Slide 1
(Wait for the cartoon character to appear)
Slide 2
My job is to speak on the diagnosis, treatment and rehabilitation and the pognosis of Anosognosia.
Questionnaires and diagnostic methods insuffiecient
Slide 3
Let us talk about the assessment of insight and awareness.
Slide 4
Assessment is a problem as results depend on what the patients says. There is no yardstick by which the doctor can assess.
Slide 5
I have displayed a few assessment techniques that are practised even though the system may not lead to perfect conclusions.
Self
The patient himself can give you certain details voluntarily. You may have to select the information that is relevant to diagnosis of anosognosia or neglect. The primary condition that accompanies the anosgnosia must be assessed too. i.e. hemiplegia, hemiparesis, schizophrenia , Alzheimer’sDisease etc. By the time the patient comes to you, there is a chance that some other doctors may have seen and diagnosed the condition. You may have to just confirm.
Slide 6
Interview
You may have to ask leading questions.
Slide 7
The assesment has to cover various aspects of assessing awareness
Slide 8
Screening question asking the patient to elaborate his difficulties. Follow-up questions may also be necessary to elicit more inormation
Slide 9
Further questions that would give a picture of the emergent awareness.
Slide 10
These question give informtion on the anticipatory awareness.
Slide 11
This question will further tell you whether the patient has accepted his problem and is willing to be compliant to treatment.
Slide 12
The patient’s frame of mind and his future cooperation may be asessed.
His willingness to accept treatment and his plans to have his condition improved will further inform you about possible treatment strategies. You may plan accordingly allowing some space for his plans.
Slide 13
He will be telling you what he does presently to get over his difficulty and whose help he gets . Has he adopted a new hobby that helps him? These should give an insight into his capacity and aim of reaching success in overcoming anosgnosia .
Slide 14
He will give information as to the effectiveness of his techique and whether he appears to have responded.
Slide 15
The scroes obtained from the questions qould help to identify the extent of the anosognisia or impairment of awareness in the patient. A high score would be 0. 10 would be the low score
Slide 16
We still have to elicit more information about his primary condition. Information about previous treatment should be elicited.
Slide 17
Do cognitive problems disturb his progress? How his friends see the problem according to him is also important.
Slide 18
I shall now speak on rehabilitation. Many studies have been done on this subject.
Slide 19
Orfei et al described a hemiplegic patient as one who will not report a deficit, may overestimate their abilities and may deny that they are unable to move a paretic limb. He said that the hemiplegic patient is unable to detect or report his unawareness.
Slide 20
He suggested that there is a need for multidimensional assessment and some directions for furture research.
Slide 21
Feinberg et al studied 2 groups of patients , one with anosognosia and the other without. The relationship between hemiplegia and visuoverbal confabulation was assessed.
Slide 22
His conclusion states that verbal confabulation is an important determinant in anosgnosia.
Slide 23
Another study of his confirms a strong relationship between anosognosia for hemiplegia and confabulations the movement og the plegic limb.
Slide 24
What exactly are we trying to rehabilitate? We would be working on the anticipatory awareness, emergent awareness and intellectual awareness. Intellectual awareness would include the awareness and the understanding of the problem.
Slide 25
Approaches to rehabilitation (Read the slide)
Slide 26
Approaches to rehabiltitation explained with model
We increase anticipatory awarenes by strategy identification, practice,monitoring and feedback.
For emergent awareness we do monitoring of self and staff , get feedback and then work on attention strategy
To initiate intellectual awareness, we resort to education, feedback from self ans staff monitoring and video clipping of the patient’ responses.
Slide 27
Our education process can involve all or some of the approaches mentioned here. (read the slide.)
Slide 28
About the prognosis. Anosognosia does affect rehaibilitation or plays a role in it
Slide 29
Gialanella et al’ article “The Rehabilitative Role of Anosognosia” speaks about his study. He concluded that the presence of anosognosia worsens the rehabilitation prognosis in hemiplegic subjects who also have neglect.
Slide 30
Appelros’ study showed that both neglect and anosognosia influenced disability and prognosis
Slide 31
Hartman-Maier in a study found that anosognosia for hemiplegia has a high risk for negative functional outcome in stroke rehabilitation. appelro et al found that both neglect and anosognosia affect rehabilitation.
Slide 32 & Slide 33
(Read the conclusions)
Slide 34
Signing off.
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