Examination of Sensory System Functions Flashcards
what is the primary sensory cortex responsible for?
ID that you are feeling something
what is the secondary sensory cortex responsible for?
ID what you are feeling
what are the sensory areas of the brain?
posterior
parietal
thalamus
are you concerned with sensory fxn on everyone w/a stroke?
yes and no
you should screen it on all, but only test when there is a concern
which sensory test/modalities do you think are a priority in individuals with a CVA?
light/fine touch
proprioception
are your priorities different for a client w/R vs L CVA?
yes
R CVA=test sensory extinction due to likely neglect
are your priorities different in acute vs chronic care?
yes
acute=more screening
chronic=more assessment
are your priorities different when you know the dx of stroke?
yes
more robust screening w/CVA for what you think might be impaired
what is the appropriate testing method for a person w/stroke or brain injury?
involved/uninvolved
distal to proximal
why do we test distal to proximal for stroke and brain injury?
bc if we test their feet and they are lacking sensation there, we don’t have to test further bc everything else up the chain will also be lacking
what do sensory testing findings tell you?
severity, assistance needs, neglect/inattention, state of what we have
what are the implications of sensory testing findings to fxn?
see what they can already do
may have to suggest routine foot checks for protective sensation
safety levels (fall risk)
how do we test static position sense (proprioception)?
with the pts eyes closed, move one limb and ask what position it is in
show bent vs straight on uninvolved limb first
perform at ankle, knee, and hip
how do we test dynamic position sense (kinesthesia)?
with the pt’s eyes closed, move their uninvolved limb and have them mirror the motion on the involved limb to check for accuracy and timing of the mov’t
perform at ankle, knee, and hip
not routinely testing, but can be screened quickly
how do we test fine/light touch and cortical localization?
using a q tip, test the plantar/dorsal foot, calf/shin, and knee with the pt’s eyes closed
show what it feels like on the uninvolved limb first
ask WHERE they feel it
ask if it feels the same on both limbs
how do we test graphesthesia/stereognosis?
for graphesthesia, draw a letter or number on the palm of their hand with their eyes closed and see if they can ID it
for stereognosis, place an object in their hand with their eyes closed and see if they can ID it
how do we test sharp/dull?
with a q tip and a toothpick
when is sensory extinction tested?
when a pt has had a R CVA (L hemi) and they have neglect
how do we test sensory extinction?
using a q tip with the pts eyes closed, test the R/L separately then do both at the same time and ask them where they feel it
what is part of sensory screening?
static position sense
fine(light) touch
what is part of the sensory examination?
static position sense
dynamic position sense
fine (light) touch with cortical localization
sharp/dull
graphesthesia/stereognosis
sensory extinction
what is the incidence of contraversive pushing?
10%
what does pusher syndrome result from?
R hemisphere stroke
posterior thalamic lesion of the R/L with impaired subjective postural vertical (graviception)
what are the 3 clinical signs of pusher syndrome?
1) spontaneous body tilting towards the more effected side (generally 20 degrees)
2) abd and ext of less effected side
3) resistance to passive correction of the tilted posture
what can we do to intervene with Pusher syndrome?
put the pt against a wall on their unaffected side and tell them to push their shoulder into the wall (or into you sitting next to them)
put the pt in front of a mirror w/a vertical piece of tape and have them line up their nose with it
take out the extremities
what does damage to the parietotemporal junction result in?
neglect
the parietotemporal junction is the equivalent to what structure?
Wernicke’s area
what is hemisensory neglect?
+/- visual orientation right
varying degrees of severity
deficit in sensation on the left (sensory absent, sensory impaired, sensory extinction)
what sensory testing is done for hemisensory neglect?
sensory extinction
what are the risks with hemisensory neglect?
hand/arm injury
what is hemispatial neglect?
++ visual orientation right
varying degrees of severity
ignores the left hemispace
poor geolocation/navigation
what are the risks of hemispatial neglect?
running into objects, people, doors on the left
WC use initially can be dangerous
t/f: pts w/pusher syndrome were found to be more severely impaired in level of consciousness, paresis of UE/LE, gait, and ADLs on admission to rehab
true
t/f: gains in ADL fxn and d/c rate to nursing home differ from hemiparetic pts w/o pusher syndrome vs those with pusher syndrome
false they don’t differ
t/f: at 6 months post stroke, pusher syndrome symptoms tend to be close to completely resolved.
true
how much longer do pusher pts tend to take to rehab than other CVA pts?
about 63% longer (3-4 weeks)
what factors adversely affect rate of recovery with pusher syndrome?
side of the lesion, # of key motor, proprioceptive, and/or hemianoptic or visual-spatial deficits
t/f: pts with 2-3 additional key postural control deficits and R brain lesions need longer
true
what is the risk with pusher syndrome?
high risk for falls
what are the treatment guidelines for pusher syndrome?
1) augment the VIS system by providing strong vertical input
2) augment SOM-proprioceptive system input by providing heavy SOM input (wall or body)
3) avoid/prevent elbow extension on the uninvolved limb (use of a pole/ball)
4) provide specific verbal feedback (pt will respond better to “lean towards the wall” than to stand upright)
5) use a problem solving strategy (involve pt verbally and visually to ID their push and reduce it like “is your nose in line with that tape?”)
6) guaranteed if pushing in sitting is bad, standing will be much worse so take it slow
7) CLOSE GUARDING IS KEY
what strong visual and somatosensory cues can be used for pushers?
lined mirrors, pics, grids, force plates, or other forms of visual biofeedback to maximize intrinsic learning
when in sitting, how should a pusher sit?
with the uninvolved side in contact with the therapist or wall
when in standing, how should a pusher stand and walk?
using a wall for heavy input to the uninvolved side in transfer and gait training
progress to a raised table
what needs to be established first in stability with pushers?
maintanance of midline orientation in sitting
after a pt has achieved midline orientation in sitting, what is the progression?
shift to the less effected side and to midline
shift to the effected side and to midline
progress to AP weight shifts, weight acceptance, and sit to stand
