Sensory Examination LECTURE 1 Flashcards
Sensory Integration: What is it?
CNS takes in all sensory information
- Environmental input
- Movement, touch, body in space, sight, sound and smell
- The brain must take in and analyze the sensory input so the reaction to it can be appropriate
- Definition: “is the ability of the brain to organize, interpret, and use sensory information”
Movement
- Motor task is _______
- Learn to anticipate what will happen?:
- Feedback IS ?
- Feed forward IS?
- practiced
- correct movement will occur
- learning in the moment
- learning in the moment
- Guides the motor response to interact with the environment
- Adapt movements
- Protect the person from injury
Sensation
- Sensation received from skin and musculoskeletal system
- Test the sensory system: need to determine the patients ability to interpret and discriminate incoming sensory info
Somatosensory
If abnormal motor behavior, could be from poor______ ________.
sensory input
What does the brain do with the information??
- Correlate sensory input with motor output
- Assess and control body’s interaction with the environment
Clinical Indications for sensory testing
- Depends on information provided in the intake
- Symptoms described by the patient
- Signs elicited during other testing and observations
- Other information
- Associated with pathology or injury
- May affect peripheral nervous system or central nervous system, or both
- Can affect ANY PART of the nervous system
- Injury, infection, compression, nutritional deficiency, injuries to nerves, CVA, TIA, MS, TBI
- Look at the PATTERN of sensory involvement
- Does it follow a peripheral or central pattern??
Sensory dysfunction
Crosses more than one dorsal root
Examples: ulnar nerve injury vs C-8
Supraclavicular nerve vs C 5,6,7
Peripheral nerve innervation
Specific nerve injuries
- Diabetic: glove and stocking distribution
- Multiple Sclerosis: scattered pattern of involvement
- Spinal Cord Injury: diffuse pattern of sensory involvement
- Can by symmetric or asymmetric
- Guillen barre syndrome
Spinal cord tracts
- Anterolateral tract
- Dorsal column
- Nerve root
- CNS lesion
Spinal cord tracts carry somatosensory and special sense information- can have damage at the tract which will manifest into various signs and symptoms
Age related changes
- Normal age related changes versus changes specific to illness/pathology
- Normal aging affects vision, hearing and somatosensory system
- Changes affect the health of the elderly patient
With aging what might you see due to sensory changes?
- Postural instability
- Increased body sway
- Balance issues
- Wide based gait
- Decrease in fine motor abilities
- Can’t recognize body positions
- Decrease in muscle mass
How do we accurately test a patient?
Testing for sensory problems
- Do preliminary testing to determine if sensory testing will be accurate
- What do you need to know?
What are the states of arousal?
Alert:
Lethargic:
Stupor/semicoma:
Coma:
Alert and attentive
- If alert: can obtain reasonable information about somatosensory system
- Attention: selective awareness of environment
- can respond to a task without being distracted by other stimuli
Increase attention by having patient repeat longer lists of items
Orientation
- Is the patient aware of time, person and place (A&Ox3)
- If not completely oriented, list what person is not oriented to
What is the 4th orientation? WHY THEIR THERE
Memory
- Long term memory: ask questions about remote past
- Short term memory: difficult to remember directions or follow any directions
- Test short term memory by asking pt to repeat a series of words. Have them repeat it a few minutes later (less than 5 minutes)
- Can ask again 30 min later: get 2 items of 3 right
Hearing
How do they respond to your voice?
Note if you alter the volume or pitch
Vision
- Make sure pt uses glasses
- Peripheral field: sit in front of patient and bring fingers in from side toward midline
- Depth perception: hold two items in front of patient, which is closer?
Sensory testing
- Patient needs to be able to respond
- Needs to be alert and oriented; have good attention, cognition and memory
Modality of sensation
- A general class of stimulus
- Determined by type of energy transmitted by the stimulus and receptors specialized to sense that energy
Modalities of sensation include:
- vision
- taste
- hearing
- smell
- pain
- temperature
- proprioception
Superficial and Deep sensation:
Extrareceptors: describe
- Superficial stimuli
- Located in skin and subcutaneous tissue
- Perceive light, pain, temperature, touch, pressure
Superficial and Deep Sensation
Proprioceptors: describe
- Deep sensations
- From muscles, tendons, ligaments, joints, fascia
- Position senses, kinesthesia, vibration
Combined cortical sensation
- Combines the information you get from superficial and deep information
- Information is combined and analyzed in cortical sensory association areas of brain
These include:
- stereognosis
- two-point discrimination,
- Barognosis,
- graphesthesia,
- tactile localization,
- analyze texture,
- double simultaneous stimulation
Spinal Pathways
Information from sensory receptors-through nerveenter spinal pathwayto brain
what are the 2 pathways
- Anterolateral spinothalamic tract
- Dorsal column-medial lemniscal system
Types of sensory receptors
name 5 types
- Mechanoreceptors
- Thermoreceptors
- Nociceptors
- Chemo receptors
- Photic/electromagnetic receptors
Cutaneous Receptor Review
what do Free nerve endings do?
- perceive pain,
- touch,
- temp.,
- pressure,
- tickle,
- itch
Cutaneous Receptor Review
Hair follicle endings
- mechanical movement
- touch
Cutaneous Receptor Review
Merkyl’s discs: below epidermis in smooth skin
- low intensity touch,
- velocity of touch,
- constant pressure on skin (important in 2 pt discrimination,
- localizing touch
Cutaneous Receptor Review
Ruffini endings
- deep layers of dermis:
- touch and pressure,
- adapt slowly,
- signal continuous skin deformation,(position sense)
Cutaneous Receptor Review
Krause’s End-Bulb: located in dermis
touch and pressure
Cutaneous Receptor Review
Meissner’s Corpuscles:located in dermis,
discriminative touch (texture), adapt rapidly, found the most where? Lips, toes, fingertips
Cutaneous Receptor Review
Pacinian Corpuscles: located in subcutaneous tissue and deep tissue (tendons, around joints)
- deep touch
- vibration,
- stimulate by rapid movement,
- adapt quickly
- Located in muscles, tendons and joints
- Muscle and joint receptors
- Affect posture, position sense , proprioception and direction of movement
- Includes muscle spindle, golgi tendon organs, free nerve endings, pacinian corpuscles and joint receptors
what receptors?
Deep Sensory Receptors
Joint receptors
- Golgi type endings: ligaments: detect rate of joint movement
- free nerve endings: joint capsule and lig., pain and crude awareness of jt movement
- Ruffini endings: joint capsule and lig., direction and velocity of jt mvment
Pacinian ending: jt capsule, monitors rapid jt mvmnt
Muscle Receptors
Muscle spindles
Monitors: change in muscle length, velocity of change
Golgi tendon organs
Prevent structural damage with extreme tension
(inhibits contracting muscle, facilitates antagonist)
Free Nerve Endings
Pain and pressure
Pacinian Corpuscles
Vibratory stimuli
Deep pressure
Pathways to transmit signals
Carried through ascending pathways in the spinal column
Comes into the _________root of the spinal cord
Ascends to higher centers
_DORSAL_
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