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Neuromanagment > Sensation > Flashcards

Sensation Flashcards

1
Q

What are sensory functions?

A
  • Vision
  • Hearing
  • Smell and taste
  • Touch
  • Pain
  • Proprioception
  • Vestibular Functioning
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2
Q

What are the special senses?

A
  • Vestibular, audition, balance, and equilibrium
  • Proprioception
  • Olfaction
  • Vision
  • Gustation
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3
Q

How are sensory functions assessed?

A

1) Observation during functional tasks
2) Hands-on assessment strategies
3) Interview questions

Do all three to get more comprehensive results!

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4
Q

What is the purpose of a sensory evaluation?

A
  • Assess extent of sensory loss
  • Evaluate and document sensory loss
  • Identify lesion location
  • Determine functional impairment and limitation
  • Provide direction of treatment and interventions
  • Determine time to begin sensory re-education, safety education, desensitization
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5
Q

Why is a sensory assessment critical?

A

Deficits may present safety risks to individuals who are older, have neurological impairments, and live alone

Assessments need to be interpreted cautiously

Need to understand cognitive level of patient while doing sensory assessments - patient may have trouble articulating what they are feeling. Observing during functional tasks may be a more appropriate assessment

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6
Q

What is the primary somatosensory system?

A

Primarily for reception. To receive information from the outside world.

  • Light touch
  • Pain
  • Temperature
  • Pressure
  • Vibration
  • Proprioception
  • Kinesthesia (awareness of position and movement of the parts of the body by means of sensory organs/proprioceptors in muscles/joints
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7
Q

What is the secondary somatosensory system?

A

Also known as the cortical system and perceives information.

  • 2-point discrimination
  • Stereognosis
  • Graphesthesia
  • Simultaneous stimulation
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8
Q

What is the nerve for olfaction?

A

CN 1 - olfactory nerve

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9
Q

What is the nerve for vision?

A

CN 2 - optic nerve

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10
Q

What are the nerves for gustation?

A

CN 7 - facial nerve (taste receptors on anterior of tongue)

CN 9 - glossopharyngeal nerve (taste receptors on posterior of tongue

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11
Q

What is the nerve for audition, balance, and equilibrium?

A

CN 8 - vestibulocochlear nerve

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12
Q

Why are there different receptors in the somatosensory system?

A

Specialized to respond to stimulation of specific nature

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13
Q

What is a mechanoreceptor?

A

Stimuli: mechanical stress, pressure changes (baroreceptors), sound waves, gravity, vibration

Location: skin, blood vessels, ear

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14
Q

What is a chemoreceptor?

A

Stimuli: cell injury/damage, specific chemicals, total solute concentrations (osmoreceptors), blood pH (CO2 levels), prostaglandins (nocireceptors - detect pain)

Location: tongue, blood (dissolved chemicals), nose (vaporized chemicals), tissue

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15
Q

What is a thermoreceptor?

A

Stimuli: heat, cold, certain food chemicals (e.g. capsaicin)

Location: skin (external stimuli and hypothalamus (internal stimuli)

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16
Q

What is a photoreceptor?

A

Stimuli: light (visible wavelengths)

Location: eyes (rod and cone cells)

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17
Q

What three receptors are part of the special sensory system (vision, gustation, equilibrium, audition)

A

Exteroceptors: respond to external stimuli (distinguishes between sweet and spicy)

Interoceptors: respond to stimuli from internal organs (these receptors notify you if you are hungry or if you need to go the the bathroom)

Proprioceptors: detect changes in body position and movement (inner ear, muscles, tendons, and ligaments)

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18
Q

What is neuroplasticity?

A
  • Sensory perception is a dynamic process
  • Use of the hand can stimulate new receptors
  • Single stimulus may excite different receptors
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19
Q

Key Points of the Sensory System

A
  • Specialized, tactile receptors in skin, muscles, and joints
  • Neural impulses follow a specific pathway to the brain where the sensation is perceived and interpreted
  • Looking at UMN (brain and spinal cord) damage - extent and severity of sensory deficit can be predicted depending on where the injury is located
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20
Q

What is tactile sensation?

A
  • Enhanced sensation
  • Distal parts have more receptors and smaller receptive fields
  • Ability to distinguish between one and two points
  • Fine or coarse touch (includes pressure and vibration)
  • Pain and temperature are superficial sensation
  • Each sensory neuron and its distal and proximal terminations can be considered a sensory unit
  • Stimulus anywhere in the field will evoke a response but stimuli to center of field will produce sensations more easily
  • Innervation density depends on the variation in sensory units in a given area
21
Q

What is a Meissner corpuscle?

A

A mechanoreceptor for light touch and vibration (fine touch)

22
Q

What is a Pacinian corpuscle?

A

A mechanoreceptor for pressure and vibration (fine touch)

23
Q

What is a Ruffini corpuscle?

A

A slowly adapting mechanoreceptor that senses when there is a stretch of skin (fine touch)
Located in the cutaneous tissue

24
Q

What are types of coarse touch?

A
  • Itch and tickle: free nerve endings
  • Nociceptor: free nerve endings that detect pain sensation
  • Thermal receptors: detect cold and warmth
25
Q

What is somatotopic arrangement?

A
  • Information is received and organized somatotopically in primary somatosensory cortex
  • High innervation density are highly sensitive and have proportionately larger representation area with somatosensory are of cortex
  • Cerebral cortex receives information about the type and location of sensory stimulation by conscious relay pathways
  • Three neuron pathway = discriminative touch, conscious proprioception, and stereognosis:
    1) Receptors to medulla
    2) Medulla to thalamus
    3) Thalamus to cerebral cortex

Cerebral cortex = motor movement

26
Q

What areas in the body are there heavy amounts of sensory receptors?

A
  • Tongue
  • Lips
  • Hands
  • Face (eyes, ears, nose)
27
Q

What happens when there is sensory dysfunction?

A
  • Any interruptions along the ascending sensory pathway or in the sensory areas of the cortex may result in decreased or loss of sensation
  • Can result in impaired tactile and proprioceptive sensation, astereognosis, increased pain, etc.
28
Q

What happens to the sensory system when there is injury to the cortex?

A
  • Effects of CVA on sensation depends on specific disruption of blood supply
  • 60% of people with strokes in carotid artery system have sensory deficits
  • Patterns of sensory loss in head trauma are less predictable
29
Q

What are guidelines for assessment planning with cortical injury?

A

1) Quickly screen areas of body where sensation is likely to be intact
2) Assess more thoroughly areas most likely to be affected (usually contralateral side)
3) If fine touch and proprioception are intact then there is no need to assess temperature or pain
4) If pain and temperature are absent, there is no need to assess fine touch or proprioception

30
Q

Proprioception, stereognosis, point localization and threshold tests (pinprick, temperature, touch pressure) are all example of?

A

Specific sensory tests

31
Q

What does the Static 2-point discrimination (2PD) test?

A

Perception: Tactile
Main receptor: Merkel cell

Evaluates sensory receptor innervation density
Normal distance: 6 mm

32
Q

What does the tuning fork (250 Hz test?

A

Perception: Vibration

Main receptor: Pacinian corpuscle

33
Q

What does the tuning fork (30 Hz) test?

A

Perception: Vibration

Main receptor: Meissner

34
Q

What does the Ten test (moving light touch) test?

A

Perception: Pressure
Main receptor: Merkel

Reliability comparable to monofilament test

35
Q

What does the cold-heat test?

A

Perception: Temperature

Main receptor: free nerve endings

36
Q

Sensory Reeducation

A
  • Plasticity of brain allows for topographical reorganization of cerebral cortex - influenced by sensory input, learning, and experience
  • Use of body part will improve functional sensibility
  • Use of tasks stimulating localization, graded stimulus, and recognition
37
Q

What are some sensory intervention strategies?

A

The choice of an intervention depends on: the diagnosis, the prognosis, and the evaluation results

Loss of Protective Senses

  • Risk for serious injury because person cannot feel pinprick, hot, or cold
  • Education includes:
    1) Try to soften amount of force used when gripping an object
    2) Visually examine skin for edema, redness, cuts etc.
    3) Protect from being exposed to sharp items or hot or cold items
38
Q

What is discriminative sensory reeducation?

A
  • Protective sensation is intact but not able to localize
    1) Interventions include: grading of objects from grossly dissimilar to more similar objects
    2) Involves training in localization and graded discrimination
39
Q

How does localization work as an intervention?

A
  • Localization of moving touch tends to return before constant touch
  • Hand grid
40
Q

How does graded discrimination work as an intervention?

A
  • Grading from gross to fine discrimination
  • Sequencing of 3 categories:
    1) Same or different
    2) How are they the same or different?
    3) Identification of material or object - stereognosis
41
Q

How does desensitization work as an intervention?

A
  • Used for hypersensitivity
  • Usually observed when there is nerve trauma, soft tissue injuries, burn, or amputations
  • Increased use of textures, weight bearing, or mirror visual feedback
42
Q

What is the rationale for sensory reeducation after a CVA?

A

Premise: functional use of the body part with reduced sensation is possible but spontaneous use is limited. Reeducation techniques are not well defined

  • Carr and Shepard (1998) stated reorganization seems related to frequency of use
    1) Enlargement of sensory receptive areas within cortex is result of increased participation of the body part in activities requiring tactile sensations
    2) Therapists may alter the cortical map by directing sensory experiences of patient
    3) Use of meaningful and relevant sensory and motor experiences early in rehab
  • Dannenbaum and Jones (1993) feel appreciation of tactile stimulation and basic motor skills are prerequisites:
    1) 100 Hz stim with vision and w/o vision
    2) Early incorporation into functional activities and prevention of abnormal of grasp and movement
    3) Textures
43
Q

What is passive sensory training?

A

1) Cortical reorganization in response to repetitive stimulation
2) Extensive repetitive stim applied to impaired site and patient does not participate
3) Evidence is not strong at this time for passive sensory training. This training is not sustainable because the therapist has to administer intervention to patient

44
Q

What is active sensory training?

A

1) Active participation of patient
2) Identification of number of touches
3) Graphesthesia tests
4) “find your thumb” without looking
5) Identification of shape, weight, and texture
6) Passive drawing and writing

45
Q

What is mirror therapy?

A

1) Place unaffected arm in front of mirror, and then therapist gives commands to move both hands/arms
2) Requires full concentration
3) Research is not conclusive at this time

46
Q

How can you make person aware of sensory deficits?

A

1) Compensatory techniques: use vision to compensate for decreased sensation
2) Education on risk factors: water temperature or potential for burns (sun, heat)
3) Emphasize consistent skin care: skin inspections and weight shifts

47
Q

Sensory Dysfunction in SCI

A

Complete SCI is total loss of sensation in dermatomes below level of lesion

Sensory losses for incomplete SCI are related to damage within specific tracts

48
Q

What are guidelines for planning a neurological assessment?

A

1) Use a test with a strong stimulus
2) Know key sensory points within each dermatome to utilize when assessing
3) Bilateral testing is necessary
4) If patient has a known complete lesion there is no need to test multiple sensory modalities
5) Incomplete or unknown lesions = test for multiple sensory modalities

Neuromanagment (22 decks)

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