Making sense of the senses The Walton Centre For Neurology and Neurosurgery NHS Foundation Trust Making sense of the senses Professor Gus A Baker Tribune Neuropsychology Services

Sight Sound Smell Taste Touch

What can go wrong [when the senses go wrong] Agnosia Dysgraphia Anomia Alexia Aphasia Cortical blindness Dysarthria Tinnitus Ageusia Acalculia Anosmia Abulia

What do these mean Agnosia Inability to recognise and intepret objects Dysgraphia Inability in writing Anomia Inability to name objects Alexia Inability to read due to lesion Aphasia Impairment in language Cortical blindness Apparent lack of vision Dysarthria Impaired production of speech Ageusia Impaired sense of taste Acalculia Inability to calculate Anosmia Loss of sense of smell Abulia - Loss of will and decision-making ability

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Frontal and Pre-frontal Cortex

Executive Functioning Regulation and control of cognitive processes and behaviour Attention Self-monitoring Goal formation Planning Goal directed action Response inhibition Coordination of complex cognition

Behavioural Aspects Disinhibition Apathy Failure to appreciate the impact of their behaviour upon others Abulia [loss of will and decision making] “Le belle indifference”

Effects on day-to day Behaviour Impulsivity Aggressive behaviour Individual Disorganised Hyperactivity Self-control

Case of AJ Cerebral hypoxia Could not encode new information Could not learn new skills Repeated himself Asked about mars bars

Assessment of higher executive functioning Range of measures Tests of crystalised intelligence Tests of fluid intelligence Tests of memory Tests of verbal fluency Tests of Colour Word Interference Questionnaires Clinical observation Family observation

Tests of Colour Word Interference

Rehabilitation Assessment by an MDT team Intervention based on identified deficits Rehab strategies CBT Environmental Structure Family education Psychiatric and neuropsychological support

Summary The brain is complex We only appreciate its complexity when it goes wrong The effects of a brain injury can range from subtle to very severe In severe cases an MDT team is essential Even in subtle cases people and their families may need support

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