ASSESSMENT OF HIGHER MOTOR FUNCTIONS

What are the higher motor functions.?SENSORIUMPERCEPTIONSPEECH DIFFICULTIES

Why there is a need of assessing.?

SENSORIUMThe sensorium is that place where you are

aware that you are aware.FUNCTIONRegisters current internal and external

contingenciesRelates current internal and external stimuli

to our memories and to our future hopes and desires

Invests the streams of afferent stimuli with emotion,determines their significance and assigns priority whether to attend or neglect

Proposes various actions and their consequences

Directs the motor system in the actual behaviors that achieve personal survival and satisfaction

It allows us to experience life as a conscious process with a past present and future to respond appropriately

Parts of sensoriumConsciousnessAttention spanOrientationMemoryFund of informationInsight,judgement and planning

PERCEPTIONPERCEPTUAL DISTORTIONS:-IllusionsHallucinationsDelusionsAgnosiaApraxia

AGNOSIAIt is the inability to understand the

meaning, import, or symbolic sihgnificance of ordinary sensory stimuli even though the sensory pathways and sensorium are relatively intact

Types of Agnosia

Agraphognosia(agraphesthesia)ProsopagnosiaBody scheme/body image disordersTopagnosiaAutotopagnosiaRight left disorientationLeft side hemispatial inattentionAnosognosia Inattention to double simultaneous cutaneous stimuliFinger ground discriminationForm discriminationSpatial relationsTopographic disorientationDepth and distance perceptionVertical disorientation

APRAXIAIt means the inability to perform a

voluntary act even though the motor system sensory system and mental status are relatively intact

Types of ApraxiaFace tongue apraxiaArm (ideomotor) apraxiaIdeational apraxiaConstructional apraxiaDressing apraxiaGait apraxiaGlobal apraxia in children

SPEECH DISORDERSAPHASIA:- it means the ability to

understand or express words as symbols for communication,even though the primary sensorimotor pathways to receive and express language and the mental status are relatively intact

Types of AphasiaBrocca’ aphasiaWernicke’s aphasiaGlobal aphasiaConduction aphasiaTranscortical motor aphasiaTranscortical sensory aphasia

Other speech difficultiesAphoniaDysarthriaDysphasiadysprosody

ExaminationHistoryAnalysis of dysphasiaPreliminary informationSpontaneous speechComprehensionNaming objectsRepititionReadingWritingCalculation

Level of consciousnessDrowsinessStuporComaConfusion or disorientationDeliriumCatatonia

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Test for finger agnosiaSauguet’s testFinger ground discriminationThe ayres figure ground testSpatial relations testRivermead perceptual assessment batteryArnadottir OT-ADL NEUROBEHAVIORAL

EVALUATIONFor combined apraxia agnosia and aphasia

testHalstead reitan battery for cerebral

dysfunction

References

William deyer, Technique of the neurologic examination,5th edition

John spillane, Bickerstaff’s neurological examination clinical practice, 6th edition

Susan B O’ Sullivan, Thomas J Schmitz, Physical rehabilitation, 5th edition

THANK YOU