Cognition and Sensation

Question 1

order of assessments

Answer 1

1. arousal/attention/cognition
2. vital signs
3. sensation
4. m. tone
5. ROM
6. strength
7. coordination
8. balance
9. endurance
10. function

Question 2

arousal

Answer 2

state of being awake

Question 3

attention

Answer 3

responsiveness to a task or concentrating on info without being distracted by other stimuli

Question 4

cognition

Answer 4

mental action or process of acquiring knowledge and understanding through thought, experience, and the senses

Question 5

measurements of arousal, attention, cognition

Answer 5

• 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

Question 6

orientation x 3

Answer 6

person, place, time/date

Question 7

orientation x 4

Answer 7

person, place, time/date + why are you here/what just happened to you?

Question 8

Mini-Cog

Answer 8

• screen for cognitive impairment in older adults

- 3 item recall test for memory and simple scored clock drawing test

Question 9

Mini-Cog scoring alogrithm

Answer 9

• 0 recall = abnormal
• 1-2 item recall + abnormal clock draw = abnormal
• 1-2 item recall + normal clock draw = normal
• 3 item recall = normal

Question 10

Glasgow Coma Scale

Answer 10

• most appropriate for recent TBIs

- mostly used in ER and ICU to record initial status, monitor changes, and make prognosis

Question 11

Glasgow Coma Scale scoring

Answer 11

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

Question 12

decorticate posture

Answer 12

• abnormal flexion
• UE: shoulder ADD, elbow flexion, wrist flexion
• LE: extension + PF

Question 13

decerebrate posture

Answer 13

• abnormal extension
• UE: shoulder ADD, elbow ext, pronation, wrist flexion
• LE: ext + PF
• WORSE PROGNOSIS

Question 14

Rancho Los Amigos Scale

Answer 14

• 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

Question 15

Rancho Los Amigos levels

Answer 15

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

Question 16

vital sign assessments

Answer 16

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

Question 17

when should you perform a sensory assessment?

Answer 17

beginning; hx or systems review (includes sensory screening) may indicate a pathology that may result in sensory changes

Question 18

what differences will you see if the sensory loss comes from the CNS?

Answer 18

• usually more diffuse pattern
• sometimes unpredictable and scattered (SCI, MS)
• body region
• will not follow dermatomal pattern

Question 19

what differences will you see if the sensory loss comes from the PNS?

Answer 19

• impairments follow distribution of involved n. and pattern of innervation
• glove/stocking distribution (diabetes)
• peripheral n. distribution pattern
• dermatomal pattern

Question 20

what changes in sensation will you see in the elderly?

Answer 20

reduced ability to detect pain, pressure, vibration, temp., and touch

Question 21

common neuro conditions that result in impaired sensation

Answer 21

CVA/TIA, SCI, brain tumor, MS, brain injury

Question 22

when during the overall assessment should you test sensation? why?

Answer 22

after arousal, attention, cognition testing and before motor function testing b/c helps PT to differentiate impact of sensory impairment on motor function

Question 23

when do you perform cranial n. testing?

Answer 23

if you suspect a lesion of brain, brainstem, or cervical spine (sensory, motor, or both)

Question 24

3 division of sensory receptors

Answer 24

superficial
deep
combined (cortical)

Question 25

superficial sensory receptors

Answer 25

exteroceptors - pain, temp., light touch, pressure

Question 26

deep sensory receptors

Answer 26

proprioceptors - position sense, kinesthesia, vibration

Question 27

combined (cortical) sensory receptors

Answer 27

both extero- and proprioceptors + intact cortical sensory association areas - stereognosis, two-point discrimination, barognosis, graphesthesia, tactile localization, texture recognition, double simultaneous stimulation

Question 28

what are the pathways that connect the receptors in the brain?

Answer 28

anterolateral spinothalamic and dorsal column-medial lemniscal system

Question 29

what type of sensation does the anterolateral spinothalamic pathway carry?

Answer 29

pain, temp., light touch, tickle, itch, sexual

Question 30

what type of sensation does the DC-ML pathway carry?

Answer 30

discriminative touch, pressure, vibration, movement, proprioception