Examination of Sensory System Functions

Question 1

what is the primary sensory cortex responsible for?

Answer 1

ID that you are feeling something

Question 2

what is the secondary sensory cortex responsible for?

Answer 2

ID what you are feeling

Question 3

what are the sensory areas of the brain?

Answer 3

posterior

parietal

thalamus

Question 4

are you concerned with sensory fxn on everyone w/a stroke?

Answer 4

yes and no

you should screen it on all, but only test when there is a concern

Question 5

which sensory test/modalities do you think are a priority in individuals with a CVA?

Answer 5

light/fine touch

proprioception

Question 6

are your priorities different for a client w/R vs L CVA?

Answer 6

yes
R CVA=test sensory extinction due to likely neglect

Question 7

are your priorities different in acute vs chronic care?

Answer 7

yes

acute=more screening
chronic=more assessment

Question 8

are your priorities different when you know the dx of stroke?

Answer 8

yes

more robust screening w/CVA for what you think might be impaired

Question 9

what is the appropriate testing method for a person w/stroke or brain injury?

Answer 9

involved/uninvolved

distal to proximal

Question 10

why do we test distal to proximal for stroke and brain injury?

Answer 10

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

Question 11

what do sensory testing findings tell you?

Answer 11

severity, assistance needs, neglect/inattention, state of what we have

Question 12

what are the implications of sensory testing findings to fxn?

Answer 12

see what they can already do

may have to suggest routine foot checks for protective sensation

safety levels (fall risk)

Question 13

how do we test static position sense (proprioception)?

Answer 13

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

Question 14

how do we test dynamic position sense (kinesthesia)?

Answer 14

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

Question 15

how do we test fine/light touch and cortical localization?

Answer 15

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

Question 16

how do we test graphesthesia/stereognosis?

Answer 16

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

Question 17

how do we test sharp/dull?

Answer 17

with a q tip and a toothpick

Question 18

when is sensory extinction tested?

Answer 18

when a pt has had a R CVA (L hemi) and they have neglect

Question 19

how do we test sensory extinction?

Answer 19

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

Question 20

what is part of sensory screening?

Answer 20

static position sense

fine(light) touch

Question 21

what is part of the sensory examination?

Answer 21

static position sense

dynamic position sense

fine (light) touch with cortical localization

sharp/dull

graphesthesia/stereognosis

sensory extinction

Question 22

what is the incidence of contraversive pushing?

Answer 22

10%

Question 23

what does pusher syndrome result from?

Answer 23

R hemisphere stroke

posterior thalamic lesion of the R/L with impaired subjective postural vertical (graviception)

Question 24

what are the 3 clinical signs of pusher syndrome?

Answer 24

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

Question 25

what can we do to intervene with Pusher syndrome?

Answer 25

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

Question 26

what does damage to the parietotemporal junction result in?

Answer 26

neglect

Question 27

the parietotemporal junction is the equivalent to what structure?

Answer 27

Wernicke’s area

Question 28

what is hemisensory neglect?

Answer 28

+/- visual orientation right

varying degrees of severity

deficit in sensation on the left (sensory absent, sensory impaired, sensory extinction)

Question 29

what sensory testing is done for hemisensory neglect?

Answer 29

sensory extinction

Question 30

what are the risks with hemisensory neglect?

Answer 30

hand/arm injury

Question 31

what is hemispatial neglect?

Answer 31

++ visual orientation right

varying degrees of severity

ignores the left hemispace

poor geolocation/navigation

Question 32

what are the risks of hemispatial neglect?

Answer 32

running into objects, people, doors on the left

WC use initially can be dangerous

Question 33

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

Answer 33

true

Question 34

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

Answer 34

false they don’t differ

Question 35

t/f: at 6 months post stroke, pusher syndrome symptoms tend to be close to completely resolved.

Answer 35

true

Question 36

how much longer do pusher pts tend to take to rehab than other CVA pts?

Answer 36

about 63% longer (3-4 weeks)

Question 37

what factors adversely affect rate of recovery with pusher syndrome?

Answer 37

side of the lesion, # of key motor, proprioceptive, and/or hemianoptic or visual-spatial deficits

Question 38

t/f: pts with 2-3 additional key postural control deficits and R brain lesions need longer

Answer 38

true

Question 39

what is the risk with pusher syndrome?

Answer 39

high risk for falls

Question 40

what are the treatment guidelines for pusher syndrome?

Answer 40

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

Question 41

what strong visual and somatosensory cues can be used for pushers?

Answer 41

lined mirrors, pics, grids, force plates, or other forms of visual biofeedback to maximize intrinsic learning

Question 42

when in sitting, how should a pusher sit?

Answer 42

with the uninvolved side in contact with the therapist or wall

Question 43

when in standing, how should a pusher stand and walk?

Answer 43

using a wall for heavy input to the uninvolved side in transfer and gait training

progress to a raised table

Question 44

what needs to be established first in stability with pushers?

Answer 44

maintanance of midline orientation in sitting

Question 45

after a pt has achieved midline orientation in sitting, what is the progression?

Answer 45

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