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The purpose of my literature review is to examine the various

therapeutic intervention strategies being administered to adult and

children who have perceptual,spacial, gross and fine motor proficient

disabilities.Furthermore what approaches appear to be working in their

rehabilitation process.adults with perceptual dysfunction secondary to

brain injury often includesOccupational therapy has been one of the

main therapeutic strategies used for perceptual retraining according to

(Holzer, Strassny, Senner-Hurley & Lefkowitz, 1982; Hopkins & Smith,

1983; Prigitano, 1986; Siev Freishtat, & Zoltan, 1986; Trombly, 1983, Van

Deusen, 1988; Wahlstrom. 1983).A variety of approaches for this

retraining has been offered by various occupational therapists. Several

authors have categorized these approaches differently (Abreu & Toglis,

1987; Neistadt, 1988; Siev et al., 1986; Trombly, 1983) It appears that

amongst all of these authors only Tromblys and Neistadt go on the

common assumptions underlying different treatment approaches, and

neither of the two authors have fully explicated the assumptions

underlying the classifications.Occupational therapy treatment

techniques for perceptualdeficits fall into two categories.

Adaptive and Remedial.Adaptive, functional occupational therapy

approaches, such as the developmental.Adaptive skills, occupational

behavior, and rehabilitation treatment paradigms (Hopkins & Smith,

1983),promote adaptation of and to the environment to capitalize on

the clients inherent strengths and situational advantages. These

approaches provide training not in the perceptual skills of functional

behavior but in the activity of daily living behaviors themselves.

On the other hand remedial approaches, such as perceptual

motor training (Abreu, 1985), sensory integration(Ayres, 1972)and

neurodevelopmentaltreatment (Bobath, 1978) seek to promote the

recovery or reorganization of impaired central nervous system

functions, specifically.Whereas sensory integration techniques address

the sensory processing upon which perceptual discriminations are

based. Sensory integration was not developed


for clients with frank

brain lesions and so they are not applicable, in its entirety, to this

population.But some sensory integration techniques.However can be

used cautiously withSome adults with brain injury (Fisher, 1989).

Neurodevelopmental treatment deals withproprioceptive and Kinesthetic

perceptious as they relate to functional movement patterns. These

approaches provide training in the perceptual processing components of

functional behavior withperceptual drills or specific sequences of


These are the common assumptions underlying the adaptive and

remedial treatments used currently.Occupational therapys perceptual

retraining literature includes description of both adaptive and remedial

approaches. (Siev et al. 1986), for

example four perceptual treatment Approaches for adults:

A) Sensory integration

B) Transfer of training

C) Functional training and

D) Neurodevelopmental.

Three of these approachessensory integration, transfer of training,

and neurodevelopmental canbe classifiedasremedialbecausetheir

underlying assumptionsmatchtheremedialassumptionoutlined

previouslysuchasthe retrainingsequences.

Inthe sensory integration and neurodevelopmentalapproaches,

the therapist provides controlledvestibular,tactile,proprioceptive,and

kenestheticstimulation to promotenormalcentralnervoussystem

processing of sensory information. Theoretically, because perceptual

motor behaviors are performed in response to the nervous systems

interpretation of sensory inputs, normal sensory processing should help

the client to make more normalperceptualmotor responses.In the

transfer of training approach, therapists have been known to use such

activities like puzzles and pegboards to provide practice in the

perceptualskills judged to be needed for those activities. The client

practices those skills that have been impaired by their brain injury.

Improvement in deficit skills is assumed to transfer the other activities

requiring that skill.Authors have stated that because all tasks require

the use of more than one perceptual skill, it is difficult to know

exactly which skills a client is actuall

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using to accomplish functional

activities. The expectation of improvement and transfer of skills

implies that tasks used in this approach force the brain repair or

recognize itself to effect a successful behavioral response to the


The functional approach could be classified as adaptive, because

its underlying assumptionmatchthe adaptive assumption.In the

functional approach, perceptual retraining is included in areas of daily

living training .Clients are taught, in the process of such training,

how to compensate for whatever perceptual deficits they may have by

changing theirapproaches to functional tasks to take maximum

advantage of intactperceptual skills.

Authors (Klonoff, H. Clark, & Kloproff. PS 1993) described a

cognitive rehabilatation model that views perception from an

information processing perspective.This model can be classified as

remedial because its assumption matches the remedial assumption.In

this model, the perceptual process involves:

A) Sensory detection

B) Analysis

C) Hypothesis formation, that is comparing the analysis with prior experiences and relating it

To the overall purpose and goal of the activity;

D) Response.

Responses can be data driven, which are direct responses to external stimuli

or conceptually driven, which proceed from external expectations of

incoming data.

Treatment in the cognitive rehabilitation model is designed to

ameliorate deficiencies along thecontinuum of the perceptual system.

(Abreu & Toglia, 1987, p. 493)by emphasizing the cognitive strategies

that underlie the performance of a variety of tasks in different

environments with differentbody positions and active movement

patterns.Strategies are defined as organized sets of rules that operate

to select and guide the ability to process information.Treatment

strategies include having clients planahead, control their speed of

response, check their work, and scan from left to right. These strategies

can be brought about and emphasized with computer games, gross

motor tasks, group activities, games and crafts.The ultimate goal of

this treatment is to improve the clients ability to handle increasing

amounts of information by developing efficient mental strategies and

an efficient behavioral repertiore. This model,then seeks to stimulate

improvements in the central nervous systems perceptualprocessing


In light of all the strategies that have been mentioned,(Abreu and

Toglia 1987) also discusssed other treatment approaches for adults with

perceptual deficits. They named these the functional, sensory

integration, and perceptual motor training approaches. The catergorization

correspondes to Siev at al,s (1986) functional training, sensory

integration, and transfer oftraining categories, respectively.

Trombly (1983) discussed neurophysiological and compensatory

approaches to perceptual retraining,which correspond to remedial and

adaptive approaches, respectively.

In the neurophysiological category,Trombly listed such techniques as

sensory retraining and visual scanning training.Also under

compensatory education, she listed backward training for specific

functional activities and structuring of the environment as techniques.

Wahlstrom ( 1983) recommended a perceptual retraining program

of sensory integration,positioning according to neurodeveloponental

treatment principles, and perceptual retraining with puzzles, pegboards

and games for all clients with head injury, except those experiencing

confusion. For confused clients, Wahlstrom recommended a functional

approach of self-care training to address perceptual deficits. Wahlstrom

earlier recommendation is clearly Remedial; and the latter one is


One of the last strategies I would like to mention is known at

the Constructional Deficit Approach.Constructional skill is the ability

to articulate parts into a single entity or object (Benton, 1979).This

skill is considered essential in drawing, both

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