Sensory and Reflex Testing Flashcards
first thing to do before sensory testing
mental status testing
cerebrum test
superficial
light touch
pin prick
deep pressure
temperature
deep
tested on distal extremities (hand and foot)
proprioception (position sense)
kinesthesia (movement sense)
vibration
most important sensory test when pt has stroke or brain problem
combined cortical
types of combined cortical sensory tests
2-point discrimination
stereognosis
graphesthesia
barognosis
tactile localization
double simultaneous stimulation
texture recognition
2-point discrimination
start from wide to narrow and ends at the last 2 points where pt can discriminate the 2 points
once pt senses one-point, move the points 1 point wider
if the patient has intact 2-point discrimination and stereognosis, ____ are also ____
combined cortical sensations are also normal
2-point discrimination normal values
Fingertips: 3-5mm
Dorsum of the hand: 20-30mm
Palms: 8-15mm
Stereognosis
identify objects with eyes closed
use familiar objects: coins, tissue, pin
introduce the object first and let them feel it with eyes open
Graphesthesia
trace letter/number on pt’s palm (or any body part) and ask them to identify what was written
wipe a tissue on pt’s palm after every letter/number to indicate “restart”
Barognosis
distinguish weights
use the same shape and size of objects; objects must only differ in weight
Tactile localization
pt’s eyes closed, place a dot on any part of their skin and ask them to point where the dot is placed
measure distance of dot PT inputted from where the pt identified to have felt the sensation
Double Simultaneous Simulation
apply two sensations simultaneously on both sides (either proximal/distal) or on one side (either proximal/distal)
ask pt to verbally identify c eyes closed, where they felt the sensation
Extinction phenomenon
absence of sensation of the distal extremities in DSS
sensation is perceived on proximal part ONLY during DSS
Superficial Reflex
Upper Abdominal Reflex
Lower Abdominal Reflex
Plantar Scratch
Anal Reflex
Deep Tendon Reflex
Biceps, Brachialis Reflex
Brachioradialis Reflex
Triceps Reflex
Patellar Reflex
Ankle (Achilles) Reflex
Upper Abdominal Reflex
T8-T10
kung saan stimulus, doon papunta umbilicus
Lower Abdominal Reflex
T10-T12
Plantar Scratch
L2-S1
flexion of toes when you scratch the foot
Anal Reflex
S2-S4
visible “winking” of anus
Biceps, Brachialis Reflex
C5-C6
Brachioradialis Reflex
C5-C6 / C6-C7
Triceps Reflex
C6-C7 / C7-C8
Patellar Reflex
L2-L4
Ankle (Achilles) Reflex
S1
Deep Tendon Reflex Grade: 0
Areflexia (absent reflex)
Deep Tendon Reflex Grade: +
Hyporeflexia (or diminished reflex)
Deep Tendon Reflex Grade: ++
Normoreflexia (normal reflex)
Deep Tendon Reflex Grade: +++
Hyperreflexia (increased reflex)
Deep Tendon Reflex Grade: ++++
Clonus
UMN condition
+++ or ++++
LMN condition
+ or 0
should be suppressed at a certain age
primitive reflex
should exist even when you get old
physiologic reflex
absence of this indicates a possible impairment
physiologic reflex
Righting Reflex
automatic reactions that enable a person to assume the normal standing position and maintain stability when changing positions
Equilibrium Reflex
important for balancing
Protective Extension Reflex
pt’s tendency to extend hand when they are about to fall
Pathologic Reflex
normal adults: there should be NO response to stimulus that triggers the pathologic reflex
abnormal findings
Babinski
Stimulus: stroking of lateral aspect of sole of foot; should be firm and brisk
Positive Response: extension of big toes & fanning of four small toes
Chaddock
Stimulus: stroking of lateral side of foot beneath lateral malleolus; J stroke from below lateral malleolus to the foot
Positive Response: extension of big toes & fanning of four small toes
Oppenheim
Stimulus: stroking of anteromedial surface of tibia; stroking of shin & direction should be towards the foot
Positive Response: extension of big toes & fanning of four small toes
Gordon
Stimulus: squeezing of calf muscles (gastrocs) firmly
Positive Response: extension of big toes & fanning of four small toes
CI: DVT
Piotrowski
Stimulus: percussion/tapping (c 2 fingers) of tib. ant. muscle
Positive Response: DF & supination of foot
Brudzinski
Stimulus: passive flexion of one lower limb; flex unaffected leg
Positive Response: flexion of opposite lower limb
*sign of UMN
Hoffman
Stimulus: tapping of index, middle, or ring finger (distal phalanx)
Positive Response: flexion of the distal phalanx of thumb
*sign of LMN
Rossolimo
Stimulus: tapping of plantar surface of toes
Positive Response: plantarflexion of toes
Schaefer
Stimulus: pinching (should not be painful) of Achilles tendon in middle third
Positive Response: flexion of foot and toes
*sign of LMN
Associated reactions (Brunnstrom)
if you do something in one part of the body, then an associate reaction will occur
pt’s c neurologic problems or brain injury
Raimiste’s Phenomenon
same with Sterling’s stimulus and reaction/response but differs on body part
for LE (hip) ABDUCTION only
resistance of abduction of the unaffected side = associated abduction on the affected side
Sterling’s Phenomenon
same with Raimiste’s stimulus and reaction/response but differs on body part
for UE (shoulder) ABDUCTION only
resistance of abduction of the unaffected side = associated abduction on the affected side
Marie-Foix Phenomenon (a.k.a. Bechterev’s)
for LE
passively flexing the toes on the affected side = will elicit massive flexion of the entire LE on ipsilateral side
Soque’s Phenomenon
for UE
passively flexing the shoulder of the affected side = will elicit extension of the fingers ipsilaterally
can be used for managing flexion synergy
Homolateral Synkinesis
passively flexing the UE will elicit flexion of the LE (ipsilat)
*if all UE segments are passively flexed, all LE segments on ipsilat. side will also flex
passively extending the UE will elicit extension of the LE (ipsilat)
UE will always be the stimulus; test done on affected side
