Sensory Assessment Flashcards
Pathways & Sensation
- Anterolateral (Spinothalamic) = ?
- DCML = ?
Sensory Assessment
Pathways and Sensation:
(-) Anterolateral (Spinothalamic):
- Pain
- Temperature
- Crude touch
(-) DCML
- Light touch (precise localization)
- Two point discrimination
- Pressure
- Vibration
- Proprioception (joint position sense and kinesthetic awareness)
- Barognosis
- Graphesthesia
- Texture recognition
- Stereognosis
Types of Sensation
- Superficial Sensation = ?
- Deep Sensation = ?
- Combined Cortical = ?
Sensory Assessment
Types of Sensation:
- Superficial sensation:
- Pain (sharp/dull)
- Touch awareness
- Temperature
- Pressure
- Deep sensation:
- Kinesthetic awareness / joint movement sense
- Proprioception / joint position sense
- Vibration
- Combined cortical:
- Stereognosis
- Tactile localization
- Two point discrimination
- Double simultaneous stimulation
- Graphesthesia
- Barognosis (recognition of weight)
Sensory Exam Considerations
Flip & Read
Sensory Assessment
Sensory Exam Considerations Cont.
Flip & Read
Sensory Assessment
Prior to Testing
What should we do = ?
Sensory Assessment
Prior to Testing:
- Need to assess patient’s ability to participate in testing
- Check arousal and orientation
- Request patient not to guess if uncertain of the correct response
- Patient to be in a comfortable, relaxed position
- “Trial run” or demonstration of each test should be performed just prior
Sequence of Sensory Testing
Always test the dermatomes in a _ ? _ order.
Sensory Assessment
Sequence of Sensory Testing:
- Touch:
- Always test the dermatomes in a systematic order (top to bottom)
- Proprioception:
- Joint regions
- Includingshoulder, elbow, wrist, interphalangeal (IP) joints, spine, hip, knee, ankle, and toes
Terms for Documentation
- Absent = ?
- Anesthesia = ?
- Impaired = ?
Sensory Assessment
Terms for Documentation:
- Absent:
- At the opposite end of the spectrum, if sensation is completely lost and the individual has no sensibility in the affected region
- Anesthesia:
- When all sensory modalities are lost
- Impaired:
- Decrease in intensity compared with what is typically felt for that region or the person is less consistent in the report
Terminology Describing Common Sensory Impairments
Flip and read
Sensory Assessment
Terminology Describing Common Sensory Impairments:
Touch Awareness and Tactile Localization
- Test = ?
- Equipment = ?
- Method = ?
- Interpretation = ?
Sensory Assessment
Touch Awareness and Tactile Localization:
- Test:
- Before testing touch, ask subject to “Say yes when you feel the touch and then point to or tell me where you feel it.”
- Equipment:
(a) Several options exist clinically for light touch:
- A wisp pulled from a cotton ball is most often used
- A thin piece of facial tissue or Kleenex
- A camel hair brush
- Method:
- Apply the selected light-touch sensory input to the skin surface at one small location.
- Ask the patient to respond each time they feel the sensation with an affirmative response such as “O.K.” or “now.”
- To introduce variability in testing, either alter the time interval between applications to prevent patient prediction of the next application or by asking the patient, “Do you feel anything?” at times when you are not applying a light-touch stimulation.
- Once the extent of the impairment has been mapped, test peripheral nerve distributions to determine whether the loss is in a dermatomal or peripheral nerve distribution.
- Interpretation:
- If subject’s responses are accurate, this indicates that the pathway for discriminative touch (dorsal column/medial lemniscus system) is intact from the periphery to the cerebral cortex.
Testing Sharp / Dull
Sharp/dull testing is used to assess integrity of the _ ? _ pathway.
Sensory Assessment
Testing Sharp / Dull:
- Sharp/dull testing is used to assess integrity of the “pain” pathway ( lateral spinothalamic tract ).
Testing Sharp / Dull - Method
- Regardless of the instrument used, deliver the inputs of sharp and dull in a variable order following a _ ? _ sequence.
Sensory Assessment
Testing Sharp / Dull:
- Method:
- Regardless of the instrument used, deliver the inputs of sharp and dull in a variable order following a systematic dermatomal sequence.
Testing: Sharp/ Dull - Interpretation
What is a normal response = ?
Sensory Assessment
Testing: Sharp/ Dull - Interpretation:
(a) Normal response:
- Able to differentiate accurately between sharp and dull stimuli
Testing: Sharp/ Dull - Interpretation:
Complete peripheral nerve lesions produce loss of _ ? _ in the region supplied by the nerve.
Sensory Assessment
Testing: Sharp/ Dull - Interpretation:
- Complete peripheral nerve lesions produce loss of all sensations in the region supplied by the nerve.
Testing: Sharp/ Dull - Interpretation:
Lesions of the anterolateral tracts produce inability to distinguish = ?
Sensory Assessment
Testing: Sharp/ Dull - Interpretation:
- Lesions of the anterolateral tracts produce inability to distinguish sharp from dull .
Testing: Sharp/ Dull - Interpretation:
Lesions of the primary sensory cortex interfere with ability to = ?
Sensory Assessment
Testing: Sharp/ Dull - Interpretation:
- Lesions of the primary sensory cortex interfere with ability to localize the stimulus , although the subject may be able to distinguish sharp versus dull .
Tactile Threshold (Pressure)
A full set consists of 20 filaments (ranging from 1.65 to 6.65), each with a different strength related to length and thickness of the monofilament.
- Within normal limits= ?
- Loss of protective sensation = ?
- Marked sensory loss = ?
Sensory Assessment
Tactile Threshold (Pressure):
- A full set consists of 20 filaments (ranging from 1.65 to 6.65), each with a different strength related to length and thickness of the monofilament.
- The higher the assigned number, the moreforce is required for the filament to bend.
- Interpretation:
- Within normal limits= 2.83
- Loss of protective sensation = 5.07 (10 g)
- Marked sensory loss = 6.10 (75 gms)
Joint Movement - Interpretation
Normal response = ?
Sensory Assessment
Joint Movement:
(-) Ask subject to “Tell me whether I am moving your joint up or down.”
(-) Firmly hold the sides of the phalanx (usually big toe or a finger), and passively flex or extend the joint Randomize the order of flexions/extensions.
(-) Interpretation:
- Normal response = no errors
Vibration - Interpretation
Primarily tests the large, _ ? _ nerve fibers, and the _ ? _ neurons.
Sensory Assessment
Vibration - Interpretation:
Primarily tests the large,
- Aβ peripheral nerve fibers , and the
- Dorsal column/medial lemniscus neurons
Combined Cortical Test
Because these tests depend on touch sense, they cannot be performed when = ?
Sensory Assessment
Combined Cortical Test:
- Because these tests depend on touch sense, they cannot be performed when primary touch sensation is abnormal .
- Two Point Discrimination
- Localization of Touch
- Bilateral Simultaneous Touch
- Graphesthesia
- Stereognosis
Two-PointDiscrimination: Interpretation
Ability to accurately discriminate in normal ranges indicates that = ?
Sensory Assessment
Two-PointDiscrimination: Interpretation
- Ability to accurately discriminate in normal ranges indicates that the pathway for discriminative touch (dorsal column/medial lemniscus system) is intact from the periphery to the cerebral cortex.
Testing Bilateral Simultaneous Touch - Interpretation
If a person can accurately report stimuli presented on each side of the body separately but not when presented simultaneously, this indicates a lesion in the = ?
Sensory Assessment
Testing Bilateral Simultaneous Touch - Interpretation:
- Tests for sensory extinction.
- Used to determine whether a person can attend to stimuli on both sides of the body simultaneously.
- If a person can accurately report stimuli presented on each side of the body separately but not when presented simultaneously, this indicates a lesion in the parietal lobe , on the contralateral to the side of the body where sensory extinction occurs.
Testing Graphesthesia- Interpretation:
If touch sensation is intact yet the person cannot perform this task, this indicates a lesion in the = ?
Sensory Assessment
Graphesthesia - Interpretation
- Tests = DCML system and parietal lobe.
- Normal response = Able to identify numbers or letters.
- If touch sensation is intact yet the person cannot perform this task, this indicates a lesion in the contralateral parietal cortex or adjacent white matter.
Testing Stereognosis - Interpretation:
If touch sensation is intact yet person cannot identify the object, this indicates a lesion in the = ?.
Sensory Assessment
Testing Stereognosis - Interpretation
If touch sensation is intact yet person cannot identify the object, this indicates a lesion in the contralateral parietal cortex or adjacent white matter.
