Sensory and Motor Fn (Neuro) Flashcards
What is peripheral nerve involvement?
Demonstrate a pattern of sensory invovlement that corresponds to the pattern of the innervation of the affected nerve(s)
Carpal tunne syndrome - median Nerve distribution
What does nerve root involveemnt look like?
Dermatomal pattern of sensory invovlement
Dermatome: area of skin supplied by SINGLE nerve root
What does spinal cord involvement look like?
SCI presents with a DIFUSE pattern of sesnroy invovlement (BELOW LEVEL OF LESION)
TYPICALLY BILATERAL - not symmetrical
UNILATERAL = Lower Mn
- sesnory impairment depends on the spinal tract that is affected
What does Brainstem involvement look like?
IPSILATERAL (same side) fascial impairments
CONTRALATERAL (opp side) trunk and limb impairments
What does brain involvement look like??
Cortical lesion: dependant on area of SOMATOSENSORY cortex
Deeper lesions: involving thalamus and adjacent structures can lead to diffuse unilateral dysfucntion
Contrlateral side affected (crossed tracts)
Describe feed forward sensation and movement
Sensory information is received DURING the movement to monitor and adjust the motor output
ex: slipping on ice - we can quickly stabilize ourselves to avoid slipping
Define Feedforward
Sesnroiy information from PAST experiences are used for ANTICIPATORY adjustments (e.g postural control, movement)
- IF we have walked on ice before - we have previous experience so when taking a step we would be more cautious and cordinating how mm are contracted.
How to complete sensory testing
Order of testing (3)
- to perform a motor task sensory input is required. –> test sensation prior to assessing motor function and coordination
VISION SHOULD BE OCCLUDED
- show them what is “normal” by providing stimulus to intact area
- applied randomly and unpredictable manner \
- Superficial sensations: pain, temp, light touch and pressure
- Deep sensations: proprioception, Kinessthesia, Vibration
- Combined cortical sensations
- sterognosis
- tactile localization
- 2-point discrimination
- double simultaneous stimulation
- Graphesthesia\
- Recognition of texture
- Barognosis
What should be recorded suring Sensation testing?
- Modality tested ( e.g. pain, temp, touch)
- Surface areas affected (quality of involvement and pattern distribution)
- Degree of severity of involvement (absent, impaired, delayed responses)
- subjective feelings about altered sensation
- potential impact of sensory impairment on function (decreased sensaiton of the feet can imapct gait and lead to falls)
Describe the superficial sensations (4)
- Pain perception: assesses sharp/dull discrimination
indicated function of protective sensation (nociceptors intact - respond to noxious stim) - Temperature awareness: ability to distinguish Warm or cold stimulus –> using two test tubes
- Touch awareness (light touch) : assess awareness of TACTILE input –> start with cotton and move onto monofilaments for gradation
- Pressure perception: assesses perception of pressure by deep receptors –> using PT fingertip or cotton - firm pressure
Describe deep sensations tested(3)
- Proprioceptive awareness
- determine joint position sense and the awareness of joints at rest
- FIRST TELL Pt What the appropriate responses are (UP or DOWN)
- Passively place joint in space and ask if up or down –> OR copy with opposite hand. - Kinesthesia Awareness: Awareness of MOVEMENT
WHILE THE THERAPIST IS MOVING THE JOINT IN SPACE decribe what is occurring (“moving down, moving UP) –> or pt can mirror movement with opposite limb - Vibration perception
- ability to perceive vibration stimuli
- 128Hz tuning fork - plae vibrating or not vibrating tuning fork on BONEY PROMINENCE (pisiform)
- STRIKE TUNING FORK ON EVERY TRIAL (and stop the vibrations with hand after striking so the noise of striking the fork does not equate to vibration stimuli - FALSE POSITIVE)
What are the 7 Cortical sensations tested
- Stereognosis
- assess TACTILE object recognition
- objects of varying shapes and sizes placed in hand - identify it - Tactile localization: ability to localize touch senation
- cotton swab or fingertip - touch different surfaces on skin - POINT TO EXACT LOCATION OF TOUCH - distance between touch and guess recorded - 2-point discrimination : ability to perceive two separate points on the skin simultaneously and measure detectable distance between the points - using circular 2-point or reshaped paperclips
- progressively decrease the distance between the two points until pt can only detect a SINGLE stimuli - Double simultaneous stim
- assesses the ability to perceive simultaneous touch stimulus on:
a) identical locations on opposite sides of body
b) proximally and distally on a single extremity
c) proximal and distal on one side of body (shoulder and leg of right side)
Extinction phenomenon: only proximal stimuli is percieved - distal stimuli is being “extinct”
- Graphesthesia: ability to identify either numbers, letter or designs being traced (think of bar graph - has numbers, letters and designs)
- agree on orientation “6 or 9” - Texture recognition
- assess the ability to differentiate among various textures (wool, silk) - Barognosis: assess recognition of weight
- small object same size and shape, but varying weight in hand - which is lighter or heavier
What is Allodynia
Non-noxious stimuli produces pain (CRPS)
What is Analgesia
Loss of pain sesnitivty (inability to feel pain)
What is Causalgia
Burning painful sensation, often along nerve distribution
What is Dysesthesia
touch sensation produces pain
What is hyperalgesia
Heightened sensitivity to pain (CRPS)
What is hyperasthesia
heightened to sensory stimulus
Hypoalgesia
DECREASED sensitivity to pain
Paresthesia
Abnormal sensation with no apparent cause (numbness and tingling)
What are the two approaches to treating sensory impairments
- Compensatory approach: educated on how to accommodate with having sensory impairment
- goal is to achieve functional capacity by developing alternative strategies and environmental adaptation in SAFE manner (checking water temp using thermostat instead of dipping feet if thermal sensation is impaired) - Sensory integration approach: pt works towards functional skills through GUIDED practice with controlled sensory intake. Activates higher brain centers (central processing) –> use this if any ability to plastic changes
What are upper motor neurons
- motor neurons that originate in the brain, brain stem or spinal cord
- they carry information DOWN to the LMN
- MN that originate before anterior horn cells of the spinal cord
LMN gets info from UMN and carries it towards muscles
describe S+S of LMN vs UMN
WEAKNESS
ATROPHY
FASICULATIONS
REFLEXES
TONE
WEAKNESS
UMN: Yes (spastic paralysis)
LMN: Yes (Flaccid paralysis)
ATROPHY
UMN: NO
LMN: YES (if mm is Dennervated it is not in use therefore atrophy)
FASICULATIONS (twitching contractions in Dennervated mm)
UMN: No
LMN: yes
REFLEXES
UMN: Hyperreflexia
LMN: hyporeflexia/Areflexia
TONE:
UMN: Increased
LMN: decreased
What are the S+S seen in UMN(7)
- Clonus
- Babinski
- Hyperactive stretch reflexes
- involuntary flexor and extensor spasm
- exxagerated cutaneous reflexes
- Loss of precise autonomic control
- Dyssynergic movement patterns (coactivation of agonist and antagonist)
