CVA Examination sensation and Reflexes Flashcards

Question

what are example of sensory patterns

Answer 1

*Peripheral nerve injury Ex: ulnar half of the ring finger *Peripheral neuropathy secondary to Diabetes Glove and stocking distribution *Multiple Sclerosis Unpredictable/scattered pattern *SCI Diffuse pattern below the lesion level that is typically bilateral

Answer 2

*Spinal cord tract integrity *Nerve root involvement has evidence of motor and sensory loss *CNS lesions (e.g., CVA) may result in significant sensory impairments with a diffuse pattern (e.g., head, trunk, and limbs)

Answer 3

*Sharp/dull discrimination *Indicates function of protective sensation *Random perpendicular application of sharp and dull ends of a safety pin/paper clip

Answer 4

*Test the ability to distinguish between warm and cool stimuli *Two test tubes with stoppers are required *Ideal cold temperatures are between 41-50 deg F *Ideal warm temperatures are between 104 and 113 deg F *The side of the test tube should be placed in contact with the patient’s skin in a random fashion *Difficult test to perform as the tube temperature changes rapidly when exposed to air

Answer 5

*Determines perception of tactile input *Often a piece of cotton or tissue is used *The tested area is lightly touched or stroked

Answer 6

*Examines the awareness of movement *The extremity/joint is moved passively through a small ROM *The patient is asked to state up, down, in, out, etc.

Answer 7

*Test joint position sense and the awareness of joints at rest *The extremity or joint is moved through the ROM and held statically *The patient should verbally describe or demonstratively (on the contralateral extremity) duplicate the position

Answer 8

*This test requires a turning fork that vibrates at 128 Hz *The base of the vibrating tuning fork is placed on a bony prominence *Random application of vibrating and non-vibrating stimuli is required to identify if sensation is intact or impaired *Auditory clues can reduce accuracy of test results *The patient is asked to verbally identify if the stimulus is vibrating or non-vibrating upon each contact

Answer 9

*The test determines the ability to recognize the form of objects by touch *Items used should be small, easily obtainable and culturally familiar *Items should be of differing sizes and shapes *An item is placed in the patient’s hand, he or she can manipulate the object and then verbally identify the item Test samples can be given during explanation and demonstration of the test

Answer 10

*This test determines the ability to localize touch sensation on the skin (topognosis) *The patient is asked to identify the specific point of application of a touch stimulus (e.g., tip of ring finger, medial malleolus, etc.), and not simply the perception of being touched *This test is often combined with pressure perception or touch awareness *Use of a cotton swab or fingertip is used to touch different skin surfaces The patient is asked to verbalize description of the location of the stimuli or point to the area The distance can be recorded between the application site and the site indicated by the patient

Answer 11

*This test determines the ability to perceive two points applied to the skin simultaneously *It is the measure of the smallest distance between two stimuli that can still be perceived as two distinct stimuli *Results can be negatively influenced by fatigue *Values vary for different individuals and by gender and body part -The most refined location is the distal upper extremity *To increase validity testing should occur with some application of two- and one-point stimuli *The patient is asked to identify the perception of ”one” vs. “two” stimuli Normative values do exist

Answer 12

*This test determines the ability to perceive simultaneous touch stimuli *The 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 *The extinction phenomenon is the term used to describe a situation in which only the proximal stimulus is perceived with “extinction” of the distal *The patient is asked to verbalized when and how many stimuli are felt

Answer 13

*This test determines the ability to recognize letters, numbers, designs “written” on the skin *A fingertip or pencil eraser are used to trace on the palm of the patient’s hand *An orientation of drawings should be agreed upon during the trial *Between each separate drawing, the palm should be wiped with a cloth indicating changes in figure to the patient *This can be a useful test is paralysis limits grasp of an object such as required for stereognosis testing *The patient is asked to verbally identify the figures drawn on the skin *A series of drawing can be present to a patient for pointing if language or speech impairments are present

Answer 14

*This test determines the ability to differentiate various textures *Suitable textures may include cotton, wool, burlap, silk, etc. *The items are placed within the patient’s hand and he or she is asked to manipulate the texture *The patient is asked to identify the individual texture as they are placed within the hand

Answer 15

*This test determines the ability to recognize different weights *A set of discrimination weights consisting of objects of the same size and shape but of graded weight is used *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 each weight *The patient responds by indicating if an object is “heavier” or ”lighter”

Answer 16

Learning motor behavior is dependent on the patient’s ability to take in sensory information from the body and the environment (sensory intake), process it (sensory integration), and use it to plan and organize behavior (output).”

Answer 17

*A reflex is an involuntary, predictable, and specific response to a stimulus that is dependent on an intact reflex arc (sensory receptor, afferent neurons, efferent neurons, and responding muscles or gland). *A muscle contraction is produced as a result of stimulation of the stretch-sensitive IA afferents of the neuromuscular spindle *Reflexes are tested by tapping sharpely over the muscle tendon with a standard reflex hammer or with the tips of the therapist’s finger *The muscle should be positioned in midrange and the patient should be instructed to relax

Answer 18

jaw, biceps, brachioradialis, triceps, finer flex, hamstrings quads achilles

Answer 19

0 absent no response 1+ low normal, diminished 2+ normal 3+ brisker or more reflexive than normal 4+ very brisk, hyperreflexive with clonus 5+ sustained clouns

Answer 20

*These reflexes are elicited with a light stroke applied to the skin *The expected response is a brief contraction of muscles innervated by the same spinal segments receiving the afferent inputs from the cutaneous receptors Examples: -Plantar reflex: abnormal sign would be a Babinski reflex -Abdominal reflex: an abnormal response would be a loss of a response or asymmetry -These may be absent in individuals who are obese or who have had abdominal surgery