Sensory and Postural Deficits: Exam 1 Flashcards
Somato-sensory impairments
Pt may exp. LOSS of what?
-
Sensation
- tactile
- proprio
- pain/temp
- vis. field
- Perception
- Cognition
**MAJOR cause of disability
Somatosensory impairs are often neglected in therapy
Implications?
- fork slips out of hand
- not knowing if knee will buckle
- lack of confidence
- Pt may adapt to one-handed function OR give up attemping tasks (stairs for ex.)
- NOT GOOD !!!
Tactile Impairments include…
- Localization and discrimination of stimuli
- Stereognosis
- recognizing obj. in your hand
- 2-pt discrim
- 2.83, 3.22
- <5mm-5mm===normal
- correlation b/w recovery in hand and touch sensibility
Stereognosis
-
Tactile ID of common objects
- recognition phys objects
- recognition nature of objs
- NOT innate ability
What is the ABSENCE of Stereognosis ?
Astereognosis
2-pt. Discrim.
Ability to recognize what?
2 points when simultaneously applied
VISION OCCLUDED!!!
2-PT Discrim.
when can 2 poins be felt as 1?
IF they are in close proximity
W/ ANY Sensation test OTHER THAN VISION
EYES CLOSED!!!
Proprio. Impairments
impairment in recognition of……
Direction
Pos. in space
Proprio impairments are most obvious where?
DISTALLY
ankle, wrist
Often involved in proprio impairments
kinesthesia
Proprio. is crucial for what ?
Balance
Manipulative actions
Central Pain or….
Thalamic Pain
Awful!!!
- 2% pts following CVA
- More common in L. Hemiplegia
Peripheral pain often comes from….
2* complications
Explain Central Pain aka Thalamic Pain
- burning (dysesthesia), unpleasant tingling, pins, needles, numbness
-
Exaggerated by:
- mvmt
- stress
- lt. touch
Some ways that we can examine Sensory Impairs
- Lt touch (DCML)/Sharp-Dull Discrim (spinothalamic)
- Heat/Cold
- Sense of passive mvmt and pos.
- Vibration
- Tactile
- stereognosis
- 2-pt discrim
-
PAIN
- Quant/Qual
Visual Impairments can involve 2 things:
- Reception of input to the eye due to retinal dysf.
- Perceptual-cognitive
Remembe w/ visual impairs that…..
pre-existing cond. may exist
W/ visual impairments make sure you consider…..
glare
lighting
Crucial that you distinguish visual impairments from….
NEGLECT
- lack of awareness 1/2 of body and proprio representation
- They Completely ignore it
Ex. of Visual Field Defs
-
Homonymous Hemianopsia
- ”same side 1/2 no eye”
Homonymous hemianopsia is NOT
Neglect
In Homonymous Hemianopsia
what is lost?
temporal field vs. nasal field
Lose temporal field on LEFT
Lose nasal field on RIGHT
Loss of vision in same side of ea. eye
Homonymous Hemianopsia
Visual Pathway
COME BACK TO THIS AND RE-WATCH WHAT HE SAYS !!!
SEE PICS
Disruptions in the visual pathway
MAKE MORE CARDS ON THIS!!!!!!!!
see pics
Visual Field Testing
What does that look like?
See pics!!!
perceptual-cognitive defs are defs in the interaction b/w…..
perception and cognition
Perception is the ability to ______ and ______ sensory info.
process and interpret sensory info.
Cognition is the ability to ______ and ______ INFORMATION
JUST information***
process and interpret INFORMATION
just INFORMATION
Perceptual-Cognitive Impairs
4 disorders/impairments
- Body Scheme Disorders
- Spatial Relations Disorders
- Agnosia
- Apraxia
Perceptual-Cog Impairs
Body Scheme Disorders
Unilateral Neglect
R and L Discrimination
Agnosia or…
inability to recognize familiar objects
ex. toothbrush, hairbrush
Apraxia
Inability to perform purposeful, skilled motion, in the presence of adequate strength, sensation, coordination
- NOTE: often shows when CHALLENGED to do activity
-
ex. “get up and walk”
- cannot do it
-
ex. “get up and walk”
Ex’s of test results w/ unilateral neglect
they often cannot “finish” things on the side neglected
see pics
Tx of Somatosensory impairments
somatosensory impairs CAN improve…..
b/w R and L what side usually can improve more?
L. Hemiplegia < R. Hemiplegia
Somatosensory Impairments
Principles of Tx:
- Session starts and ends w/ tasks the pt CAN do
- Tasks should be interesting to the pt
- Vision and use of UNAFFECTED hand to teach perception
- Freq. rests utilized!!!!!!!!!
What would be some suggestions for Tx. w/ Somatosensory Impairs?
- ID # of touches or lines——read article!!!
- ID letters and #’s drawn on arm or hand
- Find your thumb when blindfolded
- Discrim. of shape, wt, texture of obj’s OR materials placed in hand
- Passive drawing
Somatosensory Impairment Tx’s
Specific UE tasks
- Discrim. common objs thru tactile sense only
- Hand-eye coord.
Somatosensory impairments Tx:
Activities to address Neglect
- FORCING USE OF LIMB
- Wt. bear
- Standing
Somatosensory impairments Tx
Visual tasks
- Reading
- Scanning
Postural orientation is the orientation of body to….
body to environment
Postural stability===Balance
2 components:
Static and Dynamic EQUILIBRIUM
Postural Control=====>
Orientation + Stability
Postural Control
what 2 systems are involved?
MSK system
NMSK system
The Neuromuscular system specifically is ability to coordinate what ?
muscle synergies
Postural deficits can include what?
4 things
- Sequencing prolems—activate @ right time
- Activation of postural responses
- Scaling of mm activity
- Adaptation of motor responses
Postural orientation:
Static is…
Maintain vertical orientation
Postural Orientation:
Motor Mechanisms
- spontaneous postural sway
- alignment
- Postural tone
Postural Orientation:
Sensory Mechanisms:
3
- visual
- vestibular
- somatosensory
Postural orientation
Explain the Typical Development
- Righting rxns
- keeps you in vertical
- Protective Extension
- Equilib rxns
Postural orientation
what kind of progression should there be?
Cephalocaudal progression
“head to tail” progression
In terms of Postural Orientation
Adult-like mvmt patterns @ when?
7-10yrs
Postural orientation
Normal aging process that certain things are lost/affected
Systems affected?
- MM strength
- disproportionate loss of fast-twitch fibers
- LESS amp, SLOWER rxn times
- disproportionate loss of fast-twitch fibers
- ROM
-
Sensory
- impaired, less info for change in pos’s
Postural orientation
Aging process and Postural sway
INC’d sway
Abnormal Posture
Many pot. variations ….
- lean towards INVOLVED
- lean towards UNINVOLVED
-
Dependent on patho.
- PD
- CP
- CVA
- knee hyperext, Pusher syndrome
Pusher Syndrome aka…
Contraversive Pushing
Pusher syndrome
Pt pushes forcefully w/ the non-paretic extremities TOWARDS paretic side
Pusher syndrome is likely due to damage where?
Ventral Posterolateral Nucleus of Thalamus
When Pusher Syndrome is on the RIGHT
assoc’d w/….
Neglect
When Pusher Syndrome on LEFT
assoc’d w/
Aphasia
In Pusher Syndrome….
person feels that their upright is shifted by __________ from midline, thus they pushing to restore their perceived midline BACK to vertical
18-20 degrees
Posture: Examination
Alignment should be in what?
Sitting or standing use a plumb line/grid
Posture Exam:
Consider these things (balance support)
Foot position
BOS
Posture exam:
wt. scales under ea. foot
why would you do this?
See if there is even distribution of wt b/w both sides or if they are leaning/overusing one side
Posture Exam:
we want to attempt to standardize measurement
meaning?
Make sure that whatever we use is REPRODUCABLE
Posture: Tx
We want to develop an initial position that will allow…..
3 goals of Tx
- Develop initial position
- that is appropriate for functional task
- is efficient
- is stable
In Symmetrical/Vertical Posture
What kind of feedback would you give?
verbal cues
manual cues
visual cues
Symmetrical/vertical posture
practice this way!
- eyes open/closed
- consider effect of AD’s
