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PHYSDYS

Assessing and Optimizing Sensation

TermDefinitionEx. relevant to OT practiceSuperficialDeepCorticalStimulus (S) Response (R)Scoring and Expected Results
SENSATION 1 ● “Sensibility” ● Influence motor and processing aspects → perception and motor skills ● Used to manage effective movement and to correct errors in movement through feedback ● Senses may affect performance in various areas of occupation.
SENSATION 2 ● W/ sensory loss, in the hand, fine coordination is impaired, manipulative ability is decreased. W/o enough tactile sensation, the force used to grip an object is either too high/low resulting in objects slipping from grasp ● Protects body from injury
Somatosensation = tactile + proprioception
Sensory Function ● Visual Functions Quality of vision, visual acuity, and visual field functions to promote visual awareness of environment at various distances for functioning
Sensory Function ● Hearing Functions Sound detection and discrimination; awareness of location and distance of sounds
Sensory Function ● Vestibular Functions Sensation related to position, balance, and secure movement against gravity
Sensory Function ● Taste Functions Association of taste qualities of bitterness, sweetness, sourness, and saltiness
Sensory Function ● Smell Functions Sensing of odors and smells
Sensory Function ● Proprioceptive Functions Awareness of body position and space
Body Function ● Touch Functions Feeling of being touched by others or touching various textures, such as those food; presence of numbness, paresthesia, hyperesthesia
Body Function ● Interoception Internal detection of changes in one's internal organs through specific sensory receptors (e.g., awareness of hunger, thirst, digestion, state of alertness)
Body Function ● Pain Unpleasant feeling indicating potential or actual damage to some body structure; sensations of generalized of localized pain (eg., diffuse, dull, sharp, phantom)
Body Function ● Sensitivity to temperature and pressure Thermal awareness (hot and cold), sense of force applied to skin (thermoreception)
SENSORY SYSTEM ● Center of receptive field ● Somatosensory: parietal lobe ● Somatotopic arrangement ● Sensory unit ○ May sineserve na area ng skin.
Receptive field ○ Has a center (more sensitive) and periphery ○ On the joints, it’s overlapped. ■ Kaya if we feel pain, hindi lang isang part yung masakit.
Innervation density ○ Depending on the representation on the primary somatosensory cortex (in the parietal) ○ More innervation density for fine motor
Types of Sensation: Constant touch or pressure Sensory Receptor: ● Merkel's Cell ● Ruffini's end organ Type of Afferent Neuron: Type A-beta slowly adapting I and II myelinated neurons Pathway: Ascend in dorsal column and medial lemniscus of spinal cord in posterior pyramidal tract, cross to opposite side in medulla Termination of Pathway: Thalamus and somatosensory cortex
Types of Sensation: Moving touch or vibration Sensory Receptor: ● Meissner's corpuscles ● Pacinian corpuscles ● Hair follicles Type of Afferent Neuron: Type A-beta rapidly adapting I and II myelinated neurons Pathway: Ascend in dorsal column and medial lemniscus of spinal cord in posterior pyramidal tract, cross to opposite side in medulla Termination of Pathway: Thalamus and somatosensory cortex
Types of Sensation: Proprioception and kinesthesia Sensory Receptor: ● Same as both moving and constant touch/vibration + touch receptors found in skin and joint structures ● Muscle spindles ● Golgi tendon organs Type of Afferent Neuron: Same as for moving touch/vibration plus A-alpha myelinated neurons Pathway: Same as for moving touch/vibration plus spinocerebellar tracts Termination of Pathway: Same as for moving touch/vibration plus cerebellum
Types of Sensation: Pain (pinprick) Sensory Receptor: ● Free nerve endings Type of Afferent Neuron: Type A-delta myelinated neurons Pathway: Immediately cross to opposite side and pass upward in anterior spinothalamic tracts of spinal cord Termination of Pathway: Brainstem, thalamus and somatosensory cortex
Types of Sensation: Pain (chronic) Sensory Receptor: ● Free nerve endings Type of Afferent Neuron: Type C unmyelinated fibers Pathway: Immediately cross to opposite side and pass upward in anterior spinothalamic tracts of spinal cord Termination of Pathway: Brainstem, thalamus and somatosensory cortex
Types of Sensation: Temperature Sensory Receptor: ● Free nerve endings ● Warm receptors ● Cold receptors Type of Afferent Neuron: Type A-delta myelinated neurons and type C unmyelinated fibers Pathway: Immediately cross to opposite side and pass upward in anterior spinothalamic tracts of spinal cord Termination of Pathway: Brainstem, thalamus and somatosensory cortex
SOMATOSENSORY SYSTEM ● Mechanoreceptors: touch, pressure, stretch and vibration ● Thermoreceptors: heating and cooling ● Chemoreceptors: cell injury or damage; stimulated by substances ● Nociceptors: pain
Sensory Disturbance: Paresthesia Tingling, electrical or prickling sensation
Sensory Disturbance: Hyperalgesia Increased pain; often occurs during nerve regeneration
Sensory Disturbance: Hypersensitivity Increased sensory pain
Sensory Disturbance: Dysesthesia Unpleasant sensation that may be spontaneous or a reaction to stimulation
Sensory Disturbance: Allodynia Pain caused by a stimulus that would not normally cause pain
Levels of Sensation ● Pain ● Thermal ● Light touch ● Pressure ● Proprioception ● Kinesthesia ● Vibration ● Stereognosis ● Two-point discrimination ● Barognosis ● Graphesthesia ● Recognition of texture ● Olfactory ● Gustatory
Superficial Sensations: Detected in our skin ○ First to check or evaluate
Deep Sensations : Detected in our joints and muscle ○ Tested especially when cortical is involved
Cortical Sensations: Require some processing by the cortex to discriminate one stimulus from another; are dependent on deep and superficial sensations ○ Cognitive or perceptual involvement
Stereognosis highest touch sensation (mahirap ibalik)
NEURAL PATHWAYS OF SENSORY STIMULI 1 ● Problems in any part of this pathway, will result in problems in sensation. ● In the case of burns, the receptors may be damaged. In some cases, peripheral nerves are affected just like in the case of nerve lacerations and compressions.
NEURAL PATHWAYS OF SENSORY STIMULI 2 ● For central nervous lesions like stroke/head trauma the terminal pathway is affected ● Table emphasizes it's vital to integrate what you have learned in Anatomy & Med Surg as this test and interventions may vary for prognosis and diagnosis for recovery
HIERARCHY OF SENSORY CAPACITY Top to Bottom: ● Recognition ● Quantification ● Discrimination ● Detection (single point stimulus) ● Since it’s a hierarchy, you need to acquire foundational skills first– the lower levels before going up.
Detection: : ability to identify a single stimuli, “may nararamdaman ba siya or wala?
Discrimination: ability to distinguish two stimuli, eg. sharp vs dull sensation, hot or cold
Quantification: ability to differentiate, different characteristics or strength of one stimulus, eg. arranging a set of objects from hottest to coldest, smooth to rough
Recognition: The highest level; ability to recognize objects by touch alone and is also called stereognosis.
ASSESSMENT OF SENSORY FUNCTIONS 1 PURPOSE ● Assess the type and extend ● Evaluate and document sensory recovery ● Assist in diagnosis ● Determine impairment and functional limitation ● Provide direction for occupational therapy intervention
ASSESSMENT OF SENSORY FUNCTIONS 2 PURPOSE ● Determine time to begin sensory re-education ● Determine need for education to prevent injury during occupational functioning ● Determine need for desensitization
SOMATOSENSORY DEFICIT PATTERNS Cortical: ● Brain lesion ● Stroke ● Sensory perception ● Depends on specific cortical area ● Sensory loss is more diffused Spinal: Follows dermatomal patterns Peripheral: Depends on the nerve(s) involved and its innervation
General Guidelines for Sensory Evaluation 1 ● Take note of the affected side Pain and temperature tactile sensation (light touch) and proprioception
General Guidelines for Sensory Evaluation 2 ● Test for light touch and pain (ASIA) stimulus to key sensory points for each dermatome in a rostral to caudal direction ● Also involves MMT Test bilaterally ●Protective sensation might need more sensitive evaluation
COMPONENTS OF SENSORY EVALUATIO ● Interview → standardized test → functional observation ● History Taking ● Sensory Test ● Sympathetic phenomen
History Taking and Interview 1 ● Client interview and review of medical reports ● Name, age, hand dominance, gender, occupation ● Date of injury, nature of injury ● Client description of the sensory problem and how sensation affects functional hand use
History Taking and Interview 2 ● Screening of motor function, and grip and pinch tests, if appropriate ● Any medications the client takes that may interfere with sensation should be noted
Sympathetic Phenomena ● Cutaneous sensory fibers and sympathetic fibers follow the same pathways ● Take note of the sympathetic signs (poor prognosis)
Sympathetic signs (poor prognosis) 1: ○ Vasomotor (skin temp, color, cold intolerance) ○ Sudomotor (abnormal sweating, lack of sweating) ○ Pilomotor changes
Sympathetic signs (poor prognosis) 2: ○ Trophic changes (decrease in nutrition with atrophy of nails, finger pulps, slower healing, hair changes) ○ Increased risk for injury and slowness of healing
Dry skin - indicative of poor tactile discrimination
GENERAL PRINCIPLES 1 ● Use clear and understandable instructions ● Do visual inspection first ● Matter of Fact - no emotions ● Stabilize the limb you are testing ● Make sure that the environment is free from background noise and free from distractions
GENERAL PRINCIPLES 2 ● Demo = With Vision, Test = No Vision ○ 10 trials on the unaffected then proceed to the affected side ● Stimulus application: Irregular patterns and not predictable, Catch trials ○ You have to apply randomly ● Test, retest
GENERAL PRINCIPLES 3 ● Unaffected → Affected area ● Avoid auditory cues or facial expressions ● Note any skin differences ● Ensure client’s comfort
GENERAL PRINCIPLES 4 ● OT: Use clear, understandable instructions in language cx can understand; cx: can understand instructions & use spoken language
STANDARDIZED TESTS FOR SENSATION 1 Sensory Test: ● Touch threshold ● Measure of threshold of light touch sensation Test Instrument: ● Semmes-Weinstein monofilaments ● Weinstein Enhanced Sensory Test (WEST)
Semmes-Weinstein Begin testing with filament marked 2.83; hold filament perpendicular to skin, apply to skin until filament bends. Apply in 1.5s, and remove in 1.5s. Repeat 3 times at each testing site, using thicker filaments if the patient doesn't perceive thin ones. Patient says, "yes" upon feeling the stimulus MAHABA LOOK KA SA TRANSES
WEST Patient is prompted to stimulus, and then filament is applied perpendicular to skin and held for 1 second, then slowly lifted. Catch trials consisting of prompt without filament applications are randomly inserted within test sequence. Patient responds with "yes" or "no" to indicate whether stimulus was felt. mahaba din, nasa transes beh
STANDARDIZED TESTS FOR SENSATION 2 Sensory Test: ● Static two-point discrimination ● Measures innervation density of slowly adapting fibers of the hand Test Instrument: ● Disk-Criminator ● aesthesiometer Begin w/ a 5-mm separation of points. Lightly apply 1 or 2 points in a transverse/longitudinal orientation of the hand; hold for at least 3s or until pt responds. Gradually adjust distance to find least distance that pt can correctly perceive two points. Patient responds by saying. "one," "two," or "I can't tell." transes
STANDARDIZED TESTS FOR SENSATION 3 Sensory Test: ● Static two-point discrimination ● Measures innervation density of quickly adapting fibers of fingertips Test Instrument: ● Disk-Criminator ● aesthesiometer transes Patient responds by saying. "one," "two," or "I can't tell." Score is smallest distance at which perception of 1 or 2 pts is better than chance. When the pt's responses become hesitant/inaccurate, require 2 of 3, 4 of 7, or 7 of 10 correct responses. Norms 2-4 mm for ages 4-60 yrs 4-6 mm for ages 60 yrs above
● Plantar has more threshold since it has more fats. ● Hold for 1.5 seconds ● Basis for sterognosis ● Usually only done in the fingertips ● Trial can be providing 2-point, 1-point, or none
STANDARDIZED TESTS FOR SENSATION 5 ● Hold for 3 seconds ● Moving: only in DIP; proximal to distal; transverse ● Static: proximal to distal; transverse
NON-STANDARDIZED SENSORY TESTING ● Superficial pain ● Temperature ● Two-point discrimination (static, moving) ● Touch pressure (light touch and deep pressure) ● Touch localization ● Proprioception ● Kinesthesia ● Stereognosis
SUPERFICIAL PAIN (PROTECTIVE) ● Materials: large safety pin, golf tee, or straightened paper clip ● Stimulus (S): large safety pin or straightened paper clip ● Response (R) : Ask client if the stimulus is “sharp” or “dull”
Intact protective sensation: correct responses for both types of stimulus
● Absent protective sensation: incorrect response to both sharp and dull
Hyperalgesia: if dull sensation is reported as sharp
(+) pressure sensation: if sharp sensation is reported as dull ● Alternate between sharp and dull and ensure that each spot has one sharp and one dull application.
Scoring for Superficial Pain ● (+S) correct response to sharp
Scoring for Superficial Pain ● (-S) no response to sharp
Scoring for Superficial Pain ● (D) sharp is reported dull
Scoring for Superficial Pain ● (+D) correct response to dull
Scoring for Superficial Pain ● (-D) no response to dull
Scoring for Superficial Pain ● (S) dull is reported sharp
Intact protective sensation Correct response to both sharp and dull ● 7/10
Impaired protective sensation Incorrect response to both sharp and dull
Absent protective sensation Inability to perceive being touched
Hyperalgesic Heightened pain reaction to the stimulus
THERMAL SENSATION ● Materials: Four test tubes (2 cm in diameter with stopper) (hot, warm, tepid, coldwater) ● Subtest I: ○ Cold (–45 F or 7 C) and Hot (–110 F or 43 C) ○ Place the side of the test tube to skin surfaces; ask if it is “hot” or “cold” ● (+) / (0)
Scoring for Thermal Pain ● (+) Intact correct response to BOTH cold and hot
Scoring for Thermal Pain ● (-) Impaired incorrect response to either or both
Scoring for Thermal Pain ● (0) Absent Felt nothing ★ If impaired or absent do not proceed to subtest II anymore
Subtest II: ○ After occluding the client’s vision proceed to touch the tubes and arrange them from hottest to coldest. ○ Proceed if client was (+) for subtest I ○ Ask client to touch the tubes and arrange them from hottest to coldest (L–R): yellow (hot), green (warm), orange (tepid), red (cold); ○ Normal hand can detect temperature 1 to 5 C apart
LIGHT TOUCH AND DEEP PRESSURE 1 ● Materials: Cotton swab, camel hair brush, or tissue ● Stimulus: (LT) light brushing and (P) pressing on the area until skin is blanched, ● Test uninvolved area first to establish standard
LIGHT TOUCH AND DEEP PRESSURE 2 ● Ask if the client can sense the stimulus; ● Light touch and deep pressure: Yes or no ● Hold for 1.5 seconds
Scoring for Thermal Pain ● (+) Intact Can detect stimulus
Scoring for Thermal Pain ● (-) Impaired Incorrect responses to stimulus
Scoring for Thermal Pain ● (0) Absent Cannot recognize stimulus
TOUCH LOCALIZATION ● Materials: Cotton swab, pencil eraser, camel hair brush, ● S: Light touch ● R: Ask if the client can sense the stimulus, then ask to locate ● Correct: within 1 cm of actual placement
Scoring for Touch Localization ● (+) Intact can recognize AND localize stimulus
Scoring for Touch Localization ● (-) Impaired can recognize stimulus
Scoring for Touch Localization ● (0) Absent CANNOT recognize and localize
PROPRIOCEPTION (POSITION SENSE) 1 ● Usually done for cortical affectations (Ex: Stroke) ● Test: Extremity or joint to be assessed is moved through a range of motion (small increments) and held in a static position ● Identify initial, mid, and terminal positions
PROPRIOCEPTION (POSITION SENSE) 2 ● Caution with hand placements ● Trial run ● Ask the client duplicate the position on the other side (Trombly)
Scoring for Proprioception ● (+) Intact Correctly identified/copied position
Scoring for Proprioception ● (-) Impaired Incorrect responses
Scoring for Proprioception ● (0) Absent Unable to detect
KINESTHESIA (MOVEMENT SENSE) ● Awareness of joint movement ● Extremity or joint to be assessed is moved through a relatively small ROM ● Caution with hand placements (over the bony prominences) ● Ask to describe the direction of movement (Trombly) ● Larger joints < smaller joints
Scoring for Kinesthesia ● (+) Intact Correctly identified/copied position
Scoring for Kinesthesia ● (-) Impaired Incorrect responses
Scoring for Kinesthesia ● (0) Absent Unable to detect
VIBRATION 1 ● Materials: base of vibrating tuning fork placed on the bony prominence (sternum, elbow, ankle) ● Random application of vibrating and non-vibrating stimuli
VIBRATION 2 ● Ear phones may be used to avoid any auditory feedback coming from the tuning fork ● For response: Ask if there is vibration felt or none or if “vibrating” or “non vibrating
Scoring for Vibration ● (+) Intact Correctly identified both stimuli
Scoring for Vibration ● (-) Impaired Incorrect responses
Scoring for Vibration ● (0) Absent Unable to detect
TWO POINT DISCRIMINATION 1 ● Materials: aesthesiometer or reshaped paper clip ● Apply the stimulus only on the fingertips not on the palm not on the length of the finger ● Measure of the smallest distance between two stimuli that can be recognized
TWO POINT DISCRIMINATION 2 ● Two ends are gradually brought closer ● Measure by a ruler and recorded ● Alternate one point and two points
STATIC TWO POINT DISCRIMINATION ● Start at 5mm between testing points ● Randomly test one or two points; maximum of 10 applications ● Ask the client to say “one” or “two”
Scoring for Static Two Point Discrimination ● Normal 1-5mm
Scoring for Static Two Point Discrimination ● Fair 6-10mm
Scoring for Static Two Point Discrimination ● Poor 11-15mm
Scoring for Static Two Point Discrimination ● (+) Protective Sensation only Only one point is perceived
Scoring for Static Two Point Discrimination ● Anesthetic No points felt
DYNAMIC (MOVING) TWO POINT DISCRIMINATION 1 ● Materials is same with static discrimination on this test ang magmmatter would be the manner of application as it is moving from proximal to distal ● Start at 5 to 8 mm; moving from proximal to distal on the distal phalanx in a linear fashion;
DYNAMIC (MOVING) TWO POINT DISCRIMINATION 2 ● If the client responds accurately, decrease the distance between the points and repeat the sequence until you find the smallest distance that the client can perceive accurately. ● Response: Ask the client to say “ one or “two”
Scoring for Dynamic (Moving) Two Point Discrimination ● Normal for ages 4-60 2-4mm
Scoring for Dynamic (Moving) Two Point Discrimination ● Normal for ages 60 and older 4-6mm
STEREOGNOSIS 1 ● Materials: Materials: variety of small, easily obtainable and culturally familiar objects ○ At least 5 objects ● Easy object like keys, coins,
STEREOGNOSIS 2 ● Having vision occluded, place in client’s hands client is allowed to manipulate and identify the objects ● Ask the client to name the object and verbally identify the object
Scoring for Stereognosis ● (+) Intact Correctly identified all materials
Scoring for Stereognosis ● (-) Impaired Incorrect responses
Scoring for Stereognosis ● (0) Absent Unable to identify
STANDARDIZED SENSORY TEST 1 ● Semmes Weinstein or Weinstein Enhanced Sensory Test (WEST) for touch threshold and touch localization ● Disk-Criminator or Aesthesiometer for 2pt discrimination
SENSORY TEST 2 ● The tests have varying thickness there as there are number that represent the force required ● You can determine the exact threshold for the part being tested
INTERVENTION STRATEGIES 1 ● To determinet the goal, you need to know the prognosis. ● How to analyze the result ○ Compensatory - diminished or lost protective sensation ○ Desensitization ○ Sensory Re-education
INTERVENTION STRATEGIES 2 ● If there is a decrease but not a total loss of sensation the patient may be a candidate of sensory reeducation as long as the prognosis indicates that there is a potential for improvement. ● If there is hypersensitivity desensitization is indicated
INTERVENTION STRATEGIES 3 ● While if there is loss of protective sensation it will indicate that the patient is at risk of injury. The patient is taught to use vision and adaptive environment to compensate for loss of sensation to avoid injury.
Choosing an Intervention Strategy ● based on the diagnosis, prognosis, and evaluation findings ● Compensatory ● Passive sensory training ● Active sensory training
Compensatory Diminished or lost protective sensation ○ Use other senses (ex. vision) ■ Use vision to inspect the specific area. ■ Goal: To avoid injuries
Passive sensory training: lost sensation but are expected to regain some sensory ability
Active sensory training: have some sensation and potential for better sensation or better interpretation of sensory information
Compensation ● Impaired or absent protective sensation ● Goal: To avoid injury ● Reliance on other senses ● Apply splint to active but insensate injured areas to prevent injury ● Apply lotion or oil for good skin hydration ● Regular visual inspection
5 mechanisms of damage to insensitive limbs: ○ continuous low pressure ○ concentrated high pressure ○ excessive heat or cold ○ repetitive mechanical stress ○ pressure on infected tissue
Strategies: continuous low pressure ● Frequent position changes ● Cushions help to distribute forces over larger areas
Strategies: concentrated high pressure ● Careful handling of sharp tools ● Use enlarged handles on suitcases, drawers, tools, and keys ● Use of vision
Strategies: extreme heat or cold ● Mitts, protective clothing wooden or plastic handles than metal
Strategies: repetitive motions and excessive friction ● Decrease repetitions by working for shorter periods, resting, using a variety of tools, or alternating hands or type of grip ● Use enlarged or padded handles on tools
Strategies: pressure on infected tissue ● Patient education on care for blisters, cuts, and bruises necessary to avoid infection ● Rest, free from pressure and overuse
Desensitization ● Hypersensitivity ● Goal: To decrease the discomfort associated with touch in the hypersensitive area ● Based on the belief that progressive stimulation will allow progressive tolerance
Techniques ● Wean away from protective device ● Outside -> toward the area of greatest sensitivity ● Constant is tolerable than intermittent contact ● Progress to next level if no irritation observed
Level 1 Tuning fork, paraffin, massage
Level 2 Battery-operated vibrator, deep massage, touch pressure with pencil eraser
Level 3 Electric vibrator, texture identification
Level 4 Electric vibrator, object identification
Level 5 Work and daily activities
Hierarchy of Texture and Vibration Used in Desensitization ● Level 1 Dowel Textures: Moleskin Immersion Textures: Cotton Vibration: 83 cps near area
Hierarchy of Texture and Vibration Used in Desensitization ● Level 2 Dowel Textures: Felt Immersion Textures: Terry cloth pieces Vibration: 83 cps near area, 23 cps intermittent
Hierarchy of Texture and Vibration Used in Desensitization ● Level 3 Dowel Textures: QuickStick Immersion Textures: Dry rice Vibration: 83 cps near area, 23 cps intermittent
Hierarchy of Texture and Vibration Used in Desensitization ● Level 4 Dowel Textures: Velvet Immersion Textures: Popcorn Vibration: 83 cps intermittent, 23 cps intermittent
Hierarchy of Texture and Vibration Used in Desensitization ● Level 5 Dowel Textures: Semirough cloth Immersion Textures: Pinto beans Vibration: 83 cps intermittent, 23 cps continuous
Hierarchy of Texture and Vibration Used in Desensitization ● Level 6 Dowel Textures: Velcro loop Immersion Textures: Macaroni Vibration: 83 cps intermittent, 53 cps intermittent
Hierarchy of Texture and Vibration Used in Desensitization ● Level 7 Dowel Textures: Hard Foam Immersion Textures: Plastic wire insulation pieces Vibration: 100 cps intermittent, 23 cps intermittent
Hierarchy of Texture and Vibration Used in Desensitization ● Level 8 Dowel Textures: Burlap Immersion Textures: Small BBs, buckshot Vibration: 100 cps intermittent, 53 cps continuous
Hierarchy of Texture and Vibration Used in Desensitization ● Level 9 Dowel Textures: Rug back Immersion Textures: large BBs, buckshot Vibration: 100 cps continuous, 53 cps continuous
Hierarchy of Texture and Vibration Used in Desensitization ● Level 10 Dowel Textures: Velcro hook Immersion Textures: Plastic squares Vibration: No problem with vibration
Hierarchy of Texture and Vibration Used in Desensitization ● Arrange the dowel textures and immersion textures according to their own perception ○ Safest would be ask the patient to order it from least to most irritating ● Uncomfortable but tolerable for 10 minutes 3-4x daily
Other Desensitization Techniques ● Continuous pressure ● Weight Bearing pressure ● Massage (2x daily) ● TENS ● Fluidotherapy ● Shower massager
SENSORY TRAINING ● Passive - with and without any sensation ○ Repetitive stimulation of the denervated part to maintain the cortical representation of that part before training it for active. ○ No attention required on the part of the patient
SENSORY TRAINING ● Active - with beginning return of sensation ○ Sensory Reeducation: techniques of attention, learning, repeated practice, and use of alternative senses to help the patient learn to reinterpret sensation ○ 5 to 15 minutes
SENSORY TRAINING ● Goals: To maintain or restore the cortical representation and to regain the use of sensation
SENSORY RE-EDUCATION ● Help pt w/ a sensory impairment learn to re interpret the altered profile of neural impulses reaching his conscious level ● Appropriate if: pt can perceive pinprick, temp, touch but impaired tactile localization, 2pt discrimination and tactile gnosis
Sensory Reeducation: Phase 1 ● Period following nerve injury or repair and before the start of reinnervation ● Goal: Maintain the cortical representation
Somatosensory cortex: activated by visual observation of touch (visuotactile interaction) or by listening to the sounds of touching (audiotactile interaction)
Sensory Reeducation: Phase 2 (1) ● Begins with the start of reinnervation of the hand ● Moving and constant touch sequence with eyes closed -> eyes open -> concluding with eyes closed ○ Unlike desensitization which is constant first then moving ● OR eyes open -> closed -> open
Sensory Reeducation: Phase 2 (2) ● Use of a smaller and lighter stimulus as the patient improves ● Touch localization -> Discrimination of similar and different textures -> graphesthesia -> stereognosis -> occupations ● 5-15 minutes ○ Unlike desensitization which is 10 minutes
Sensory Reeducation Principles 1 - Choose a quiet environment that will maximize concentration - Sessions should be brief, approx 5-15 mins - 3 or 4 practice or homework sessions per day are recommended
Sensory Reeducation Principles 2 - Instruct the patient and/or family in techniques to be used during practice - Monitor patient's home program and progress during therapy sessions
Prerequisites for Early-Phase Sensory Reeducation - Patient must be able to perceive 30 cycles per second vibration and moving touch in the area - Patient must be motivated and able to follow through with the program
Techniques for Early-Phase Sensory Reeducation 1 - Use the eraser end of a pencil - Apply moving strokes to the area - Use enough pressure for the patient to perceive the stimulus - Ask the patient to observe what is happening first and then close the eyes and concentrate on what it being felt
Techniques for Early-Phase Sensory Reeducation 2 - Instruct the pt to put into words (silently) what is being felt - Instruct pt to observe the stimulus again to confirm the sensory experience with the perception - When the perception of constant touch returns to the area, use similar process for constant touc stimuli - Test the pt by requiring localization of moving and constant touch without seeing the stimulus
Prerequisites for Late-Phase Sensory Reeducation - Patient must be able to perceive constant and moving touch at the fingertips - Patient must demonstrate good localization of touch
Techniques for Late-Phase Sensory Reeducation 1 - Use of a collection of common objects that differ in size and shape - Instruct pt to grasp and manipulate each item w/ open eyes. then w/ close eyes. and then w/ eyes open for reinforcement - The pt should concentrate on the tactile perception
Techniques for Late-Phase Sensory Reeducation 2 - Test the patient by timing correct identification of each object without vision - Grade the practice by introducing objects of similar size but different texture and then small objects that vary in size and shape but similar in texture
GOALS FOR SENSORY RE-EDUCATION EARLY PHASE: - Reeducate differentiation of moving vs constant touch - Reeducate incorrect localization
GOALS FOR SENSORY RE-EDUCATION LATE PHASE: To guide the patient to recovery of tactile gnosis (large objects with greater differences in size, shape or texture)
PRINCIPLES ● Each task is done with and without the use of visual feedback for maximal integration of learning ● Sensory reeducation needs to be continued for a long time (repetition is necessary)
GRADATION ● Gross to fine discrimination ● 3D to 2D ● Search by hand to search among objects
DESENSITIZATION ● Based on the belief that progressive stimulation will allow progressive tolerance
TECHNIQUES ● Wean away from protective device ● Vibration (tuning fork, friction massage, electric vibrator)
OTHER TECHNIQUES ● Continuous pressure ● Weight Bearing pressure ● Massage ● TENS ● Fluidotherapy ● Typing ● Washing hair ● Macrame (to encourage use of limb)
COMPENSATION ● Reliance on other senses ● Apply splint to active but insensate injured areas to prevent injury ● Apply lotion or oil for good skin hydration ● Avoid exposure to extreme temperature
Created by: avemaria
 

 



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When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

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