CERTIFIED STROKE REHABILITATION
SPECIALIST (CSRS 2025) QUESTIONS
AND PROVEN OPTIONS
Extra personal Neglect ANSW✅✅Failure to orient to objects in far space
-neglects half of space beyond arm's reach
-behaviours occurring in a large or far space (e.g large table, hallway, shopping area)
-Pt collides into surrounding, bruises discoloration, and/or ripped fray clothing on the contralateral
UE/LE
-Often misdiagnosed as clumsiness, and/or inability to guard hemiparalysis limb from surrounding
objects
Peri personal Neglect ANSW✅✅Neglects half of space within an arm's length
(MOST COMMON)
-behaviours occur in near person space
-"clock drawing test)
-ignores food on one-side of the plate, one side of the page, one side of the clock
-THIS IS THE ONE THAT WE TEND TO MEASURE
Personal Neglect ANSW✅✅Patient attends to only one side of his/her own body during ADLs
-shaving, brushing hair, applying makeup, cleaning the side of the body on the same side as the
lesion, and ignoring the side of the body contralateral to the side of the brain lesion.
failure to direct attention, affecting the awareness of one's own body parts; unilateral lack of
awareness of sensory stimuli, personal hygiene and grooming, movement of the limbs
Object Centered Neglect ANSW✅✅Patient can perceive both the R/L side of the body &
perceptual field
HOWEVER: Individual object placed on the (L) side if the patient has (L) neglect are only perceived as
1/2 their. (e.g. patient ignores left side of a cup even when it is place on the right side of his/her
body; omits text that is on the contralateral side of lesion)
: Half the drawing
,Extinction (NEGLECT) ANSW✅✅Patient can attend to stimuli coming into the visual field from
either side of the body
HOWEVER
when stimuli comes from both sides of the body SIMULATANEOUSLY, (e.g cup place in both hands)
pt will only attend to IPSILESIONAL stimulus (thus extinguishing the contralateral stimulus" (L hand
will fade away while R hand still holds cup in tack)
Differential Diagnosis : Neglect vs Homonymous Hemianopsia ANSW✅✅Client with Neglect:
CANNOT GO PAST MIDLINE
-Turning head contralesionally causes inability to see stimulus
-client may not demonstrate insight into visual loss
-will not scan during clinical test (everything is fine)
Client with HOMO-Hemianopsia
-Turning head contralesionally they can see stimulus on the wall of in front of them
-client demonstrates insight into visual loss
-can scan and perform clinical test (will attempt to actively compensate
Assessment of NEGLECT
THINGS TO CONSIDER ANSW✅✅-Make sure that your assessment is catching multiple domains (
use good assessments)
-Make sure you are insightful if patient has other deficits (e.g global aphasia "DOES THE PATIENT
UNDERSTAND THE TASK)
-Look for poor eye contact, failure to care for one-side of the body and not the other, does patient
drop things on one side
BEST SCALE/ WIDELY USED
-Catherine Bergago SCALE: all the task are imbedded in functional activities 10-item checklist (assess
performance of different daily activities rather than using test situation) (can understand level of
neglect mild, moderate severe)
-Personal Neglect Test (e.g bathing, shaving, combing hair)
-Paper-Pencil Test: Line bisection test, Reading on a text on the (L), Line crossing subtest, Star
cancellation test
,-Extrapersonal Test of Neglect: Point to objects
Interventions for Neglect ANSW✅✅Simple/Strategies
Compensatory Strategies
-Modifying the environment or task (colored tape, blinking LED lights)
-Give the patient feedback
-Mental Imagery
-Providing Therapy (behavioral therapy) kitchen timer set at short intervals (complete task in ignored
field)/ Limb activation Training EBRSR
Restorative Strategies
-Medications
-Special techniques: glasses, brain stimulation
Awareness Training: Neglect ANSW✅✅Grading or shaping the patient awareness of non-intact
perceptual field (start big /end small) and have person work across the midline
GOAL: Build INSIGHT into deficits
- (lighthouse sweep across) scanning
-flash cards
-cueing grading (min, mod, max)
-create a map of the room
-anchors (stickers/ paper scan space and find)
2nd strategy TENS 15 min electrodes placed on the posterolateral aspect of neck (lateral to spine)
and upper trapezius on neglect side
Apraxia
(Lesson 6)
2 types of Apraxia
-Ideational Apraxia
-Ideomotor Apraxia
Damage to the praxis system: The network of structures underlying praxis is thought to include the
frontal and parietal cortex, basal ganglia, and white matter tracts containing projections between
these areas ANSW✅✅A neurological disorder characterized by the inability to perform learned
, (familiar) movements on command, even though the command is understood and there is a
willingness to perform the movement. Both the desire and the capacity to move are present but the
person simply cannot execute the act.
-the inability to carry out learned, skilled motor acts despite preserved motor and sensory systems,
coordination, comprehension, and cooperation
- difficulty in executing learned movements sequences beyond limitations that could be explained be
weakness, lack of coordination, sensory deficits/loss, comprehension of deficits, memory and/or
motivation
Ideational Apraxia
Conceptual Apraxia ANSW✅✅inability to formulate an initial motor plan and sequence tasks
where the proprioceptive input necessary for movement is impaired
-A breakdown of knowledge of "what" is to be done
-Loss of mental representation about the concept required for performance
-Lack of knowledge regarding object use
-Breakdown in sequencing of an activity steps or use of objects in relation to each other
-a condition in which an individual is unable to plan movements related to interaction with objects,
because they have lost the perception of the object's purpose. Characteristics of this disorder
include a disturbance in the concept of the sequential organization of voluntary actions
ex. dressing apraxia, tool apraxia
Ideomotor Apraxia
Motor Apraxia ANSW✅✅a condition where a person plans a movement or task, but cannot
volitionally perform it. Automatic movement may occur, however, a person cannot impose
additional movement on command
-breakdown in knowledge of "how" a task is to be done
-Loss of access to kinetic memory patterns so that purposeful movements cannot be produced or
achieved because of defective planning and sequencing of movements, even though the purpose of
task is understood
-Difficulty with motor planning in general (awkward or clumsy movements/ poor foot placement)
-Difficulty with planning movements to cross bodies midline (difficulty adjusting grasp on hair brush
when moving to other side)
- Difficulty using correct grip to conform to objects
(Using pinch grip to pick up a bottle when you should be using a cylinder grip on base)
SPECIALIST (CSRS 2025) QUESTIONS
AND PROVEN OPTIONS
Extra personal Neglect ANSW✅✅Failure to orient to objects in far space
-neglects half of space beyond arm's reach
-behaviours occurring in a large or far space (e.g large table, hallway, shopping area)
-Pt collides into surrounding, bruises discoloration, and/or ripped fray clothing on the contralateral
UE/LE
-Often misdiagnosed as clumsiness, and/or inability to guard hemiparalysis limb from surrounding
objects
Peri personal Neglect ANSW✅✅Neglects half of space within an arm's length
(MOST COMMON)
-behaviours occur in near person space
-"clock drawing test)
-ignores food on one-side of the plate, one side of the page, one side of the clock
-THIS IS THE ONE THAT WE TEND TO MEASURE
Personal Neglect ANSW✅✅Patient attends to only one side of his/her own body during ADLs
-shaving, brushing hair, applying makeup, cleaning the side of the body on the same side as the
lesion, and ignoring the side of the body contralateral to the side of the brain lesion.
failure to direct attention, affecting the awareness of one's own body parts; unilateral lack of
awareness of sensory stimuli, personal hygiene and grooming, movement of the limbs
Object Centered Neglect ANSW✅✅Patient can perceive both the R/L side of the body &
perceptual field
HOWEVER: Individual object placed on the (L) side if the patient has (L) neglect are only perceived as
1/2 their. (e.g. patient ignores left side of a cup even when it is place on the right side of his/her
body; omits text that is on the contralateral side of lesion)
: Half the drawing
,Extinction (NEGLECT) ANSW✅✅Patient can attend to stimuli coming into the visual field from
either side of the body
HOWEVER
when stimuli comes from both sides of the body SIMULATANEOUSLY, (e.g cup place in both hands)
pt will only attend to IPSILESIONAL stimulus (thus extinguishing the contralateral stimulus" (L hand
will fade away while R hand still holds cup in tack)
Differential Diagnosis : Neglect vs Homonymous Hemianopsia ANSW✅✅Client with Neglect:
CANNOT GO PAST MIDLINE
-Turning head contralesionally causes inability to see stimulus
-client may not demonstrate insight into visual loss
-will not scan during clinical test (everything is fine)
Client with HOMO-Hemianopsia
-Turning head contralesionally they can see stimulus on the wall of in front of them
-client demonstrates insight into visual loss
-can scan and perform clinical test (will attempt to actively compensate
Assessment of NEGLECT
THINGS TO CONSIDER ANSW✅✅-Make sure that your assessment is catching multiple domains (
use good assessments)
-Make sure you are insightful if patient has other deficits (e.g global aphasia "DOES THE PATIENT
UNDERSTAND THE TASK)
-Look for poor eye contact, failure to care for one-side of the body and not the other, does patient
drop things on one side
BEST SCALE/ WIDELY USED
-Catherine Bergago SCALE: all the task are imbedded in functional activities 10-item checklist (assess
performance of different daily activities rather than using test situation) (can understand level of
neglect mild, moderate severe)
-Personal Neglect Test (e.g bathing, shaving, combing hair)
-Paper-Pencil Test: Line bisection test, Reading on a text on the (L), Line crossing subtest, Star
cancellation test
,-Extrapersonal Test of Neglect: Point to objects
Interventions for Neglect ANSW✅✅Simple/Strategies
Compensatory Strategies
-Modifying the environment or task (colored tape, blinking LED lights)
-Give the patient feedback
-Mental Imagery
-Providing Therapy (behavioral therapy) kitchen timer set at short intervals (complete task in ignored
field)/ Limb activation Training EBRSR
Restorative Strategies
-Medications
-Special techniques: glasses, brain stimulation
Awareness Training: Neglect ANSW✅✅Grading or shaping the patient awareness of non-intact
perceptual field (start big /end small) and have person work across the midline
GOAL: Build INSIGHT into deficits
- (lighthouse sweep across) scanning
-flash cards
-cueing grading (min, mod, max)
-create a map of the room
-anchors (stickers/ paper scan space and find)
2nd strategy TENS 15 min electrodes placed on the posterolateral aspect of neck (lateral to spine)
and upper trapezius on neglect side
Apraxia
(Lesson 6)
2 types of Apraxia
-Ideational Apraxia
-Ideomotor Apraxia
Damage to the praxis system: The network of structures underlying praxis is thought to include the
frontal and parietal cortex, basal ganglia, and white matter tracts containing projections between
these areas ANSW✅✅A neurological disorder characterized by the inability to perform learned
, (familiar) movements on command, even though the command is understood and there is a
willingness to perform the movement. Both the desire and the capacity to move are present but the
person simply cannot execute the act.
-the inability to carry out learned, skilled motor acts despite preserved motor and sensory systems,
coordination, comprehension, and cooperation
- difficulty in executing learned movements sequences beyond limitations that could be explained be
weakness, lack of coordination, sensory deficits/loss, comprehension of deficits, memory and/or
motivation
Ideational Apraxia
Conceptual Apraxia ANSW✅✅inability to formulate an initial motor plan and sequence tasks
where the proprioceptive input necessary for movement is impaired
-A breakdown of knowledge of "what" is to be done
-Loss of mental representation about the concept required for performance
-Lack of knowledge regarding object use
-Breakdown in sequencing of an activity steps or use of objects in relation to each other
-a condition in which an individual is unable to plan movements related to interaction with objects,
because they have lost the perception of the object's purpose. Characteristics of this disorder
include a disturbance in the concept of the sequential organization of voluntary actions
ex. dressing apraxia, tool apraxia
Ideomotor Apraxia
Motor Apraxia ANSW✅✅a condition where a person plans a movement or task, but cannot
volitionally perform it. Automatic movement may occur, however, a person cannot impose
additional movement on command
-breakdown in knowledge of "how" a task is to be done
-Loss of access to kinetic memory patterns so that purposeful movements cannot be produced or
achieved because of defective planning and sequencing of movements, even though the purpose of
task is understood
-Difficulty with motor planning in general (awkward or clumsy movements/ poor foot placement)
-Difficulty with planning movements to cross bodies midline (difficulty adjusting grasp on hair brush
when moving to other side)
- Difficulty using correct grip to conform to objects
(Using pinch grip to pick up a bottle when you should be using a cylinder grip on base)
