Sensory Testing Flashcards
What are sensory abilities?
Pain - differentiation between sharp and dull
Light touch
- localization
- moving touch
- stationary
Temperature
Vibration
Proprioception
Reflexes
Why do we do sensory testing?
Individuals with muscle weakness often have peripheral nerve problems.
Decreased sensation is often a safety issue and may not be apparent to the client.
Can interfere with function
May be a problem we can impact
- assist in the diagnosis
- accommodate
- rehabilitate
What types of injuries cause sensory issues?
Peripheral nerve injury
- you will see sensory loss along the distribution of that nerve, usually unilateral
Nerve root
- loss of sensation in the dermatome of the affected nerve root, typically unilateral
Spinal cord
- depends on all or part of the cord is damaged
- based on the tracts that are damaged
Brainstem
- sensory loss of the contralateral side and cranial nerve sensory disturbances on the ipsilateral side
Cerebral cortex - strokes
- sensory loss in the contralateral limbs
Lesion to posterior column
Leads to bilateral loss of proprioception, vibratory sense, and two point discrimination below the lesion
Damage to anterolateral tract
Loss of pain and temperature sensation on the contralateral side below the level of the lesion
Complete spinal cord injury
Lose all sensory modalities bilaterally
Hyperesthesia
Abnormal pain
A heightened response to sensory input
Hyperpathia
Overly sensitive to pain
Neuralgia
Shock like pain along a dermatome or peripheral nerve distribution
Dysesthesia
Numbness, tingling, or burning in the absence of stimulation
Sometimes called parethesia
When do we assess sensation
General overview as part of client interview
When directed by a client’s history, diagnosis, or disease
If it is expected to be an issue with the diagnosis.
General principals of sensory testing
Testing is specific to the client
- not typically compared to a norm (Semmes Weinsten is the exception)
Client should be comfortable
Explain the procedures to the client
Vision should be obscured
Test from normal to impaired area (move from center out)
Area of “normal” should be the standard
Keep careful notations
Equipment should be sterilized or disposed of after each use.
Possible problems with sensory evaluation
Tactile agnosia - inability to recognize objects through touch
- PNS
- CNS
- cognition
- fear
- desire to please
Hierarchy of sensation
- Deep pressure
- this is not completely cutaneous - Protective sensations
- pain and temperature - 30 Hz vibration
- Moving touch
- Constant touch
- 256 Hz vibration (smaller tuning fork)
- Touch localization
- Two point discrimination
- moving
- constant - Stereognosis
Sensory retraining
Therapist does it
Client does it
Therapist does it while client closes eyes
LEAP testing
Lower extremity amputation prevention
5 steps:
1. Annual foot exam with 5.07 monofilament
2. Patient education
3. Daily inspection
4. Footwear
5. Management of small issues
- barefoot
- toenails
Testing of protective sensation: pain
Most basic
Tested subjectively by asking client, often use analog scale
Tested by sharp/dull
- use safety pin
- test an undisturbed area first so they know what to expect
- have patient cover their eyes
- follow sensory map to assess area of disruption
- if you get conflicting info back up and retest
- dispose of safety pin
Testing of protective sensation: temperature
Hot/cold
Use glass tubes or a testing kit
- can use spoons in a pinch
Test exactly like you do for pain, but allow contact for 2-4 seconds
Map areas carefully
Vibration
Using a tuning fork
- 30 Hz is felt first
- 256 Hz comes in later
“Tell me STOP when you feel vibration stop”
Test on chin or sternum for practice
Have them close their eyes
Strike fork and touch boney prominence, when they say “stop,” immediately go to the other side. If they feel the vibration for more than 1-2 seconds on unaffected side, the test is positive for sensory loss.
Move proximal to distal
Typical test pattern for vibration
LE - distal phalanx of big toe, medial malleolus, knee, ASIS, spinous process of lumbar vertebra
UE - DIP of index, ulnar styloid, olecranon process, acromion process, spinous process of cervical vertebra
Test for light touch
You feel moving before you feel static
Use a piece of cotton
“Say yes each time you feel a touch.”
- moving first
Start at suspected area, move toward normal
Carefully map and compare to dermatome and peripheral nerve charts
Check moving and constant
Test for touch localization
Use the eraser end of a pencil
Use about as much pressure as if you were mashing a key on a keyboard
Have the client close their eyes
- touch spot and then have the client touch the same spot with their other hand
The client should be within 1-2cm
Agraphagnosia
inability to recognize letters traced on the skin
Test for two point discrimination
Also called the Dellon Two Point Test
Moving and constant, moving comes first
Primarily used to assess the UE, specifically fingertips.
Use a disK-criminator
- spaced from 1-15mm apart, as well as 20 and 25mm
The
Moving two point distcimination test
Norms:
Normal ~ 2-3mm
Fair ~ 4-6mm
Poor ~ 7-9mm
“Tell me if you feel one or two points.”
Place one peg on the DIP joint and drag toward the end of the digit, roll between the 1 and others until you get the lowest consistent number
Keep perpendicular to the surface
Static two point discrimination test
Just like the moving, except you don’t move
Make sure points are perpendicular to the surface
Norms:
Normal~1-5
Fair~6-10
Poor~11-15
Non functional~16+
Stereognosis
The ability to identify items with out looking
Use a screen to block vision
Use 5-10 items that are similar in size
Have client tell you what it is
Proprioception
Where the body is in space
Can be done with any body segment
Grasp the segment on the boarder opposite of what you are testing
Have the patient watch you move the segment and tell you “up or down.” Then have the client close their eyes and repeat.
Semmes Weinstein Monofilament Test
Short and long version
Used primarily with the hands and feet
Make the patient comfortable
Explain the procedure, tell them to say “yes” when touched
Press the monofilament at a 90º angle, enough to bow it
- hold for 1.5 seconds
- can repeat up to 3x
Map clearly the problem areas
Risk of injury
Semmes Weinstein Categories
Patellar tendon reflex
Neurological integrity of L4
- supine or seated
- knee is flexed and quads relaxed
- with broad side of hammer, whack the patellar tendon, slightly below the patella
- should see knee extension
- Distract by having them hold hands and pull
Achilles tendon reflex
Integrity of S1
- prone, supine, or seated
- flex knee to 90º, gently stretch the foot into dorsiflexion
* holding too hard will mask the effect
- tap the achilles tendon with the broad end of hammer
- should see plantar flexion
Bicep brachii reflex
Integrity of C5
Forearm rested over your arm, your thumb over the biceps tendon
Strike your thumb with the small end of the hammer
Should see elbow flexion
Clench teeth
Brachioradialis reflex
Integrity of C6
Position just like biceps
Strike the radial side of forearm, just above the radial styloid
Should get elbow flexion
Triceps reflex
Integrity of C7
Basically the same as biceps
With small end hit the triceps tendon
Should see extension