Week 8 - Sensation Flashcards
What are the 7 Principles of SENSe training?
- Select
- Attentive exploration
- Feedback
- Calibrate
- Anticipate
- Repeat and progress
- Transfer
In sense training, what are the three main things that the patient needs?
One side of the body must have normal sensation to enable neuroplasticity for the affected side
A good level of hearing and cognition
What are the three steps of somatosensory system?
- Receiving information
- Transfer of information
- Interpretation of information (sensory processing)
Describe a 1st order neuron
Cell body in the dorsal root ganglion, one axon connnected to a sense organ and one going to the spinal cord/brain stem.
Describe a 2nd order neuron
Cell body in the spinal cord/brain stem, axon crosses and goes into the contralateral thalamus
Describe a 3rd order neuron
Cell body in the thalamus, axon to primary sensory cortex
What sensory info is the lateral spinothalamic tract responsible for?
Pain and temperature
What sensory info is the anterior spinothalamic tract responsible for?
Light and crude touch
What sensory info is the dorsal column responsible for?
Discriminative touch (localisation of touch and vibration), conscience proprioception (proprioception and kinaesthesia) and stereognosis
What is the spinocerebellar tract responsible for?
Ipisilateral upper-extremity proprioception
What are mechanoreceptors responsible for?
Touch
- Fine touch
- Pressure
- Stretch
- Vibration
SUPERFICIAL - sensation from the skin
What are chemoreceptors responsible for?
Pain
They respond to substances released when a cell gets injured or infected
SUPERFICIAL - sensation from the skin
What are thermorecptors responsible for?
Temperature
They respond to stimulation of heating or cooling
SUPERFICIAL - sensation from the skin
What are nociceptors responsible for?
They are subset receptors to mechanoreceptors, chemoreceptors and thermoreceptors and are sensitive to stimuli that damage or threaten to damage stimuli
What is the Somatosensory System?
A term used to describe the transfer of sensory information from the skin and musculoskeletal systems
Most somatosensory info is not consciously perceived, rather it I processed at the spinal level or by the cerebellum to adjust movement and posture
What are three characteristics of the primary somatosensory cortex?
- Located post central gyrus of parietal lobe
- Projection to primary motor cortex and association areas
- Provides sensory input needed for motor planning, initiation and regulation of on-going movement
What can lesions in the primary somatosensory cortex result in?
- Contralateral sensory loss
- Uncoordinated movements
- Neglect
What type of sensory loss usually occurs with a stroke in the anterior cerebral artery (ACA)?
Contralateral lower extremity sensory loss
What type of sensory loss usually occurs with a stroke in the middle cerebral artery (MCA)?
Contralateral sensory loss of upper-extremity, lower extremity and facial regions
What two senses usually recover first after injury?
Pain and temperature usually recover before light touch and proprioception
What are some common behaviours associated with unilateral neglect?
- Not being aware of stimuli on the side opposite of the brain injury
- A bias in attention to information presented on the same side as the lesion
Describe unilateral extrapersonal neglect (spatial neglect)
- Inattention to visual stimuli presented in the contralateral extra personal space
- Can occur with or without deficits such as hemianopia
- Can occur together or seperate to unilateral body neglect (personal neglect)
- Can be near or far
Describe unilateral body neglect (personal neglect)
- Failure to respond or orientate to body side contralateral to the lesion
- Can occur together or seperate to extrapersonal neglect (spatial neglect)
Describe motor neglect
- The underuse of a contralateral limb that cannot be explained by primary sensorimotor deficits
- Attends when attention is drawn to it
What is the difference between a visual field loss and neglect?
Visual field loss is when a person has a deficit that impacts their sight (like hemianopia), where as neglect is a deficit in the way a person perceives sensory information
What is pusher syndrome?
A person who pushes and leans over towards their affected side.
Why is it important for OT to assess sensation?
- Determine at what time it is appropriate to commence sensory re-education
- Determine if there is a need for desensitisation
- Determine if there is a need for education about preventing injury during occupational functioning
- May require additional prompts and techniques to assist with moving the body in space
What is important to remember when assessing light touch and deep pressure using the neurophys?
- Need to start proximal and work distal
- Demonstrate first on the unaffected limb
- Be patient when the client is responding
What is important to remember when assessing sharp/dull discrimination using the neurophys?
- Need to remember it is about differentiating between sharp and dull stimuli, not the location of stimuli
What is important to remember when assessing sharp/dull discrimination using the neurophys?
- Need to remember it is about differentiating between sharp and dull stimuli, not the location of stimuli
What is important to remember when assessing temperature using the neurophys?
- Some kits for temperature testing do not have everything you need. In these instances, the use of small glass bottles with hot and cold water are appropriate
What is important to remember when assessing proprioception using the neurophys?
- Remember to position the affected arm, and wait three seconds before expecting the client to copy that position using their affected arm
What is important to remember when assessing kinaesthesia using the neurophys?
- Give the client time to respond and show clearly if their joint is moving up or down, wait between the movements and vary the degrees of movement
What is important to remember when assessing stereognosis using the neurophys?
- You need to move the object around in the client’s hand if they do not have the in-hand manipulation skills to do it themselves, you may have to play some objects in their hands more than once
What must the client have before assessing sensation?
A good level of hearing and cognition
What are the three main assessments of SENSe Assess
- Tactile Discrimination Test (TDT)
- Wrist Position Sense Test (WPST)
- Functional Tactile Object Recognition Test (fTORT)
