Wednesday, March 4, 2009

Frontal lobe dysfunction

Recently i have worked with a patient who had difficulty organizing herself ? problems with initiation, and severe short term memory impairment.

I linked this all to frontal lobe damage and found a wonderful website (link below)

I am particularly interested in motor planning and the dysfunction of dyspraxia.

Dyspraxia is the inability of the brain to conceive, organize and carry out a sequence of events. In particular the inability to self organise.

During my assessments with this patient i noticed that the ability to organize was difficult.
For example i asked her to get her things ready for the shower. She went over to find her clothes and could not organize this and required verbal prompting. She was searching though her clothes but was unable to pick and choose the clothes she needed. She also required verbal prompting to organise her toiletries and get herself off to the bathroom. I think she would have taken all day with out prompting and don't know if she would have been successful after that.

Initially i thought it may have been difficult for her to choose the clothes - she had an idea of what she needed (she said i need a singlet, and knickers) but was unable to search - she may have had a plan of what she had to do but she couldn't execute this plan. She kept picking things up, putting them away and couldnt choose items of clothing.

On another occasion during a kitchen assessment i asked her to make a cup of tea. Everything was all organized for her and this was alot easier - everything was laid out in front of her and i introduced her to the environment. However this time i had some concerns as she was troubled with interacting purposefully with the environment. E.g. she picked up the jog to pour tea into the cup but didnt realise that she was ment to pick up the teapot that she had been waiting for.
This could have been memory - but i thought it was more to do with noticing environmental cues.

I would be interested in talking about these cues and my hypothesis further in supervision more to make sure i have got to grips with what a deficit in motor planning looks like, and to discuss other "obvious" observations that could arise in the future.

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