Sensory Exam - Reflexes and Bed Positioning Flashcards
What are our preliminary considerations for a sensory exam?
- ALERT
alert patients can give reliable info
proportionally greater loss of reliable info comes with lethargy, obtunded, stupor, or coma
-ORIENTED
disoriented patients may not give reliable info - SELECTIVE ATTENTION
selective awareness of the environment or responsiveness to a stimulus/task without being distracted by other stimuli
What do we need to consider about cognition as a preliminary consideration?
- can they understand verbal or written instruction (verbal processing)
- short term memory deficits
What does a test of sensory funciton require?
a response, usually verbal, to the stimulus.
- patients with deficits in arousal, orientation, attention and/or cognition may not be able to accurately be tested
What kind of impairments will not adversely affect sensory test results?
vision, hearing or speech
- if appropriate adaptations are made in providing instructions and indicating responses
What pathways does sensation testing broadly assess?
- anterolateral spinothalamic and DCML pathways
What direction should we sensory test?
Distal to proximal
What should we instruct our patient not to do?
guess
What should our application of stimuli be like?
RANDOM
- unpredictible placement
- vary timing
What should our cueing be during a sensory exam?
- give cues to assist with accurate responses “hot or cold” “sharp or dull”
- “tell me when you feel something” opposed to “do you feel that”
What areas should we avoid testing?
desensitized surface areas
- scar tissue, calloused areas
- DO NOT TEST OVER CLOTHING
What should we do to the patients vision?
block it!
What should we do for PRIVACY?
DRAPING
What is the scoring for sensory testing?
2 = normal
1 = impaired or delayed
0 = absent
NT = not testable
What are some superficial sensations?
- pain perception
- temperature awareness
- touch awareness
- pressure perception
What are some deep sensations?
- kinesthesia awareness
- proprioceptive awareness
- vibration perception
What are some combined cortical sensations?
- stereognosis
- tactile localization
- two-point discrimination
- double simultaneous stimulation (extinction)
- graphesthesia
- recognition of texture
- barognosis
How do we test tactile localization?
monofilament testing
What is stereognosis?
ability to recognize form of objects by touch only
- Bags of misc objects
What is double simultaneous stimulation?
ability to feel two different touch stimuli at two different locations
How do we test double simultaneous touch?
- touch R and L at same time location with same pressure (proximal and distal)
What is extinction phenomena?
does not feel involved side
What is two-point discrimination?
ability to feel two points applied to skin at same time
What is graphesthesia?
draw word on someones hand - pt should be able to identify whats drawn
How do we test recognition of texture?
ability to recognize familiar textures rubbed on skin such as cotton, wool, burlap and silk
What is barognosis?
ability to recognize different weights with objects of similar size
- use different weights similar in size
What can DTRs help with?
assist the therapist in determining the type of pathology that exists and may aid in the localization of the lesion when combined with other screening or evaluation tests
What are the common DTRs and their levels?
- biceps tendon (C5-C6)
- brachioradialis tendon (C5-C6)
- triceps tendon (C6-C7)
- patellar tendon (L3-L4)
- Achilles tendon (S1-S2)
How are DTRs graded?
on a scale of 0-5
- 2+ is normal
- some variation of normal
What will we find with DTRs with UMN?
DTRs are increased (ex stroke)
What will find with DTRs with LMN>
DTRs are decreased (ex peripheral neuropathy)
What is the scoring of DTRs?
0 - absent, no response
1+ - low normal, diminished
2+ - normal
3+ - brisker or more reflexive
4+ - very brisk, hyper reflexive with clonus
5+ - sustained clonus
What do superficial cutaneous reflexes indicate?
UMN symptom
- indicates impairment of corticospinal tract
What is a positive of babinski?
splaying toes
What is a positive of Hoffmans?
quick opposition motion of thumb and first digit
What does bed positioning matter?
helps prevent the development of postures that can lead to increased spasticity, contractures, or decubitus (pressure) ulcers
When is bed positioning instituted?
early - even before full consciousness is regained
How should we position patients with spasticity?
out of spasticity and reflex dependent posture frequently seen with hemiplegia
How can bed positioning help rehab?
increases patient comfort, thus rest and recovery, which increases the ability to participate in rehab
How often should we change a patients position?
every two hours and check skin for pressure sores
What is the supine lying position?
- head and trunk at midline
- affected UE supported by a pillow with the scapula in slight upward rotation and protraction
- arm positioned slightly higher and away from the trunk
- elbow in extension with forearm pronated
- wrist in neutral and fingers with open hand
- pelvis protracted and leg in neutral position
- slight flexion at the knee to prevent extensor tone
How can we position a patient to be lying on the less affected side?
- trunk is straight or slightly elongated
- support affected UE with pillow and shoulder flexed forward and supported with elbow in neutral
- forearm is in neural
- pelvis posterior tilted slightly and affected leg in slight flexion
- hip maintained in neutral position
- knee and ankle supported on pillow
- may need to add folded pillow or wedge to back support to keep pt in position
How do we position a patient lying on the affected side?
- trunk in neutral
- affected shoulder is positioned forward
- elbow extended, when possible and forearm supinated
- place a pillow between patients legs
- affected hip is positioned forward with hip slight flexion and slight knee flexion
- less affected leg in flexion
