping individuals with agnosia cope with their condition. Several case studies surrounding agnosias exists in the literature. Treatment principles in these case studies include rehabilitation revolving around repetitive training of impaired function and compensation with utilization of spared function to compensate for the deficit (Ghadiali, 2004). Occupational therapy (OT) is often involved with providing strategies to help individuals with agnosia and his or her caregivers cope and adapt. Hence, the goal of treatment and OT is to develop remedial and compensatory approaches to enable the individual with agnosia to function independently within their context. The following aresome general OT strategies to help accomplish this goal.

 Perform tasks in predictable environments (Rai & Kline, 2004): e.g. place a set of clothes on the same place every morning

 De-clutter: e.g. place commonly used items out for use

 Provide verbal cues: e.g. encourage individuals with prosopagnosia to use a birthmark or facial feature to recognize loved ones

 Develop a routine in order to develop consistency in task stimuli

 Burns (2010) suggests the following strategies:

o Use Alternative Cues

– Individuals with prosopagnosia can use distinct facial characteristics such as hair style to improve recogniton

– Learn to use contextual information or information revealed during a conversation

– Tactile markers with differing textures can be used in the environment to signify dangerous objects

o Use Alternative Strategies

– Writing down what others say may help an individual with pure word deafness understand a verbal direction or communication; lipreading can also aid in comprehension

– Individuals with alexia can learn to read fairly well through lettertracing

– Teaching an individual with visual object agnosia to feel an object can assist in recognition

o Organizational Strategies

– Organization of clothing using clearly labeled drawers, cabinets, or storage can help making dressing choices easier

– Organization of prepared food so that the individual with agnosia knows where the foods will always be found

– Objects that are used together can be kept in drawers with labels,tactile cues, or colour codes so the individual with

– agnosia knows what each drawer contains

Disclaimer: Research on the use of interventions for agnosias were difficult to come across in the literature, especially auditory and tactile agnosias. In addition, controlled treatment studies with individuals with agnosia are rare. There are, however, several case studies on visual forms of agnosias in the literature. Nevertheless, strategies and interventions are not discussed in depth within these studies. The databases of PubMed, Google Scholar, and Western University library’s Summon feature were utilized using keywords “agnosia” AND “rehabilitation” OR “intervention” OR “treatment” for this search. More research needs to be conducted on general interventions for agnosias.

Any form of agnosia is likely to hinder an individual’s engagement in their day to day activities. Occupational performance issues vary depending on the type of agnosia experienced. Generally, however, the inability to recognize various stimuli can cause issues relating to the person, their occupation, and environment (using the outline of the Canadian Model of Occupational Performance and Engagement). In regards to an individual’s occupation, recognition deficits can lead to occupational performance issues with self-care, productivity, and leisure. For self-care, individuals may need help with eating because they cannot recognize a spoon and fork and as a result use a knife to eat instead (e.g., using a knife to eat a bowl of soup). Grooming can also be difficult if the individual cannot recognize a comb and the purpose of a com Others may need to leave their employment because they are unable to recognize their work setting or carry out previously familiar productivity tasks. There can be occupational performance issues with schooling because of an inability to recognize environmental sounds, such as a school bell, for individuals with nonverbal auditory agnosia. In addition, those with prosopagnosia can have difficulties with recognizing faces of teachers and fellow students, which can lead to hindering of social relationships. A decrease in leisure pursuits may also occur because recognition deficits can lead to difficulty in sustaining participation in leisure activities and as a result decrease engagement in previous enjoyed activities. It is important to note that since memory skills are generally intact for individuals with agnosia, these individuals can still navigate their way around even though they are unable to recognize all the objects or sounds they encounter.

ADAPTED:

https://agnosia-ot.weebly.com

Occupational Therapy Assessments

There are currently no standardized Occupational Therapy (OT) assessments identified in the literature that exclusively assesses or screens for agnosia. However, various assessments are used in the process of diagnosing an individual with agnosia. In particular, these assessments are heavily used during neuropsychological testing as tools to rule out alternative explanations for an individual’s recognition deficits. Some of these are identified in the table in the previous webpage on Neuropsychological Testing. For example, to determine for the possibility of dementia, the Dementia Rating Scale can be used. A reason why there are limited standardized assessments is possibly because of the rare nature of agnosia. Agnosia accounts for less than one percent of all neurological patients (Zihl & Kennard, 1996), which means that there is a small number of cases that can be studied. Despite no OT assessments existing that directly assesses for agnosia, there are several standardized screening assessment batteries that measures and screens visual perceptual skills. Examples include the The Rivermead Perceptual Assessment Battery (RPAB) and the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA). The following table highlights several common assessments batteries for assessing visual perception in adults. From the tables below, it is important to point out that only the Ontario Society of Occupational Therapy Perceptual Evaluation (OSOT) exclusively addresses agnosia. It lists visual agnosia as one of its six functional areas. There are two test items for the functional test area of visual agnosia: Shape Recognition and Match 9 Shapes to Form Board. Despite only the OSOT having agnosia listed as a functional area or subtest, there is no need to conclude that other assessments cannot be used to assess for visual agnosia. For example, the RPAB involves subtests that measures deficits at different levels of perceptual processing. This includes simple processing such as copying shapes and matching colours. These tasks can be used to assess for apperceptive and colour agnosias, respectively.

The Occupational Therapy Adult Perceptual Screening Test (OT-APST) is another standardized screening tool that includes exclusive testing for visual agnosia in one of its subtests. The OT-APST is a brief screening tool that enables Occupational Therapists to test for the presence of visual perception impairment. The following are general information about this assessment (Zeltzer, n.d.):

 Used with clients with stroke

 Consists of 25 items across 7 subtests: agnosia, visual relations, unilateral neglect, body scheme, apraxia, acalculia, and functional skills

 Only available in English

 Takes 20-25 minutes to administer

The subtest for agnosia has 5 items and is organized as follows (Zeltzer, n.d.):

 Colour agnosia: The client is requested to name/identify six colors in an array toevaluate color recognition skills.

 Object agnosia: The client is presented with a stapler that he/she must name and describe in terms of its use to demonstrate object recognition and naming.

 Figure-ground: The client must recognize five items in an overlapping array to demonstrate figure-ground/perceptual closure skills.

 Shape constancy: The client is presented with a mixed array of 10 shapes of varyingsizes and positioned at different angles. The client must name/point on command to four common shapes to demonstrate shape recognition ability.

 Reading-alexia: The client is asked to read a passage of text that has indentations of random lengths on both sides of the page to be sensitive to attention/neglect changes to both the left and right side of space.

ADAPTED :

http://strokengine.ca/assess/module_otapst_quick-en.html

Aphasia VS Agnosia

Agnosia is not a speech or language disorder per se. However, agnosia may affect a person’s ability to recognize speech or name objects and thus present with some similarities to Wernicke’s aphasia or anomia. Auditory agnosia, for example, is characterized with difficulty to distinguish speech from non-speech sounds even though hearing is normal. Persons with Wernicke’s aphasia also have troubles understanding speech but the underlying causes are different from those in agnosia and usually they recognize speech sounds as such (see Wernicke’s aphasia). In visual agnosia, patients cannot recognize objects. However, in anomia patients recognize the object but can’t recall its name. Neither anomia nor agnosia is a problem of memory.

ADAPTED :

1. https://healthjade.com/aphasia/

Alexia

A

An acquired condition, usually as a result of brain damage (such as follows strokes in adults),marked by an impairment in reading, in which reasonable vision, intelligence, and most language functions other than reading remain intact. apperceptive agnosia A form of visualagnosia in which a person cannot reliably name, match, or discriminate visually presentedobjects, despite adequate elementary visual function (visual fields, acuity, and color vision).associative agnosia A form of visual agnosia in which a person cannot use the derivedperceptual representation to access stored knowledge of the object’s functions and associations but is able to opy and match the drawing even though unable to identify it. Balint’s syndrome. Agnosic syndrome that results from large bilateral parietal lesions and is composed of three deficits: (i) paralysis of eye fixation with inability to look voluntarily into the peripheral visual field, (ii) optic ataxia, and (iii) disturbance of visual attention such that there is neglect of the peripheral field. dorsal simultanagnosia An inability to detect more than one object at a time, with difficulty shifting attention from one object to another. dorsal stream The stream of cortical visual projections from primary visual cortex to posterior parietal cortex, concerned primarily with the visual control of action and representation of spatial information inferotemporal cortex. Inferior surface of the temporal lobe that is particularly important for object recognition. Klu¨ver–Bucy syndrome Agroup of impairments, including visual agnosia, resulting from bilateral damage to the temporal lobes. optic aphasia A condition in which a person cannot name a visually presented object, despite being able to indicate the identity of the object through gesture and to sort the visual stimuli into categories. prosopagnosia A form of visual agnosia in which a person cannot recognize faces, despite adequate elementary visual function (visual fields, acuity, and color vision). ventral simultanagnosia A reduction in the ability to rapidly recognize multiple visual stimuli, such that recognition proceeds in a part-by-part fashion ventral stream The stream of cortical visual projections from primary visual cortex to the inferotemporal cortex, concerned primarily with representing the identity of stimuli by such characteristics as shape and color.

ADAPTED :

https://slideplayer.com/slide/5155204/

Tactile Agnosia

Tactile or somatosensory agnosia refers to the inability to recognize an object through touch despite the physical ability to manipulate the object.

Individuals with tactile agnosia can still perceive an object’s tactile characteristics such as its weight and texture, but unable to name or comprehend the significance of the object.Yet you may be unable to understand the significance or the use of the object. Lesions in the parietal lobe of the brain are the cause of tactile agnosia.

I) Apperceptive tactile agnosia refers to the ability to distinguish tactile characteristics (i.e. temperature, texture, size) but difficulty with making an association with the tactile characteristics and a perceptual representation of an object. For example, an individual with apperceptive agnosia, when feeling a shoe, would be able to describe its hard sole and skinny laces but would not be able to put the descriptions together and recognize that the object is a shoe.

II) Associative tactile agnosia refers to deficits that occur when individuals cannot use the integrated tactile percepts to access their knowledge or an object (Reed, 2010). In other words, an individual with associative agnosia cannot verbally describe the characteristics of an object such as its texture or shape. However, the ability to draw objects that are tactually presented is in tact but despite this capability, individuals are unable to recognize the objects, determine if two objects felt are from the same category, or whether both objects perform the same function (Reed, 2010).

III) Astereognosis is the inability to identify objects by touch alone. This condition makes you unable to associate information about size, weight, and texture with the right words. You can still name objects by sight. You are also able to draw pictures of objects, as well as reach for them.

IV) Autotopagnosia is when you lose the ability to orient the parts of your own body. Damage to the left parietal lobe of the brain causes this condition. You are aware of where your limbs are in space at all times, even with closed eyes. But this awareness gets distorted when the brain’s internal representation of the body is damaged.

ADAPTED:

1. https://agnosia-ot.weebly.com
2. https://www.healthline.com/symptom/agnosia

The Journey Begins

Thanks for joining me!

Good company in a journey makes the way seem shorter. — Izaak Walton

Auditory Agnosia

Auditory Agnosia is also know as pure word deafness. It’s the inability to recognize or process spoken words or environmental sounds despite intact hearing. It develops when the A1 sound-processing region of the brain is disconnected from its language centers. The individual can still read, write, and speak with pure word deafness. He/she can still have the ability to detect and make simple judgments about sounds but they are unable to identify the sources of the sounds. For instance, upon hearing an explosion, an individual with auditory agnosia may describe it as a loud sound but wouldn’t be able to recognize it as an explosion.

Individuals with auditory agnosia have adequate elementary sensory processing — including hearing .

Types of Auditory Agnosia

There are many types of auditory agnosia: Apperceptive Auditory Agnosia, Associative Auditory Agnosia,
Phonagnosia, Auditory Sound Agnosia,  Verbal Information Agnosia,
Cortical Deafness and Amusia.

I) Apperceptive Auditory Agnosia is the individual is unable to repeat a word or imitate a sound (auditory).

II) Associative Auditory Agnosia is the individual is able to repeat a word or imitate a sound normally but will not be able to match different examples of sounds. For example, an individual wouldn’t be able to match 2 different doorbell sounds, 2 different baby cries, or a man and woman saying the same words.

III) Phonagnosia

Phonagnosia is the inability to recognize and identify familiar voices. It develops when the brain suffers damage to certain part of the sound association region. This region is located in the right half of the brain. The individual still can understand words spoken by others if he/ she has phonagnosia. He/she can also recognize environmental sounds or sounds made by objects.

IV) Auditory Sound Agnosia- Inability to identify non-verbal sounds.

V) Non-verbal Auditory Agnosia- Inability to recognize environmental sounds

VI) Pure Word Deafness/Verbal Information Agnosia- Inability to comprehend spoken language.

VII) Cortical Deafness- Loss of awareness of sound. In severe condition, an individual may appear to be deaf.

VIII) Amusia/ReceptiveAgnosia/Sensory Agnosia- Inability to express and perceive music. An individual also loss the ability to sing, hum or whistle and provide recognition or emotional response to music.

ADAPTED:

1. https://agnosia-ot.weebly.com
2. https://www.healthline.com/symptom/agnosia

Deep Understanding of Agnosia

Classes of Agnosia

Agnosia can be divided into 2 classes: Apperceptive and Associative.

Apperceptive Agnosia is a failure in recognition due to deficits in early stages of perceptual processing. Apperceptive agnosia patients can’t draw, match or copy objects.

Associative Agnosia is a failure in recognition although there is no deficit in perception. Associative agnosia patients can draw, match or copy objects.

Types of Agnosia

We are going to discussed the 3 main types of agnosia: Visual, Auditory, and Tactile.

VISUAL AGNOSIA

Visual agnosia occurs when there is brain damage along the pathways that connect the occipital lobe of the brain with the parietal and temporal lobes. The occipital lobe assembles incoming visual information and the parietal and temporal lobes allow he/she to understand the meaning of the information.

Visual agnosia refers to the inability to recognize familiar objects and faces in the context of preserved vision functions (i.e. visual acuity, visual field). Visual agnosia can be classified into:-

I)Apperceptive Visual Agnosia 

II)AssociativeVisual Agnosia 

I) Apperceptive Visual Agnosia is usually caused by lesions to the parietal or temporal lobes on both sides of the brain. Apperceptive visual agnosia  is the inability to reliable name, match or discriminate visually presented objects, despite adequate function. For example, an individual with apperceptive agnosia  is unable to copy and match a drawing of an object but able to verbally identify the object. When he/she tries to copy a picture of a circle and he will end up drawing a series of concentric scribbles.

Apperceptive Visual Agnosia

Apperceptive Visual Agnosia
Unable to copy and match a drawing of an object.

II) Associative Visual Agnosia is the inability to use derived perceptual representation to access stored information of the object’s functions and associations. Individual with associative visual agnosia is able to use the object, copy and match drawing of an object but unable to identify and name it. However, although those with associative agnosia may be able to copy a drawing with details, but they do so without being informed by the stored knowledge of the stimulus. In other words, if he is given a copy of distorted drawing, he will include the distortion in their drawing without being aware of the error.

Associative Visual Agnosia 
–Able to copy and match drawing of an object but unable to identify and name it.

Integrative Agnosia is present in the individual with symptoms of both apperceptive and associative agnosia.

III) Prosopagnosia (face blindness)

Prosopagnosia is the inability to recognize faces. It is caused by issues with the fusiform face area (FFA), a specific region of the brain that recognize faces. Difficulty with facial recognition also occur in Alzheimer’s disease that happens due to brain deterioration that damages FFA region.

IV) Achromatopsia (Colour Agnosia)

Achromatopsia is the loss of colour vision due to lesions in the V4 region of the brain. It’s the inability to name colors despite able to perceive them. Colour anomia results when a lesion separates the V4 regions of the brain from the language areas.

V) Agnosic Alexia (Pure Alexia)

Pure alexia is the inability to recognize words visually. It’s not possible to read with pure alexia. The individual can still speak and write without difficulty.

VI) Akinetopsia (Motion blindness)

Akinetopsia is the inability to perceive motion. The condition cause you to see moving things and objects as a series of stills, like an object moving under a strobe light. If the condition is severe, you may not be able to see any motion at all.

VII) Simultanagnosia

Simultanagnosia is the inability to perceive overall meaning of a whole image or shape, despite ability to recognize individual details or elements.

ADAPTED:

1. https://agnosia-ot.weebly.com
2. https://www.healthline.com/symptom/agnosia

Agnosia

Brief Idea of Agnosia

What is Agnosia?

 

Agnosia is a rare neurological condition that targets recognition and identification of objects and/or persons. It is characterized by an inability to know, name, identify, and extract meaning from visual, auditory, or tactile impressions.Despite being able to see, hear, speak, and think normally, a person with agnosia cannot recognize something or someone he or she once knew. The loss of the ability to recognize cannot be explained by a generalized loss of knowledge or inadequate attention to the task. Agnosia is not due to memory loss.

Symptoms of agnosia may varies according to the area of brain that is affected. It is only limited to only one sensory modality, for example, visual or hearing or tactile. For instance, an individual with visual agnosia would not be able to visually recognize an object when asked to name it despite able to describe its visual characteristics (e.g. shape, colour). Another example, the auditory agnosia. He/she is not being able to identify whether a presented sound is a “cough”. Subsequently, if an individual is provided with the correct answer and then presented the stimulus again after an extend period of time, he/she with agnosia would still be unable to correctly identify the stimulus.

ADAPTED:

1. https://agnosia-ot.weebly.com
2. https://rarediseases.info.nih.gov/diseases/8/agnosia

CAUSES OF AGNOSIA

Agnosia can cause by strokes, traumatic brain injury (TBI), dementia, a tumor in the brain, developmental disorders, encephalitis, anoxia, overexposure to environmental toxins (e.g. carbon monoxide poisoning) and other neurological conditions. Agnosia can also be a result of degeneration of parts of the brain that are involved in the integration of experience, perception, and memory.

Agnosia occurs due to sensory perception of a perceived stimuli is disconnected from memories with the perceived stimuli. This means there is no deficit to memory but there is a disruption in the pathway that processes specific stimuli. In another words, he/she with agnosia can perceive a stimulus without its meaning associated.

Causes of agnosia result in damage to different regions of the cerebrum that integrates perceptions, memory and recognition. As a consequence, symptoms of agnosia develop due to the inability to retrieve information from those damaged areas of cerebrum. Individual with agnosia may retain their cognitive abilities in other areas. For example, people with visual agnosia can’t name an object when shown a picture of the object. However, he/she can immediately recognize the object if he/she can touch or hear a description of the object’s appearance. Besides, individual with tactile agnosia would not be able to recognize the same object with touch but can immediately name it if he/she sees the object.

ADAPTED:

1. https://agnosia-ot.weebly.com
2. https://rarediseases.info.nih.gov/diseases/8/agnosia