Lab 7 - Sensation and Deep Reflexes Flashcards
What are 4 types of sensation testing?
- 2-point discrimination
- Tactile extinction
- Stereognosis
- Graphesthesia
How do you administer the 2-point discrimination test
Measure on the back over the inferior angle of the scapula and over the palmar surface of the distal phalanx of the little finger
eyes closed
How do you administer a test for tactile extinction
Present two simultaneous sensations to a patient touching one or both sides of their body randomly and the patient should be able to identify if one side or both sides are touched at the same time (swipe hands on forearms)
eyes closed
What happens if a person fails tactile extinction
They are declared to have perceptual deficit (parietal lobe) of tactile extinction
How do you administer stereognosis testing
- Ensure patient has motor control to manipulate objects (eg. keys, coin, paper clip) in both hands
- Ask patient to close eyes
- Present small object to patient and ask them to identify the object by feeling with hands and fingers
- Make sure to test both sides
What does a stereognosis test determine
Ensures the client has contralateral cerebral sensory cortex intact -> if not they are diagnosed as absent stereognosis
How do you administer a test for graphesthesia and when?
Use when patient cannot manipulate objects in hand (eg. stroke-hemiparesis)
1. Ask patient to close eyes
2. Tell client whether using numbers or letters
2. Ask client to identify capital letter or single digit number drawn on palm of clients hand
What does a graphesthesia test determine?
Ensures client has contralateral cerebral sensory cortex intact -> if not they are diagnosed with absent graphesthesia
When measuring for superficial sensations of pain, temperature, light touch, discriminative touch and pressure what are 2 important things you should always do?
- Determine if patient can firstly acknowledge that a sensation is present
- Determine if the quality of sensation is important by comparing it bilaterally
Describe how to administer the pin prick and light touch assessment
- Demonstrate what client would expect to feel on presumed intact area (eg. on cheek, forehead or unaffected limb)
- Instruct client to tell you when they feel something during test
- Ask client to close eyes
- Perform testing using systematic approach (change pattern)
- When client feels something ask where they felt it and if it felt the same as the intact area (keep responses neutral never tell when correct or incorrect)
- Continue testing as needed
Why do we assess both light touch and pinprick sensation
To assess both spinothalamic and DCML sensory tracts
Why do we need to ask if sensation can be felt, where it is felt and if it felt the same as the other side?
To tell a difference between normal and possibly altered sensations
When a sensation is impaired how do we determine if it follows a peripheral nerve or dermatomal pattern?
Determine by testing other areas of the dermatome or up the nerve distribution
What are 3 ways that your handling of administering the test cause issues during sensation of the test?
- Moving hands too much during manipulation
- Working on top of a joint
- Not comparing lesioned sensation to normal sensation
What are the 7 deep tendon reflex assessments and identify location
- Jaw
- Biceps brachii
- Brachioradialis
- Triceps brachii
- Patellar Tendon
- Medial Hamstring
- Achilles Tendon
What is the scale to measure deep tendon reflexes
What are 5 factors may alter resting reflexes
- Nerve damage
- Anxiety/stress
- Spasticity of muscle
- Dehydration
- Larger muscle density
What are 2 strategies to increase someones reflexes if you are having trouble seeing a response
- Repositioning
- Stimulating muscle relaxation
Is hyperreflexia a sign of UMN or LMN impairment
UMN
Is hyporeflexia a sign of UMN or LMN impairment
LMN
Should deep sensations of position sense (proprioception) and movement sense (kinaesthesia) be tested together?
No
Purpose of two point discrimination
Distance to be able to distinguish between two points
Purpose of tactile extinction
To be able to identify between sharp and soft objects and if not they have perceptual deficit (parietal lobe)
Stereognosis
Patient can manipulate and identify objects by feeling them. If they cant they are diagnosed as absent for stereognosis
Graphasthesia
When a patient cant manipulate an object in their hand (eg. stroke) the client must identify capital letters or single digit numbers. Ensures if contralateral cerebral sensory cortex is intact. The patient is diagnosed with absent graphesthesia if unable to perform task.
What are the 5 superficial sensations
- Pain
- Temperature
- Light touch
- Discriminative touch
- Pressure
How should superficial sensations be tested (2)
- Acknowledge the sensation
- Quality of the sensation
** ALWAYS COMPARE BILATERALLY
Why do we need to assess both light touch and pinprick sensations
To assess both the corticospinal and the DCML sensory tracts
Why do we need to ask if the sensation can be felt, where it is felt, and if it is the same as the other side (or presumed intact area)?
To assess both the corticospinal and the DCML sensory tracts
To tell the difference between normal and possibly altered sensation (contrast
If sensation is impaired, how do we determine if it follows a peripheral nerve or dermatomal pattern?
Dermatone is a more widespread area vs peripheral follows a nerve pattern (eg. Forearm and ulnar vs ulnar
How could your handling cause an issue during sensation testing?
Moving your hands too much during manipulation/sensation testing, working on top of a joint, not comparing normative sensation to possible lesioned sensation
