CVA Examination Flashcards
What is the prupose of a sensory screen?
Identifies need for further investigation
What is the purpose of a sensroy exam?
Involves testing sensory integrity by determining the patient’s ability to interpret and discriminate among incoming sensory information
Where are sensory receptors located?
In the distal end of an afferent nerve fiber
What do sensory receptors give rise to?
Give rise to the perception of a specific sensation once stimulated
What are the 3 divisions included in sensory receptors?
-Superficial sensation
-Deep sensations
-Combined (cortical) sensations
What are the types of sensory receptors?
-Mechanoreceptors
-Thermoreceptors
-Nociceptors
-Chemoreceptors
-Photic (electromagnetic)
-Cutaneous receptors
-Deep sensory receptors
What are mechanoreceptors?
Respond to mechanical deformation of the receptor or surrounding area
What are thermoreceptors?
Respond to changes in temperature
What are nociceptors?
Respond to noxious stimuli and result in the perception of pain
What are chemoreceptors?
Respond to chemical substances
What are photic (electromagnetic)?
Responds to light within the visible spectrum
What are cutaneous receptors?
Located at the terminal portion of the afferent fiber
Where are deep sensory receptors located?
Located in muscles, tendons, and joints
How are sensory signals carried?
Via the ascending pathways
How does information enter the spinal cord?
Through the dorsal roots
What are the three major tracts of the spinothalamic system?
-Anterior
-Lateral
-Spinoretlicular tract
What is the route for the anterolateral spinothalamic system?
Dorsal roots > immediate crossing to ascend the spinal cord through the medulla, pons, and midbrain > VPL of the thalamus > projections are sent to the somatosensory cortex via the internal capsule
What is the transmission of thermal and nociceptive information in the anterolateral spinothalamic system?
Pain modulation, temperature, crudely localized touch, tickle, itch, and sexual sensations
What type of information does the anterolateral spinothalamic tract carry?
Pain and temperature
What is the route for the dorsal column-medial lemniscal system?
Enter through the dorsal column > ascend to the medulla and synapse with dorsal column nuclei (nuclei gracilis and cuneatus) > cross to the opposite side and pass up to the thalamus (via medial lemniscus) to the VPL > somatosensory cortex
What sensation does the dorsal column-medial lemniscal system mediate?
Discriminative touch and pressure sensations, vibration movement, position sense, and awareness of joints at rest
What type of information does the dorsal column-medial lemniscal system carry?
Carry discriminative sensations such as kinesthesia and touch
What are the 3 parts that the somatosensory cortex is divided into?
-Primary somatosensory cortex (post central gyrus)
-Secondary somatosensory cortex
-Posterior parietal cortex
What is responsible for superficial sensations?
Exteroceptors
What are exteroceptors?
Information is received from the external environment via the skin and subcutaneous tissue
What are the 3 types of superficial sensation?
Pain perception
Temperature awareness
Touch awareness
What is responsible for deep sensation?
Proprioceptors
Where do proprioceptors receive stimuli from?
Muscles
Tendons
Ligaments
Joints
Fascia
What are proprioceptors responsible for?
Position sense
What are the 3 types of deep sensations?
Kinesthesia awareness
Proprioceptive awareness
Vibration perception
What is combined cortical sensation?
Information comes from both exteroceptive and proprioceptive receptors as well as intact function of cortical sensory association areas in the brain
What are the different types of combined cortical sensations?
Sterognosis perception
Tactile localization
Two-point discrimination
Double simultaneous
Graphesthesia (traced figure identification)
Recognition of texture
Barognosis
How do you test pain perception?
Sharp/dull discrimination
Radom perpendicular application of share and dull ends of a safety pin/paper clip
What is the purpose of pain perception?
Indicates function of protective sensation
How do you test temperature awareness?
Two test tubes with stoppers
Cold between 41-50˚F
Warm between 104-113˚F
Side of test tube should be placed
What is the purpose of temperature awareness?
Test the ability to distinguish between warm and cool stimuli
How do you test touch awareness?
Often a piece of cotton or tissue is used
The test area is lightly touched or stroked
What is the purpose of touch awareness?
Determines perception of tactile input
How do you test kinesthesia awareness?
The extremity/joint is moved passively through a small ROM
The patient is asked to state up, down, in, out…
What is the purpose of kinesthesia awareness test?
Examines the awareness of movement
How do you test proprioceptive awareness?
The extremity or joint is moved through the ROM and held statistically
The patient should verbally describe or demonstrate on the contralateral extremity to duplicate the position
What is the purpose of proprioceptive awareness test?
Test joint position sense and the awareness of joints at rest
How do you test vibration perception?
Requires a tuning fork
The base of the vibrating tuning fork is placed on bony prominence
Random application of vibrating and non-vibrating stimuli required
Auditory cues can reduce the accuracy
Pt is asked to verbally identify if the stimulus is vibrating or non-vibrating
How do you test the stereognosis perception?
Items used should be small, easily obtainable and familiar
Items are different in size
Item in place in patients hand and they have to identify the object
What is the purpose of stereognosis perception test?
Test determines the ability to recognize the form of objects by touch
How do you test tactile localization?
Pt is asked to identify specific point of application of touch stimulus
Test is often combined with pressure perception or touch awareness
Use a cotton swab for the test
Pt is asked to verbalize description of the location of stimulus
What is the purpose of tactile localization test?
Test determines the ability to localize touch sensation on the skin
How do you test two point discrimination?
Results can be negatively influenced by fatigue
Pt is asked to identify the perception of one stimulus vs two stimuli
What is the purpose of two point discrimination test?
Test determines the ability to perceive two points applied to the skin simultaneously
How do you test double simultaneous stimulation?
Therapist simultaneously touches identical locations on opposite sides of the body, proximally and distally on opposite sides of the body
Proximal and distal locations on the same side of the body
Pt is asked to verbalize when and how many stimuli are felt
What is the purpose of double simultaneous simulation test?
Test determines the ability to perceive simultaneous touch stimuli
What is the extinction phenomenon?
Describes a situation in which only the proximal stimulus is perceived with “extinction” of the distal
How do you test graphesthesia?
A fingertip or pencil eraser are used to trace on the palm of the Pt’s hand
Between each separate drawing, the plan should be whipped with a cloth indicating changes in figure to the Pt
What is the purpose of graphesthesia?
Test determines the ability to recognize letters, numbers, designs, “written” on the skin
Why is testing graphesthesia useful?
Useful to test paralysis limits grasp of an object for stereognosis testing
How do you test recognition of texture?
Items are places within the patient’s hand and they are asked to manipulate the texture
Pt is asked to identify the individual texture as they are placed in their hand
What is the purpose of recognition of texture test?
Helps determine the ability to differentiate various textures
What type of textures would you use for the recognition of texture test?
Cotton, wool, burlap, silk…
What is the purpose of barognosis?
To determine the ability to recognize different weights
How do you test baragnosis?
The therapist may place a series of different weights in the same hand, place a different weight in each hand, or ask the patient to use a fingertip grip to pick up the weight
The patient responds by indicating if the object is heavier or lighter
What is a reflex?
Is an involuntary, predictable, and specific response to a stimulus that is dependent on an intact reflex arc (sensory receptors, afferent neurons, efferent neurons, and responding muscle or gland)
What is a muscle contraction?
Is produced as a result of stimulation of the stretch-sensitive IA afferents of neuromuscular spindle
How are reflexes tested?
Tested by tapping sharply over the muscle tendon with a standard reflex hammer or with the tips of the therapist’s finger
What are the characteristics of UMN injury?
Type of paralysis - spastic
Atrophy - no disuse atrophy
DTR - increased
Pathological reflexes - Present
Fasciculation and fibrillation - absent
What are the characteristics of LMN injury?
Type of paralysis - flaccid
Atrophy - severe atrophy
DTR - absent
Pathological reflexes - absent
Fasciculation and fibrillation - may be present
How are superficial cutaneous reflexes elicited?
With a light stroke applied to the skin
What is the expected response for a superficial cutaneous reflex?
Brief contraction of muscles innervated nut the same spinal segments receiving the afferent inputs form the cutaneous receptors
