Cognition and Sensation Flashcards
order of assessments
- arousal/attention/cognition
- vital signs
- sensation
- m. tone
- ROM
- strength
- coordination
- balance
- endurance
- function
arousal
state of being awake
attention
responsiveness to a task or concentrating on info without being distracted by other stimuli
cognition
mental action or process of acquiring knowledge and understanding through thought, experience, and the senses
measurements of arousal, attention, cognition
- Glasgow Coma Scale
- Rancho Los Amigos Levels of Cognitive Function
- Mini-Cog
- Mini-Mental State Examination (MMSE)
- Montreal Cognitive Assessment (MoCA)
- Orientation x 3-4
orientation x 3
person, place, time/date
orientation x 4
person, place, time/date + why are you here/what just happened to you?
Mini-Cog
- screen for cognitive impairment in older adults
- 3 item recall test for memory and simple scored clock drawing test
Mini-Cog scoring alogrithm
- 0 recall = abnormal
- 1-2 item recall + abnormal clock draw = abnormal
- 1-2 item recall + normal clock draw = normal
- 3 item recall = normal
Glasgow Coma Scale
- most appropriate for recent TBIs
- mostly used in ER and ICU to record initial status, monitor changes, and make prognosis
Glasgow Coma Scale scoring
measures:
- eye opening response (1-4)
- verbal response (1-5)
- motor response (1-6)
*1= bad score, higher # = good score* Severe = < 8 Moderate = 9-12 Minor = >/= 13
decorticate posture
- abnormal flexion
- UE: shoulder ADD, elbow flexion, wrist flexion
- LE: extension + PF
decerebrate posture
- abnormal extension
- UE: shoulder ADD, elbow ext, pronation, wrist flexion
- LE: ext + PF
- WORSE PROGNOSIS
Rancho Los Amigos Scale
- general progression of a TBI
- measures levels of awareness, cognition, behavior, and interaction with the environment
- in neuro rehab and hospitals, used as a guide for crafting and planning appropriate PT
- ONLY a guide! Not a definitive timeline in brain injury recovery
Rancho Los Amigos levels
Level I - no response, needs total assistance
Level II - generalized response, needs total assistance
Level III - localized response, needs total assistance
Level IV - confused-agitated response, needs max assist
Level V - confused-inappropriate response, needs moderate assistance
Level VI - confused-appropriate response, needs moderate assistance
Level VII - automatic-appropriate response, needs minimal assistance
Level VIII - purposeful-appropriate response, needs stand-by assistance
vital sign assessments
BP, HR, RPE, pulse oximetry
*test intially for baseline, at each session for medically unstable pts and pts with cardiopulmonary risk factors for response to interventions
when should you perform a sensory assessment?
beginning; hx or systems review (includes sensory screening) may indicate a pathology that may result in sensory changes
what differences will you see if the sensory loss comes from the CNS?
- usually more diffuse pattern
- sometimes unpredictable and scattered (SCI, MS)
- body region
- will not follow dermatomal pattern
what differences will you see if the sensory loss comes from the PNS?
- impairments follow distribution of involved n. and pattern of innervation
- glove/stocking distribution (diabetes)
- peripheral n. distribution pattern
- dermatomal pattern
what changes in sensation will you see in the elderly?
reduced ability to detect pain, pressure, vibration, temp., and touch
common neuro conditions that result in impaired sensation
CVA/TIA, SCI, brain tumor, MS, brain injury
when during the overall assessment should you test sensation? why?
after arousal, attention, cognition testing and before motor function testing b/c helps PT to differentiate impact of sensory impairment on motor function
when do you perform cranial n. testing?
if you suspect a lesion of brain, brainstem, or cervical spine (sensory, motor, or both)
3 division of sensory receptors
superficial
deep
combined (cortical)
superficial sensory receptors
exteroceptors - pain, temp., light touch, pressure
deep sensory receptors
proprioceptors - position sense, kinesthesia, vibration
combined (cortical) sensory receptors
both extero- and proprioceptors + intact cortical sensory association areas - stereognosis, two-point discrimination, barognosis, graphesthesia, tactile localization, texture recognition, double simultaneous stimulation
what are the pathways that connect the receptors in the brain?
anterolateral spinothalamic and dorsal column-medial lemniscal system
what type of sensation does the anterolateral spinothalamic pathway carry?
pain, temp., light touch, tickle, itch, sexual
what type of sensation does the DC-ML pathway carry?
discriminative touch, pressure, vibration, movement, proprioception
