sensory testing and reeducation

Question 1

What are the general principles

Answer 1

quiet non-distractible environment
Use client friendly language
demonstrate 1st w/ vision then occluded
always test normal extremity 1st
explain the results and relate it to function

Question 2

What happens in a CNS injury

Answer 2

It is diffuse 
w/in brain/spinal cord
follows dermatomes and myotomes in SCI
Teach compensation (more preferred than sensory re-ed)
Eg. CVA SCI

Question 3

What happens in PNS injury

Answer 3

follow nerve distribution

sensory re-ed is preferred

Question 4

What is the sequence for return in PNS

Answer 4

1. Crude touch and pressure
2. tactile discrimination
3. object recognition

Question 5

What happens where there is sensory loss

Answer 5

fine motor control is impaired as well as manipulation of objects

Question 6

how does loss of tactile and proprioceptive input affect function

Answer 6

know where your body is in space

Question 7

what type of patients may have sensory impairments

Answer 7

CVA, SCI, compression injury

Question 8

What often occurs in a PNS injury

Answer 8

hypersensitivity

Question 9

What to do in PNS sensory re-ed

Answer 9

Desensitization

based on increasing pain threshold, and the idea progressive stimulation will allow progressive tolerance

Question 10

What does PNS sensory re-ed include

Answer 10

massage
taping
rolling of different textures (soft to rough)

Question 11

What is the goal of sensory re-ed

Answer 11

make interpretation off neural input more accurate

Question 12

What are the best indicators of sensory return

Answer 12

monofilaments and 2 pt. discrimination testing

Question 13

What to focus on in the early phase of sensory re-ed

Answer 13

pressure
localization of touch
moving touch

Question 14

What does the later phase of sensory re-ed focus on

Answer 14

tactile discrimination

object recognition

Question 15

What is the purpose of sensory testing

Answer 15

assist dr. in dx
baseline for tx and intervention
expectation for return to function
determine need for sensory re-ed or compensation
determine need for safety ed

Question 16

What does Dellon’s early stage of sensry re-ed consist of

Answer 16

Use pencil eraser for moving and constant touch nd touch localization
1st w/ vision, then w/out, then w/ to confirm

Question 17

What does the late phase of Dellon consist of

Answer 17

ID objects of different size
Move to objects w/ more subtle differences
Objects w/ different textures
progress to smaller objects that are different in many ways.
All 1st w/ vision, then w/out

Question 18

What does Parry’s sensory re-ed focus on

Answer 18

Focus on later stages
use blocks for retraining
describe properties of blocks (vision occluded)
Compares normal and affected hand
gradually introduce texture on blocks
then ID various textures on blocks
Move to common objects graded to size (larger to smaller)

Question 19

What does Turners sensory re-ed consist of

Answer 19

Later stages-starts when protective sensation is present
ID of objects graded as to size and properties w/ vision occluded
if incorrect, use vision and describe properties and try to feel/perceive them
All sensory retraining is one several times a day (Will have to send home program) Wh

Question 20

What to do for sensory training home programs

Answer 20

choose activities that provide challenge but also allow for success
Grade as appropriate
Start w/ few items to recognize and move to several
pt. can assemble their own collection from household items

Question 21

for compensation of PNS what should you avoid

Answer 21

exposure to heat, cold, sharp objects

Question 22

Compensation for injuries to pNS

Answer 22

Conscious awareness of force used for gripping 
Use built up handles
work simplification
change tools frequently 
watch for skin changes
frequent position changes 
good skin care techniques

Question 23

What is CNS re-ed based on

Answer 23

neural plasticity

Question 24

What is important to do in CNS sensory re-ed

Answer 24

normalize tone before re-ed so you don’t increase spasticity

Question 25

What does CNS sensory re-ed prevent

Answer 25

loss of function for individuals with CVA

Question 26

What to do in CNS sensory re-ed

Answer 26

focus on sensory input
allow sufficient time for responses
use weight bearing activities to provide sensory input 1st
follow a graded program 1st w/ vision then w/out

Question 27

What is the order you go in for the graded program for sensory re-ed

Answer 27

Tactile-provide objects for tactile exploration
Estimate quantities through touch
Discriminate b/t size and shapes, hidden in sand, beans, etc
Object recognition
Objects are graded as to texture, shape, size, etc

Question 28

Compensation for CNS

Answer 28

use other hand to assist-but want to encourage use of bilateral so they dont learn helplessness
use vision
use adaptive devices
educate as to safety- test water temp with unaffected side
Add textures to different surfaces such as handles

Question 29

What kind of pattern does sensory return follow

Answer 29

sequential

Question 30

Where is sensory re-ed usually more successful

Answer 30

PNS

Question 31

What is very important in both PNS and CNS sensor re-ed

Answer 31

Pt. education and safety