Week 4: Assessment of Sensation Flashcards
T/F: All clients w/ sensory dysfunction regardless of etiology should be evaluated to determine occupational impact of loss
True
CNS or PNS injury? Likely to have deficits in prop and stereognosis
CNS
CNS or PNS injury? Likely to have deficits in touch pressure awareness and 2 point discrimination
PNS
Respond to touch, pressure, stretch, vibration and stimulated by mechanical deformation
Mechanoreceptors
Respond to cell injury or damage and stimulated by substances that injured cells release
chemoreceptors
Respond to stimulation of heating or cooling
thermoreceptors
Three receptors are called…
nociceptors (chemo, mechano, thermo)
Tingling, electrical, prickling sensation
Paresthesia
carpal tunnel, tapping volar aspect of wrist creates parethesia, it is referred to as…
Tinel sign
Increased pain and may occur during nerve generation
Hyperalgesia
Increased sensory pain
Hypersensitivity (desensitization helps normalize this)
Unpleasant sensation that may be spontaneous or stimulated
Dyesthesia
Pain in response to stimulus that is not normally painful
Allodynia (ex. person with complex regional pain syndrome experiences pain with mere movement of air wafting over involved arm)
Area of skin supplied by one spinal dorsal root and spinal nerve
Dermatome
Dysfcuntion of peripheral nervous system
Neuropathy (order of impairment associated with peripheral neuopathy loss is light touch, cold, heat, and pain (reversed for sensory recovery)
What is order of testing for neuropathy?
light touch, cold, heat, and pain
Light touch, cold, heat and pain testing for…
neuropathy
Order of testing for sensory recovery…
Pain, heat, cold, light touch
Pain, temperature, an touch are called _____ sensation
Cutaneous
T/F: proximal parts have higher density of receptors
False. Distal parts have higher density of receptors
What are indicators of sensory problems on skin?
blisters, altered sweat patterns, calluses, shiny or dry skin, scars , wounds
T/F: lack of sweating correlates with lake of discriminative sensation
True
T/F: Nerve damage results in atrophy of soft tissue
True
Before any sensory testing, what should you do?
Occupational profile: history, name, age, hand dominance, sex, occupation, date of injury, client description of sensory problem, screening of motor function, grip, and pinch tests if appropriate
How to test for pain?
Pinching digit firmly or by pinprick
What does pinprick rule out?
Digital nerve laceration
How does pain test work?
Test on uninvolved and to see how much pressure needed. Then press sharp and dull sides. If client indicates both they have intact protective sensation. Incorrect indicates absent protective sensation
How does temperature awareness testing work?
Also protective sensation (pinprick most used), have hot and cold water in tubes, on forearm, if they sense both, they have intact protective sensation.
How do you test for touch sensation?
two point discrimination
How do you test for protective sensation?
Pain (pinprick) and temperature awareness (tubes)
How does static two point discrimination work?
Using disk criminator, test on fingertips beginning at 5mm apart and do 10 applications, client will respond if they can feel 1 or 2. 1-5mm is normal, 6 -10 is fair, 11 to 15mm is poor
What is normal static 2 point discrimination?
1-5mm
How do you test moving 2 point discrimination?
Here, you can move distance between two points until client find the smallest distance. 2-4 mm is normal.
How do you test touch pressure?
Using a monofilament
How do you test proprioception?
Hold lateral aspect of elbow, wrist, or digit and flex or extend. If client can tell what movement it is, their prop is intact
What does the Dellon Modification of Moberg Pickup test test?
Stereognosis
What tests functional sensation?
Localization of touch (different from touch pressure because it tests tactical discrimination requiring cognitive components)
How do you test localization of touch?
Using monofilament, touch on hand grid and they point where you touched. If they can ID within 1 cm of actual placement, they have intact touch localization
This phenomenon inches processes of habituation, learning, memory, and cellular recovery following injury
Neuroplasticity
Regarding neuroplasticity… T/F? Sensory perception is dynamic process that is experienced in the PNS
False. Sensory perception is dynamic process that is experienced in the CNS
Regarding neuroplasticity… T/F? Receptor morphology is affected by hand use.
True. “Use it or lose it”
Regarding neuroplasticity… T/F? Single stimulus can excite different receptors
True
How does desensitization work?
Through habituation, decrease in response following repeated benign stimuli. ex) rubbing hand on textured shirt is desensitizing and can be performed everyday
T/F: stimulation and use of body part affect the cortical map
True
T/F: sensory re-education shown to improve sensation of fingertip replantations even without repair of nerves
True
What are some ways of protective sensory re education?
- don’t expose to sharp or cold/heat items
- soften amount of pressure when gripping
- use built up hands to distribute grip area
- examine skin for edema, redness, warmth, blisters, cut
- moisturize
T/F: a client who is not able to localize stimulus but can feel it is not candidate for discriminative sensory re education
False. Client can do discriminative sensory re education if they can feel pressure but not able to localize stimulus
If you can’t fasten bra, braid own hair, locate wallet, what sensation are you lacking?
Discriminative
What’s one way to do discriminative sensory re education?
Grade grossly dissimilar objects like spoon vs. penny and over time to more similar objects like dime and penny
T/F: Localization of moving touch tends to return after localization of constant touch
False. Localization of moving touch tends to return before localization of constant touch.
What are 3 categories of levels of difficulty in discrimination?
1) same or different
2) how they are same or different
3) ID the material
Examples of discrimination training?
Place object in part of hand and have patient and have them feel different items. ID objects out of box, retrieve objects from rice, perform ADLs with eyes closed
T/F: Light touch must be intact for two point discrimination to be test
True
What are 2 categories of sensory reeducation?
The two categories of sensory re-education are protective sensory re-education and discriminative sensory re-education. Protective sensory re-education is for people who cannot feel the sensation of the pain such as a prick, blisters forming, or hot and cold temperatures. Discriminative sensory re-education is when people can feel the sensation, but do not know which part of their body is feeling it
Name three signs that represent altered sympathetic nervous system status
Paresthesia, the tingling sensation, Hyperglesia, increased pain during nerve regenerated, and Dysethesia, the unpleasant sensation that can be spontaneous or stimulated.
Explain why finger tips have enhanced sensation when compared with more proximal body parts.
Finger tips have enhanced sensation compared to proximal body parts because distal parts have higher density of receptors and smaller receptive fields.
Explain how desensitization works.
Desensitization helps normalize the phenomenon of hypersensitivity. It is when the therapist uses stimulation and modalities that is a little more of an annoyance for the client as their tolerance increases.
