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Neuromuscular Exam and Rehab Exam 1 > Sensory Exam - Reflexes and Bed Positioning > Flashcards

Sensory Exam - Reflexes and Bed Positioning Flashcards

1
Q

What are our preliminary considerations for a sensory exam?

A
  • 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
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2
Q

What do we need to consider about cognition as a preliminary consideration?

A
  • can they understand verbal or written instruction (verbal processing)
  • short term memory deficits
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3
Q

What does a test of sensory funciton require?

A

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
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4
Q

What kind of impairments will not adversely affect sensory test results?

A

vision, hearing or speech

  • if appropriate adaptations are made in providing instructions and indicating responses
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5
Q

What pathways does sensation testing broadly assess?

A
  • anterolateral spinothalamic and DCML pathways
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6
Q

What direction should we sensory test?

A

Distal to proximal

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7
Q

What should we instruct our patient not to do?

A

guess

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8
Q

What should our application of stimuli be like?

A

RANDOM
- unpredictible placement
- vary timing

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9
Q

What should our cueing be during a sensory exam?

A
  • 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”
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10
Q

What areas should we avoid testing?

A

desensitized surface areas
- scar tissue, calloused areas
- DO NOT TEST OVER CLOTHING

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11
Q

What should we do to the patients vision?

A

block it!

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12
Q

What should we do for PRIVACY?

A

DRAPING

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13
Q

What is the scoring for sensory testing?

A

2 = normal
1 = impaired or delayed
0 = absent
NT = not testable

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14
Q

What are some superficial sensations?

A
  • pain perception
  • temperature awareness
  • touch awareness
  • pressure perception
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15
Q

What are some deep sensations?

A
  • kinesthesia awareness
  • proprioceptive awareness
  • vibration perception
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16
Q

What are some combined cortical sensations?

A
  • stereognosis
  • tactile localization
  • two-point discrimination
  • double simultaneous stimulation (extinction)
  • graphesthesia
  • recognition of texture
  • barognosis
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17
Q

How do we test tactile localization?

A

monofilament testing

18
Q

What is stereognosis?

A

ability to recognize form of objects by touch only

  • Bags of misc objects
19
Q

What is double simultaneous stimulation?

A

ability to feel two different touch stimuli at two different locations

20
Q

How do we test double simultaneous touch?

A
  • touch R and L at same time location with same pressure (proximal and distal)
21
Q

What is extinction phenomena?

A

does not feel involved side

22
Q

What is two-point discrimination?

A

ability to feel two points applied to skin at same time

23
Q

What is graphesthesia?

A

draw word on someones hand - pt should be able to identify whats drawn

24
Q

How do we test recognition of texture?

A

ability to recognize familiar textures rubbed on skin such as cotton, wool, burlap and silk

25
Q

What is barognosis?

A

ability to recognize different weights with objects of similar size
- use different weights similar in size

26
Q

What can DTRs help with?

A

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

27
Q

What are the common DTRs and their levels?

A
  • biceps tendon (C5-C6)
  • brachioradialis tendon (C5-C6)
  • triceps tendon (C6-C7)
  • patellar tendon (L3-L4)
  • Achilles tendon (S1-S2)
28
Q

How are DTRs graded?

A

on a scale of 0-5
- 2+ is normal
- some variation of normal

29
Q

What will we find with DTRs with UMN?

A

DTRs are increased (ex stroke)

30
Q

What will find with DTRs with LMN>

A

DTRs are decreased (ex peripheral neuropathy)

31
Q

What is the scoring of DTRs?

A

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

32
Q

What do superficial cutaneous reflexes indicate?

A

UMN symptom
- indicates impairment of corticospinal tract

33
Q

What is a positive of babinski?

A

splaying toes

34
Q

What is a positive of Hoffmans?

A

quick opposition motion of thumb and first digit

35
Q

What does bed positioning matter?

A

helps prevent the development of postures that can lead to increased spasticity, contractures, or decubitus (pressure) ulcers

36
Q

When is bed positioning instituted?

A

early - even before full consciousness is regained

37
Q

How should we position patients with spasticity?

A

out of spasticity and reflex dependent posture frequently seen with hemiplegia

38
Q

How can bed positioning help rehab?

A

increases patient comfort, thus rest and recovery, which increases the ability to participate in rehab

39
Q

How often should we change a patients position?

A

every two hours and check skin for pressure sores

40
Q

What is the supine lying position?

A
  1. head and trunk at midline
  2. affected UE supported by a pillow with the scapula in slight upward rotation and protraction
  3. arm positioned slightly higher and away from the trunk
  4. elbow in extension with forearm pronated
  5. wrist in neutral and fingers with open hand
  6. pelvis protracted and leg in neutral position
  7. slight flexion at the knee to prevent extensor tone
41
Q

How can we position a patient to be lying on the less affected side?

A
  1. trunk is straight or slightly elongated
  2. support affected UE with pillow and shoulder flexed forward and supported with elbow in neutral
  3. forearm is in neural
  4. pelvis posterior tilted slightly and affected leg in slight flexion
  5. hip maintained in neutral position
  6. knee and ankle supported on pillow
  7. may need to add folded pillow or wedge to back support to keep pt in position
42
Q

How do we position a patient lying on the affected side?

A
  1. trunk in neutral
  2. affected shoulder is positioned forward
  3. elbow extended, when possible and forearm supinated
  4. place a pillow between patients legs
  5. affected hip is positioned forward with hip slight flexion and slight knee flexion
  6. less affected leg in flexion

Neuromuscular Exam and Rehab Exam 1 (11 decks)

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