Treating Sensory Loss Flashcards
Why do we need to treat sensory loss?
To improve motor control
How do we experience sensation?
- Stimulation of peripheral receptors (Pacinian corpuscles, Meissner’s corpuscles, etc.)
- Ascend via peripheral nerve (1a, 1b and C afferents predominantly)
- Enter spinal cord via dorsal horn
- Ascend via medial lemniscus (touch), spinothalamic (pain and temperature) and spinocerebellar (proprioception) tracts to brain
- Relays information to somatosensory areas of the cortex (parietal lobe)
- This information is integrated with other afferent information to allow us to produce appropriate motor output
What are the types of sensation?
- Pain
- Proprioception
- Muscle Stretch & Tension
- Fine pressure/ Light touch
- Deep pressure
- Temperature
- 2-point discrimination
- Vibration
What happens in the body to feel sensations?
- Stimulus is detected by sensory receptor.
- Sensory receptor sends an impulse through action potentials up the arm along neurones towards the spine, along the ulnar nerve.
- Joins the spinal cord via a synapse.
- Moves up the dorsal column to the brain to the somatosensory primary cortex in the parietal lobe.
What is sensory bombardment/stimulation?
Passive approach providing different sensory modalities to the affected area.
What techniques are used for sensory bombardment/stimulation?
- Rubbing
- Different textures
- Heat/coldexposure
- Pressures
- Vibrations
(i.e. hand may be submerged in hot then cold water (but not too hot/cold to burn)
What is the theory behind sensory bombardment/stimulation?
By providing high levels of stimulation to sensory receptors, there is increase in messages being transmitted to cortex and promotion of neuroplasticity to open or create new pathways.
What is ‘Sensory Priming’?
The use of sensory bombardment/stimulation to hopefully increase sensory awareness within the cortex before undertaking the motor relearning approach
When is Sensory re-regulation/de-stimulation used?
Patients with severe brain injuries
What does the sensory re-regulation/de-stimulation aim to do?
- Reduce externalenvironmental & physicalstimuli
- Before then providing targeted stimulus to try and elicit a response or change in behaviour from thepatient.
- If elicited, then would reduce stimulation in the environment + continue to utilise thatstimulation to try + increase the behaviour.
(i.e., Patient onbusynoisy ward, take them to a quietgym, allow to settle in environment and then use different sensory stimuli (I.e. bell,temperature, pin prick, visual, strong flavour)to see if elicits a change in behaviour from baseline (I.e. increase in tone, limb movement, eye movement))
What are the 7 principles of SENSE treatment?
- Select
- Attentive Exploration
- Feedback
- Calibrate
- Anticipate
- Repeat & Progress
- Transfer
What is the ‘Select’ principle of SENSE treatment?
- Choose the sensory modality to be trained
- Base this on the assessment and what you found to be impaired
- Use graded stimuli to treat the chosen sensory modality, but add variety
What are some example of modalities which can be used in SENSE training?
- Texture
- Limb position sense
- Object recognition
- Occupation-based sensation
What is the ‘Attentive Exploration’ principle of SENSE treatment?
- Work with vision occluded
- Patient to provide response to what they can feel
What is the ‘Feedback’ principle of SENSE treatment?
- Provide feedback that is immediate and accurate
- Can be oral or visual
- Feedback on the best method of exploration for that patient
What is the ‘Calibrate’ principle of SENSE treatment?
- Allow the patient to calibrate with what is ‘normal’
- Via other hand, via vision or imagination
What is the ‘Anticipate’ principle of SENSE treatment?
- Let the patient know what to expect
- Use a limited number of anticipation trials
What is the ‘Repeat & Progress’ principle of SENSE treatment?
- Training should be intensive
- Progress from easier to more difficult tasks
What is the ‘Transfer’ principle of SENSE treatment?
- Use a variety of stimuli so the patient can use what they have learnt in similar situations
- Givefeedback on transfer to other skills
