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Adult Rehab > Sensation > Flashcards

Sensation Flashcards

1
Q

Why would you do sensory testing?

A

-Identify a problem interfering with occuapation
–impairments hinder movement
–impairments increase the risk of injury
-Assist with diagnosis (assess type and extent of sensory
loss)
-Provide information about return of neurological function
–Evaluate and document sensory recovery
-Determine a treatment plan and approach
–Compensation (adaptation)
–Sensory re-education (remediation)
–desensitization (remediation)

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2
Q

T/F: Sensation is particularly important for hand function

A

True. E.g., Fine motor coordination, manipulation, judging force for grasp…

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3
Q

Clients with which diagnosis would most likely NOT need a sensory assessment?

a. C5-6 tetraplegia
b. Multiple sclerosis
c. Myocardial infarction
d. Carpal tunnel syndrome

A

C. Myocardial infarction: need to evaluate sensory for all others

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4
Q

What clients are appropriate for Sensory Assessments?

A
  • Any client with potential neurological involvement
  • Diagnosis determines expected sensory picture
  • Clients with:
    • -Cortical lesions
    • -LMN lesions
    • -PNI
    • -Other neurological diagnoses
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5
Q

T/F: Any client with potential neurological involvement would be appropriate for sensory assessment

A

True!

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6
Q

T/F: Diagnosis determines sensory deficits in a patient

A

False. Diagnosis determines what is expected in a sensory picture, but not always true

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7
Q

This condition results in a total absence in dermatomes below the level of lesion

A

A complete spinal cord injury. May have paresthesia (tingling or pins and needles) at level of lesion

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8
Q

This condition relates to damage within specific spinal tracts.

A

Incomplete spinal cord injury.
Anterior=pain and temperature (usually coms back before light touch and proprioception
Posterior=light touch, vibration, proprioception

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9
Q

T/F: Peripheral nerve injuries relate to dermatomes of the body while Spinal cord injury pattern varies with nerves involved and extent of damage

A

False. Spinal Cord Injuries relate to consistent dermatomes while peripheral nerve injury patterns vary with nerves involved and extend of damage

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10
Q

Damage to this area in a PNI affects a dermatome on one side of the body

A

Damage to a single nerve root affects a single dermatome on one side of the body.

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11
Q

Damage to this region in a PNI affects sensation within peripheral nerve distribution

A

Damage to a peripheral nerve affects sensation within peripheral nerve distribution

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12
Q

T/F: Sensory loss severity can very widely in a peripheral nerve injury

A

True.

  • Mild compression: increased sensitivity for light touch or vibration (slightly elevated threshold)
  • Complete transection: total loss of tactile sensation within the region
  • peripheral neuropathies: (diabetes, alcoholism) “glove and stocking distribution”…distal to proximal with possibly paresthesia/pain
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13
Q

Complete vs incomplete SCI

A
  • Complete: total absence in dermatomes below level of lesion. Might have paresthesia (tingling or pins and needles) at level of lesion
  • Incomplete: relates to damage within specific spinal tracts.
    • -Anterior=pain and temperature (usually come back before light touch and proprioception)
    • -Posterior=Light touch, vibration, proprioception, etc
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14
Q

Types of PNIs that affect sensation

A
  1. Single nerve root
    • -affects dermatome on one side of body
  2. Damage to peripheral nerve
    • -affects sensation within peripheral nerve distribution
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15
Q

Expectations for sensation in CVA and Brain injury (cortical lesion)

A
  • Contralateral sensory loss
  • perception of light touch and proprioception are most affected
  • generalized inattention/lack of awareness
  • breakdown in sensory processing-sensorimotor problem
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16
Q

T/F: In CVA and brain injuries, pain is the most affected, temperature is less affected, and fine touch/proprioception is least affected

A

False. Fine touch/proprioception is most affected, temperature is less affected, and pain is the least affected

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17
Q

T/F: Loss of proprioception and pain are more common following right CVA than left

A

True

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18
Q

What are expectations for sensory recovery in a CVA/TBI?

A

Decreased edema, increased vascular flow, plasticity and relearning

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19
Q

What are expectations for sensory recovery in a LMN injury?

A

decreased ischemia and edema with first 6 months (any recovery usually within first year)

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20
Q

What are the expectations for sensory recovery in a PNI?

A

Very likely to fully recover if compression was brief and mild:
-mild compression: full
-prolonged compression: full but not usually normal
-total transection: only with surgical intervention and adequate regrowth (pain and temp usually return first, then touch; moving before light touch and accurate localization recovers last)
-chronic conditions (peripheral neuropathy): usually not
expected

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21
Q

T/F: with PNI sensory recovery, touch usually returns before pain and temperature

A

False. Pain and temperature usually returns before touch. Moving touch returns before light touch and accurate localization recovers last

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22
Q

T/F: with PNI sensory recovery, moving touch returns before light touch

A

True. Pain and temperature usually returns before touch, moving touch returns before light touch, and accurate localization recovers last

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23
Q

T/F: Normally, you would be Sensory testing before ROM/MMT/Cognition/Vision

A

False! Normally, you would do sensory testing after ROM/MMT/Cognition/Vision testing. You may need to alter the sequence based on abilities, limitations, impairments, etc

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24
Q

Sensory Assessment is done when in the sequencing of assessing a pt?

A

Sensory Assessment follows:

-Interview, Observation of occupational performance, and ROM/MMT/Cognition/Vision

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25
Q

What might you have already observed that would provide you with information regarding a client’s sensory status?

A

Non-use
Positioning problems
Awkwardness with movement
clumsiness

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26
Q

How do you determine which sensory tests to do and the sequence to do them in?

A
  • Look at diagnosis first…steers you toward certain tests
  • General before discriminating: e.g., light touch/localization before sharp/dull. Most likely if they can’t feel anything, won’t be able to discriminate
  • Don’t do all the tests with all clients
  • For the most part the way we sequence them/present them is a rough order of general to discriminating
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27
Q

T/F: When performing sensory testing, it is typical to perform general before discriminating tests

A

True. E.g., light touch/localization before sharp/dull. Most likely if they can’t feel anything, won’t be able to discriminate.

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28
Q

T/F: With sensory testing, test the more involved side first

A

False. Test less involved side first

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29
Q

T/F: In sensory testing, you should test proximal to distal

A

True. Higher to lower dermatomes.

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30
Q

Why is it important to occlude vision during sensory testing?

A

Visual is a strong compensator

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31
Q

Procedures of sensory testing

A
  • Observe skin: thickness, calluses, bruises
  • Obtain client’s subjective report
  • Stabilize part/limb being tested
  • State instructions and demonstrate in an intact area
  • Test less involved side first
  • Test proximal to distal (higher to lower dermatomes)
  • Occlude client’s vision
  • Apply stimulus at irregular intervals
  • Avoid inadvertent cues (auditory, facial expressions…)
  • Be sure to test all areas of sensory distributions
  • Carefully observe correctness, confidence, and promptness of responses
  • Observe for hypersensitivity
  • These procedures optimize reliability. The purpose is to eliminate non-tactile cues and ensure that client’s response accurately reflects actual sensation
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32
Q

How to score Sensory Assessments

A

-Intact: Normal sensation
-Impaired:
–Able to detect some but not all of stimuli
–Perception of stimulus is different from that of intact
areas (often relates to speed of processing)
–May want to add percentages (#correct/#given)
-Absent:
–Total loss of sensation or
–Inability to detect a specific sensory modality
-Document type of test, skin area tested, and response

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33
Q

How can you assess edema?

A

Volumeter or circumferential measurement

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34
Q

How can you test for nerve regeneration

A

Tinel’s Sign: lightly tap to elicit sensation of tingling/pins and needles in the distribution of the nerves

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35
Q

This assessment examines cutaneous sensation

A

Touch Awareness. Assesses general awareness of touch input.

Function: something brushes against your arm. Know when something is touching you

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36
Q

Touch Awareness Procesure

A
  • Lightly brush/touch-stimulate a few hairs
  • Ask if client can feel anything and client responds
  • Randomize-alter timing of stimulation
  • sometimes done with localization: Ask client to point to location of stimulation
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37
Q

Scoring for Touch awareness

A
  • Intact (+): Recognizes/localizes touch
  • Impaired (-): Recognizes only
  • Absent (0): Unable to recognize or localize a stimulus
  • Score=# of correct responses (expect 100%)
  • Can be done in a standardized way-normal response is about within 3-4 mm of actual location in fingertips, 7-10 mm in palm, and 15-18 mm in forearm
38
Q

Pain Awareness (Sharp/Dull) tests what?

A

Pain awareness (sharp/dull) examines differentiation between sharp and dull-superficial pain/protective sensation. Important to recognize superficial pain/pressure sores like scrapes, cuts. At risk for injury without.

39
Q

Procedure for Pain Awareness testing (Sharp/Dull)

A
  • Use new/sterilized safety pin
  • Touch client intermittently and randomly with head and point of pin (perpendicular to skin)
  • Tap skin lightly-enough pressure to deflect skin
  • Client indicates “sharp” or “dull”
  • Touch with amount of pressure necessary to elicit correct response on uninvolved side of body
  • May use percentages to score
40
Q

Scoring for Pain Awareness (Sharp/Dull)

A

-Intact
-Impaired
-Absent
(May be aware of pressure, but lack protective sensation)

41
Q

What does pain awareness (pinwheel) test?

A

Examines response to the application of superficial pain stimulus. This is a protective sensation

42
Q

Procedure and scoring for pain awareness (pinwheel) test

A
  • Hold pinwheel between the thumb and index pinger in the indentation in the handle and roll lightly over the skin
  • test first in a known area of intact sensation such as face or neck
  • can be tested in a dermatomal pattern, or according to peripheral nerve distribution
  • client indicates whether they feel the stimulus the same as in the intact area, less than in the intact area, or not at all
  • Scoring: Intact, impaired, absent
43
Q

Procedure and scoring for temperature awareness testing

A
  • Examines discrimination between warm and cool-sensation of temperature
  • Function: safety with cooking, bathing…
  • Use test tubes filled with warm/cool water or spoons in water
  • Touch client intermittently and randomly with different temperatures
  • Scoring: Intact, impaired, absent
44
Q

This assessment tests for sense of joint position

A

Proprioception. Unconscious information regarding position of joint, ligaments, muscles, tendons-in unknown combination
Function: body in space

45
Q

Procedure and scoring for Proprioception testing

A
  • Hold the lateral aspect of the elbow, wrist, or digit
  • Move the body part into flexion or extension
  • Ask the client to identify direction of motion: up or down
  • Scoring can usually be done within a few degrees
    • -Intact
    • -Impaired: delayed/nearly correct
    • -Absent: incorrect or no response
    • -Describe client’s response!
46
Q

This assessment examines sense of joint motion

A

Kinesthesia. Need decent motor control to perform this test to mirror position with other extremity
Function: postures, walking, writing without looking, any smooth/controlled movement; input from unknown combination of muscle, joints, and tendon receptors

47
Q

Procedure and scoring for Kinesthesia testing

A
  • Occlude the client’s vision
  • move the unaffected limb into a certain posture by grasping only the lateral aspects of the limb
  • ask the client to duplicate the position with affected limb
  • Scoring:
    • -In tact
    • -Impaired
    • -Absent in each joint
    • -Normal responses are very rapid…100% expected
48
Q

Stereognosis testing requires…

A

Interpretation of sensory input

Motor function as a pre-requisite

49
Q

Procedure and scoring for Stereognosis Testing

A

-Place various items in client’s hand
-Ask client to identify item through touch
-Client names item and/or identifies properties
-May assist client with manipulation
-Adapt for speech deficits: client points to items
-Number of items is often 5…a number of small objects
known to the client
Scoring:
–Number correctly identified out of total
–Intact if assisted to manipulate
–Note if client able to correctly identify properties
–Normal=within 2-3 seconds

50
Q

This is a standardized test that is more discriminatory for sensory testing than many of the other tests and is closely linked to other sensory areas and hand function

A

Touch Pressure Threshold. A hand therapist may do this to rule out others. Also a good test of protective sensation. But it is more time consuming.

51
Q

Procedure and scoring of touch pressure threshold

A

Procedure-(Semmes-Weinstein test):
-Begin testing with filament market 2.83
-Hold filament perpendicular to skin
-Apply to skin until filament bends-bend is according to length/thickness, not pressure
-Apply in 1.5 seconds, hold 1.5 seconds, remove in 1.5 seconds
-Repeat 3 times at each testing site…use thicker filaments if the client doesn’t perceive thin ones
-Client says “yes” upon feeling stimulus
Scoring (Standardized)
-Number of thinnest monofilament felt at least 1/3 trials (normal adult=2.83 in UE)
-Pressure aesthesiometer
-20 graded monofilaments
-Different pressures-calibrated 1.65 to 6.66
-Recorded using standard color code

52
Q

What is the filament thickness for a normal adult in UE?

A
  1. 83
    - Clients who cannot feel the thickest monofilament may or may not be able to feel a pinprick, but have no other feeling and require visual guidance for all hand function
    - Typically with PNI in outpatient settings
53
Q

Interpretation of sensory findings for Diminished light touch:

A

Diminished light touch

  • Person might not be aware of loss of sensation
  • no effect on movement of hand
  • able to identify temperatures, textures and objects by touch
  • If decrease but not total loss – may be a candidate for sensory retraining…as long as prognosis indicates there is potential for improvement.
54
Q

Interpretation of sensory findings for diminished protective sensation:

A

Diminished protective sensation:

  • Decreased motor coordination-slower manipulation/dropping objects
  • Identification of temperatures and pain intact
  • At risk for injury
  • If decrease but not total loss – may be a candidate for sensory retraining…as long as prognosis indicates there is potential for improvement.
55
Q

Interpretation of sensory findings for loss of protective sensation

A

Loss of protective sensation

  • Inability to use hand without vision
  • Feel pinpricks and deep pressure
  • Less able/unable to determine temperature
  • At risk for injury
56
Q

Pt with hypersensitivity is a candidate for…

A

Desensitization

57
Q

Function of Two-Point Discrimination (static) testing

A
  • Highly sensitive
  • Predicts good hand function independent of sight
  • Predicts precision grasp (how hard to hold)
58
Q

Procedure for Two-Point Discrimination

A

-Start with points at 5 mm distance
-Test only the fingertips b/c this is the primary area of the
hand used for object exploration
-Randomly test 1 or 2 points on the radial and ulnar
aspects of each finger for 10 applications
-Pressure is applied lightly; stop just when the skin
begins to blanch
-Ask client if one or two points are felt
-Gradually adjust to find smallest correct level
-Usually done in hand, but there are norms for whole
upper body
-If no ability to do constant touch/vibration, cannot do this
-Longitudinal or transverse orientation is ok
-Use a disk-criminator or aesthesiometer

59
Q

Scoring for Two Point discrimination (static)

A

-Clients responds accurately to 2/3, 4/7, or 7/10 trials

60
Q

Norms for Two Point Discrimination (Static)

A

1-5 mm indicates normal static two-point discrimination
6-10 indicates fair static two-point discrimination
111-15 indicates poor static two-point discrimination
-One point perceived indicates protective sensation only
-No points perceived indicates an anesthetic area

61
Q

Function of Two-Point Discrimination (Moving)

A
  • Examines discrimination between one or two points on the skin
  • Predicts manipulation skills
62
Q

Procedure for Two-Point Discrimination Moving

A
  • Starts with points at 8mm distance
  • Randomly select one or two points and place in center of distal phalanx-parallel to longitudinal axis
  • Move proximal to distal along distal phalanx
  • Press until light indentation with equal pressure
  • Ask client if one or two points are felt
  • Gradually adjust to find smallest correct level
63
Q

Scoring for Two-Point discrimination Moving

A

-Smallest distance at which client is correct 7/10 trials

64
Q

Norms for Two-Point Discrimination Moving

A

2-4 mm for ages 4-60 indicates normal moving discrimination

4-6 mm for ages 60+ indicates normal moving two point discrimination

65
Q

This assessment tests spatial representation of touch receptors in cortex

A

Touch Localization. General awareness of touch input

66
Q

Procedure for Touch Localization

A

-Use Semmes-Weinstein Monofilament 4.17 or pen, pencil eraser
-Apply touch to client’s skin and ask client to remember/identify the location of stimulus (vision occluded)
-Client then uses index finger or marking pen to point to
spot just touched
-Typically therapists combine touch awareness and non-standardized localization

67
Q

Scoring for touch localization

A

Intact (+): localizes touch
Impaired (-): difficulty with localization
Absent (0): unable to localize a stimulus
Score=# of correct responses (expect 100%)

68
Q

What does a composite measure mean?

A

Beyond the strength of the individual muscles. In grip and pinch strength testing, a composite measure is taken

69
Q

T/F: There may be a 40-55% difference between dominant and non-dominant UE in grip and pinch strength testing

A

False. It is normal to have 10%-15% difference between dominant and non-dominant UE

70
Q

Procedures for Grip Strength Testing

A
  • Client seated with shoulder adducted, neutrally rotated, elbow flexed at 90 degrees, forearm neutral, wrist slightly extended
  • Handle of dynamometer at second position
  • Therapist: Ready, squeeze/pinch as hard as you can
  • Therapist urges client through 3 trial attempts
71
Q

Pinch strength testing procedure

A

3 trials for tip, lateral and three-point pinch

72
Q

How is scoring down for Grip and Pinch Strength Testing?

A

Average for 3 trials is recorded

73
Q

Volumeter procedure

A

Edema Testing. Measures mas of body part by water displacement. Most often with hand

  • Fill volumeter with water
  • Position beaker
  • Place hand in and rest middle/ring finger in dowel
  • Measure amount of water displaced
74
Q

Volumeter testing is contraindicated with…

A

Open wounds, plaster casts, vasomotor instability

75
Q

T/F: Edema can be a cause of limited ROM

A

True

76
Q

Circumferential Measurement procedures

A

-Use millimeter tape
-Measure same place on each finger, hand, etc.
–Important to measure at exactly same place from test
to test. Use anatomical landmarks
-Figure-of-eight technique
-Use opposite side as norm if not involved
-Measure changes over time/with intervention

77
Q

T/F: With Circumferential Measurement for Edema, use the opposite side as norm if not involved

A

True

78
Q

Tinel’s Sign is used for what

A

To track how far a sensory nerve has regenerated (after nerve repair)

79
Q

Tinel’s Sign Procedure

A
  • Tap along course of nerve distal to proximal

- When tapping elicits tingling sensation=indicates the location of compression or where sensory axon growth has stopped

80
Q

What is the rate of recovery for nerve regeneration?

A

1 mm/day; 1 inch/1 month

81
Q

What is the water test?

A

It is a sympathetic recovery test.

  • De-innervated skin does not wrinkle
  • Submerge hand in water for 5 min
  • Look for wrinkling
  • Patterns according to PN discributions
82
Q

What is the Ninhydrin test?

A

It is a sympathetic recovery test.

  • De-Innervated skin does not sweat
  • Use iodine and heat lamp
  • Iodine with bead up under heat lamp in portions of skin that are innervated
  • Patterns according to PN distributions
83
Q

With a SCI, you want to do sensory assessments for what purpose?

A

With an SCI, you want to know whether sensation is present or absent in each dermatome. Often touch awareness or pain awareness.

84
Q

Minimum sensory testing for SCI would include:

A

Light touch, superficial pain, and proprioception (temperature in same track as pain)

  • Vibration is not functional
  • Test Bilaterally (results may differ)
85
Q

T/F: If you are aware of the complete lesions upon admission, no additional sensory testing needs to be done.

A

False. Make no assumptions about whether sensation is present or absent

86
Q

What sensory assessments should you do with a client with PNI

A

Assess protective sensation

87
Q

With a single peripheral nerve involvement (with PNI), what do you need to make sure to do when assessing sensation?

A

Establish accurate map of body area and severity of loss

88
Q

When dealing with nerve compression and recovery, what should you do when assessing sensation?

A

Use measures that are highly sensitive (monofilament) to show small changes in sensory function

89
Q

What is the recovery sequence for PNI?

A

Pain –>Moving touch–>Light Touch–>Touch Localization

90
Q

What sensory tests should you do with functioning at C6, C7, and C8 nerve roots and/or median nerve?

A

Functional tests of sensation requiring objects or texture identification with thumb, index, and middle fingers

91
Q

What sensory assessments should you do with CVA?

A
  • Assess light touch, proprioception, pain awareness, temperature, and stereognosis
  • Note observations during ADL that appear to be loss of proprioception: proprioception assessment
  • Possible risk of injury: protective sensation (pain and temperature)

Adult Rehab (7 decks)

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