sensory testing and reeducation Flashcards
What are the general principles
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
What happens in a CNS injury
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
What happens in PNS injury
follow nerve distribution
sensory re-ed is preferred
What is the sequence for return in PNS
- Crude touch and pressure
- tactile discrimination
- object recognition
What happens where there is sensory loss
fine motor control is impaired as well as manipulation of objects
how does loss of tactile and proprioceptive input affect function
know where your body is in space
what type of patients may have sensory impairments
CVA, SCI, compression injury
What often occurs in a PNS injury
hypersensitivity
What to do in PNS sensory re-ed
Desensitization
based on increasing pain threshold, and the idea progressive stimulation will allow progressive tolerance
What does PNS sensory re-ed include
massage
taping
rolling of different textures (soft to rough)
What is the goal of sensory re-ed
make interpretation off neural input more accurate
What are the best indicators of sensory return
monofilaments and 2 pt. discrimination testing
What to focus on in the early phase of sensory re-ed
pressure
localization of touch
moving touch
What does the later phase of sensory re-ed focus on
tactile discrimination
object recognition
What is the purpose of sensory testing
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
What does Dellon’s early stage of sensry re-ed consist of
Use pencil eraser for moving and constant touch nd touch localization
1st w/ vision, then w/out, then w/ to confirm
What does the late phase of Dellon consist of
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
What does Parry’s sensory re-ed focus on
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)
What does Turners sensory re-ed consist of
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
What to do for sensory training home programs
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
for compensation of PNS what should you avoid
exposure to heat, cold, sharp objects
Compensation for injuries to pNS
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
What is CNS re-ed based on
neural plasticity
What is important to do in CNS sensory re-ed
normalize tone before re-ed so you don’t increase spasticity
