Neuromuscular Unit 5 Examination Of Sensory Function

Question 1

What is Sensory Integration?

Answer 1

The ability of the neurological system to organize and interpret sensations from the body and environment
- In a normal brain, this occurs automatically without conscious effort

Question 2

What may you hear in the subjective report that may lead you to think that the patient has a Visual Impairment?

Answer 2

• I am having trouble seeing
• I am seeing double
• I can’t see on the left side

Question 3

What may you hear in the subjective report that may lead you to think that the patient has a Somatosensory Impairment?

Answer 3

• My left side feels “numb”
• “Doesn’t feel the same since the stoke”
• “I keep bumping into things on my right side”
• “I feel like my right arm is heavy”

Question 4

During the task analysis, what may lead you to think the patient has a Vision Impairment?

Answer 4

• The patient is squinting
• The patient does not look in one direction
• The patient bumps into things

Question 5

During the task analysis, what may lead you to think the patient has a Somatosensory Impairment?

Answer 5

• The patient looks at their limb to confirm where it is in place
• Severe movement in one direction (e.g. hyperextension of the knee)
• Gross lack of use of the limb

Question 6

What is the Responsibility/Spinal Pathway of the Superficial/Exteroreceptors Sensory Receptor?

Answer 6

Pain, Temp., Pressure, Crude Touch

Anterolateral Spinothalamic Pathway

Question 7

What is the Responsibility/Spinal Pathway of the Deep/Proprioceptors (Muscle, Tendon, Joint, Fascia) Sensory Receptor?

Answer 7

Joint Awareness, Movement Awareness, Vibration, Discriminative/Light Touch

DCML Pathway

Question 8

What is the Responsibility of the Combined Cortical Sensory Receptor?

Answer 8

Stereognosis, Two-point Discrimination, Barognosis, Graphesthesia

Question 9

What is arousal? What are the different levels of Arousal?

Answer 9

The state of responsiveness/readiness of the human system to sensory stimulation/activity;

Alert, Lethargic, Obtunded, Stupor, and Coma

This is important because if the patient is not in the “Alert” status, testing will be invalid

Question 10

With Arousal, what is Alert?

Answer 10

When the patient is awake and attentive to normal levels of stimulation. Interactions with the therapist are normal and appropriate

Question 11

With Arousal, what is Lethargic?

Answer 11

The patient appears drowsy and may fall asleep if not stimulated in some way. Interactions with the therapist may get diverted. The patient may have difficulty focusing or maintaining attention on a question or task

Question 12

With Arousal, what is Obtunded?

Answer 12

The patient is difficult to arouse from a somnolent state and is frequently confused when awake. Repeated stimulation is required to maintain consciousness. Interactions with the therapist may be largely unproductive

Question 13

With Arousal, what is Stupor?

Answer 13

(Semi-coma)
This patient responds only to strong, generally noxious stimuli and returns to the unconscious state when stimulation is stopped. When aroused, the patient is unable to interact with the therapist

Question 14

With Arousal, what is Coma?

Answer 14

(deep coma)
The patient cannot be aroused by any type of stimulation. Reflex motor responses may or may not be seen

Question 15

What Somato-Sensory Test would you do with Superficial Sensation Examination?

Answer 15

• Sharp/Dull Examination - Pain
  –Pin (Sharp vs Dull)
• Temperature Awareness
  –Test Tube
• Touch Awareness
  –Cotton swab or brush

Question 16

What Somato-Sensory Test would you do with Deep Sensation Examination?

Answer 16

• Kinesthesia Awareness (Movement awareness)
• Proprioceptive Awareness (Positional awareness)
• Vibration Perception

Question 17

With Combined Cortical Sensation Examination, what are you testing for Stereognosis?

Answer 17

The ability to identify/form object (in hand usually)

Question 18

With Combined Cortical Sensation Examination, what are you testing for Tactile Localization?

Answer 18

Localize touch sensation on skin

Question 19

With Combined Cortical Sensation Examination, what are you testing for Two-Point Discrimination?

Answer 19

Perceive two distinct point (Smallest distance between 2 points - within the extremity)

Question 20

With Combined Cortical Sensation Examination, what are you testing for Double Simultaneous Stimulation?

Answer 20

Perceived Simultaneous touch (on the body)

Question 21

With Combined Cortical Sensation Examination, what are you testing for Graphesthesia?

Answer 21

The ability to recognize letters, numbers, design on skin by touch (drawing on someone)

Question 22

With Combined Cortical Sensation Examination, what are you testing for Texture Recognition?

Answer 22

The ability to differentiate different textures

Question 23

With Combined Cortical Sensation Examination, what are you testing for Barognosis?

Answer 23

The ability to perceive weight of an object

Question 24

When doing the Visual Examination, what visual Impairments may you see?

Answer 24

• Diplopia: Double Vision
• Strabismus: Malalignment (Depth perception issue)
  Lazy eye
• Nystagmus: Involuntary oscillatory deficit (Vestibular issue)
• Homonymous Hemianopia: The Pts. inability to see one side of the visual field

Question 25

How do you test for CN 2?

What happens if you have a lesion in the Retina, Optic Nerve, or Optic Tract?

Answer 25

Have patient look straight ahead at examiner’s nose. Examiner moves his finger from the periphery to the center. Test each visual field quadrant of each eye separately (i.e. upper and lower quadrants of the nasal and temporal fields of each eye)

Lesion in Retina—Blind spot in affected eye
Lesion in optic nerve—Blindness in the ipsilateral eye
Lesion in optic tract—Blindness in the contralesional side of each eye (homonymous hemianopsia)

Question 26

How do you test for CN 3,4, and 6?

Answer 26

1. Examine movements of both eyes, in all directions (H pattern), using an object or finger for the patient to follow
2. Move your finger or object at a slow and even pace
3. Test the pupillary accommodation reflex by looking at a near and far object
4. Test the pupillary light reflex by use of a penlight into each eye separately, from the side of the eye
5. Observe the patient for both the direct response and consensual response in each eye

• Pupillary Accommodation Reflex- This reflex is assessed by observing the ability of the pupil to constrict as the patients gaze is shifted from a distant to a near object.
• Pupillary Light Reflex- This reflex is assessed by observing the direct and consensual pupillary constriction in response to a light shone into one eye from the side. Test each eye separately.
  Lesions of the Oculomotor nerve may interfere with the pupillary reflex.

Question 27

What is the Patient Position when conducting Sensory Examination?

Answer 27

Be sure the patient is well supported and comfortable (sitting or supine)

Question 28

How is the Senory Examination Graded?

Answer 28

0 : Absent
1: Impaired
2 Normal

This is for Sharp/Dull, Light Touch, Kinesthesia, and Proprioception Testing