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COGNITIVE AND PERCEPTUAL DEFICITS FOLLOWING BRAIN DAMAGE: THE SPECIFICITY OF SELECTION
Selection may be too specific; so, some patients have enormous difficulty dealing with more than one thing at a time. This problem can be confined to dealing with visual stimuli, where it is termed 'simultanagnosia', a problem in processing simultaneously presented stimuli. Its effect on everyday life may be profound. Thus, I.R., who suffered bilateral occipital damage appeared to behave like a blind man despite the fact that his visual acuity was normal (Luria et al, 1963). When ascending a staircase (with his eyes fixed on the stair), he could not perceive a person approaching him and avoid a collision. If he was looking at a picture containing many items, he would always say that he could see only one object. When looking out of the window of a car, he was able to see one car, then a second, and then a third, but only one at a time.
The cases of L.E. and I.R. illustrate the importance of being able to select objects from our everyday environment to which we can respond in a coherent and planned way. Problems can occur either because patients are quite unselective (as a result of frontal lobe damage) or because selection is restricted to just one item (a condition which may result from occpital lobe damage). Both forms of deficit may profoundly affect normal everyday behaviour.
How may the therapist approach rehabilitation in these instances? For the over-selective patient, one approach may be to de-emphasize vision, implicating a training regimen which emphasizes the learning of verbal instructions. To ensure that a patient does not become diverted in a required task (e.g. entering the gym, selecting the appropriate plinth and getting undressed ready for treatment), the task could be divided into its component stages which the patient would be required to learn:
e.g. As I enter the gym, I look for the green plinth; I sit on the green plinth; I take off my shoes, socks and teeshirt; I lie down.
If this method is successful with the one task (and it may take some time to achieve success), then other activities may be treated in the same way.'
A different treatment strategy may prove more appropriate for the patient who is only able to select one item at a time. Improved scanning may help such patients. Therapy sessions could include exercises on scanning to the left and right of the environment initially in a predictable way ('move your eyes along the wall in front of you to the left corner, now move your eyes along the wall in front of you to the right corner'), followed by a more unpredictable sequence of commands ('move your eyes to the left until they reach the green plinth, move a little further to the left until they reach the wall bars, move your eyes to the right until they reach the sink, move back to the left until they reach the left corner . . .'). Emphasizing quickness and accuracy of the actual eye movements may prevent fixation on individual objects.
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