Sensation Evaluations and interventions Flashcards
What is tactile sensation?
Refers to the sense of touch, specifically the information received from varying pressure or vibration against the skin.
what type of sensation is tactile?
somatic sensation, meaning it originates at the surface of the body, rather
than internally. (
what does motor function rely heavily on?
sensory feedback
what does peripheral sensation include?
touch and pressure awareness, temperature, pain, and two-point
discrimination.
what is haptic perception?
Sense needed to determine force used in grip. Critical sense needed for successful and safe performance of daily activities
where do we find receptors for tactile sensation?
within skin, muscles, and joints
what is a sensory unit made up of?
sensory neuron and its distal
and proximal terminations
what is an example of a cortical sensory deficit pattern?
stroke
head trauma
what is a complete lesion SCI?
total loss of sensation
what is an incomplete lesion SCI?
dependent on the area damaged within specific spinal tracts
what is affected in an anterior incomplete lesion?
loss of pain, temp
what is affected in a posterior incomplete lesion?
loss of touch, vibration, proprioceptio
what does Anesthesia mean?
absent
what does Paresthesia mean?
an abnormal sensation, “asleep” or “pins & needles”
what does Hyperesthesia or Hypersensitivity
exaggerated sensation beyond expectation
what do Merkel’s cell/Ruffini’s end organs/Meissner’s and Pacinian corpuscles/hair follicles sense?
mechanical information (moving or static touch, pressure, vibration)
what are often classified as nociceptors?
free nerve endings/ thermal receptors
what do nociceptors sense?
pain and temp
what are Innervation density evaluations measuring?
Variation in the number of sensory units in a given area of skin
what are Threshold evaluations measuring?
Level at which a stimulus can be detected
what does Dysesthesia mean?
an abnormal pain sensation, e.g. “burning”, “sharp”, “stabbing”, usually associated with touch
what does Allodynia mean?
pain from a non-painful stimuli
can nerves regenerate?
yes! BUT they can get caught in scar
what are Indications for Sensory Evaluation?
Known or suspected diagnosis that affects sensory system (e.g. SCI, peripheral
nerve laceration/compression)
- Observed OP dysfunction (e.g. poor object handling or manipulation)
- Client expression of odd/unpleasant sensations (e.g. aversion to certain
materials of clothes, resistant to wearing splint)
what is an example of a sensory assessment?
Wrinkle test
what is the Procedure for Sensory Evaluation?
- Obtain history of health issue related to sensory deficits and functional challenges
- Client should be relaxed, distractions eliminated, fatigue avoided, vision occluded;
compare affected and non-affected sides if possible; avoid non-neutral position of head, neck, upper arm if nerve compression is an issue; avoid “sensory” confusion with
accidental stimuli on other parts of the hand - General observation of task performance e.g. methods used, awkward, clumsy
what are precautions for sensory evaluations?
Clients who are unable to cooperate or attend, are sedated or unable to comprehend assessment
(possibly: receptive aphasia, dementia, or ABI)
Clients with skin lesions, bruising, skin conditions, hypersensitivity, autonomic dysfunction/
symptoms (Possibly: Raynaud’s Disease, CRPS
what is an Observation & Sensory Screen useful for?
quick scan; no evidence linking abnormalities to
dysfunction
what are some visual observations we can look for during a sensory screen?
Vasomotor: temp, color, temperature
sensitivity
Sudomotor: sweating *Lack of sweating correlates with lack of discriminative sensation
Pilomotor: goose bumps
Trophic: nutrition of nails, finger pulps, hair growth
what are special tests to conduct for sensation?
Tinel’s sign
Phalen’s test
Compression tests
what are we looking for when doing special tests?
to reproduce or provoke symptoms of a specific nerve
what nerve is flexed/compressed during the phalanx test?
ulnar nerve
what are examples of standardized sensory tests?
Innervation Density: Moving two-point discrimination (m2PD), Static two-point discrimination (s2PD)
Threshold Tests: Vibration sense (30/256 cps), Touch threshold (Monofilaments)
- Touch Localization: location of perceived sensation using hand grid
- Stereognosis
what is the Recovery sequence (after complete nerve transection)?
pain
moving touch
light touch
localization
what does Two-point discrimination (moving and static) require?
cortical integration
what is two-point discrimination (moving and static) useful for?
a measurement after nerve laceration and repair
what are monofilament tests useful for?
a measure if early nerve compression is suspected
what’s the interpretation for monofilament number 2.83?
normal (WFL)
what the interpretation for monofilament number 3.61?
diminished light touch
what the interpretation for monofilament number 4.31?
diminished protective sensation
what the interpretation for monofilament number 4.56?
loss of protective sensation
what is the interpretation for monofilament number 6.65?
loss of all sensation except deep pressure
what is the interpretation if there is no response to number 6.65?
absence of all sensation
what is the treatment plan for Diminished or lost protective sensation?
Education
– Compensatory techniques to avoid injury
* Vision
* Adapted environment/devices
what is the treatment plan for Decreased but not completely lost sensation with potential for improvement?
Sensory retraining/re-education
what is the treatment plan for Hypersensitivity?
- Desensitization program
- Scar management
what diagnoses is Sensory Training/Re-education commonly used for?
- Peripheral nerve injuries (e.g., nerve lacerations, nerve compressions, injuries resulting from replantation, toe-to-thumb grafting, skin grafting)
- Stroke/Brain injury
what are the goals of sensory training?
to maintain or restore the cortical hand representation and to regain the optimal use of sensation of the hand
Hypersensitivity may result from the
following diagnoses:
- Nerve trauma
- Soft tissue injuries
- Burns
- Amputation
desensitization is design to what?
decrease the discomfort
associated with touch in hypersensitive area
what is the Rationale for Desensitization?
Patients with hypersensitivity tend to avoid using the affected part in functional activities.
Patients typically hold the affected part protectively.
Hypersensitivity can lead to disability through nonuse.
Desensitization is based on idea that progressive stimulation will allow progressive sensory
tolerance
what is the desensitization hierarchy?
- Level 1: heat/wax/warm water, light massage/touch
- Level 2: deep massage, touch pressure with pencil eraser
- Level 3: deep massage, towel/facecloth
- Level 4: battery operated toothbrush, tapping, denim
- Level 5: Work and daily activities* can be integrated in other levels through grading of these
activities
when is vibration recommended in the hierarchy?
at the end as this can be very uncomfortable for many
