Sensation Evaluations and interventions

Question 1

What is tactile sensation?

Answer 1

Refers to the sense of touch, specifically the information received from varying pressure or vibration against the skin.

Question 2

what type of sensation is tactile?

Answer 2

somatic sensation, meaning it originates at the surface of the body, rather
than internally. (

Question 3

what does motor function rely heavily on?

Answer 3

sensory feedback

Question 4

what does peripheral sensation include?

Answer 4

touch and pressure awareness, temperature, pain, and two-point
discrimination.

Question 5

what is haptic perception?

Answer 5

Sense needed to determine force used in grip. Critical sense needed for successful and safe performance of daily activities

Question 6

where do we find receptors for tactile sensation?

Answer 6

within skin, muscles, and joints

Question 7

what is a sensory unit made up of?

Answer 7

sensory neuron and its distal
and proximal terminations

Question 8

what is an example of a cortical sensory deficit pattern?

Answer 8

stroke
head trauma

Question 9

what is a complete lesion SCI?

Answer 9

total loss of sensation

Question 10

what is an incomplete lesion SCI?

Answer 10

dependent on the area damaged within specific spinal tracts

Question 11

what is affected in an anterior incomplete lesion?

Answer 11

loss of pain, temp

Question 12

what is affected in a posterior incomplete lesion?

Answer 12

loss of touch, vibration, proprioceptio

Question 13

what does Anesthesia mean?

Answer 13

absent

Question 14

what does Paresthesia mean?

Answer 14

an abnormal sensation, “asleep” or “pins & needles”

Question 15

what does Hyperesthesia or Hypersensitivity

Answer 15

exaggerated sensation beyond expectation

Question 16

what do Merkel’s cell/Ruffini’s end organs/Meissner’s and Pacinian corpuscles/hair follicles sense?

Answer 16

mechanical information (moving or static touch, pressure, vibration)

Question 17

what are often classified as nociceptors?

Answer 17

free nerve endings/ thermal receptors

Question 18

what do nociceptors sense?

Answer 18

pain and temp

Question 19

what are Innervation density evaluations measuring?

Answer 19

Variation in the number of sensory units in a given area of skin

Question 20

what are Threshold evaluations measuring?

Answer 20

Level at which a stimulus can be detected

Question 21

what does Dysesthesia mean?

Answer 21

an abnormal pain sensation, e.g. “burning”, “sharp”, “stabbing”, usually associated with touch

Question 22

what does Allodynia mean?

Answer 22

pain from a non-painful stimuli

Question 23

can nerves regenerate?

Answer 23

yes! BUT they can get caught in scar

Question 24

what are Indications for Sensory Evaluation?

Answer 24

Known or suspected diagnosis that affects sensory system (e.g. SCI, peripheral
nerve laceration/compression)

• Observed OP dysfunction (e.g. poor object handling or manipulation)
• Client expression of odd/unpleasant sensations (e.g. aversion to certain
  materials of clothes, resistant to wearing splint)

Question 25

what is an example of a sensory assessment?

Answer 25

Wrinkle test

Question 26

what is the Procedure for Sensory Evaluation?

Answer 26

* Obtain history of health issue related to sensory deficits and functional challenges * Client should be relaxed, distractions eliminated, fatigue avoided, vision occluded; compare affected and non-affected sides if possible; avoid non-neutral position of head, neck, upper arm if nerve compression is an issue; avoid “sensory” confusion with accidental stimuli on other parts of the hand * General observation of task performance e.g. methods used, awkward, clumsy

Question 27

what are precautions for sensory evaluations?

Answer 27

Clients who are unable to cooperate or attend, are sedated or unable to comprehend assessment (possibly: receptive aphasia, dementia, or ABI) Clients with skin lesions, bruising, skin conditions, hypersensitivity, autonomic dysfunction/ symptoms (Possibly: Raynaud's Disease, CRPS

Question 28

what is an Observation & Sensory Screen useful for?

Answer 28

quick scan; no evidence linking abnormalities to dysfunction

Question 29

what are some visual observations we can look for during a sensory screen?

Answer 29

Vasomotor: temp, color, temperature sensitivity Sudomotor: sweating *Lack of sweating correlates with lack of discriminative sensation Pilomotor: goose bumps Trophic: nutrition of nails, finger pulps, hair growth

Question 30

what are special tests to conduct for sensation?

Answer 30

Tinel’s sign Phalen’s test Compression tests

Question 31

what are we looking for when doing special tests?

Answer 31

to reproduce or provoke symptoms of a specific nerve

Question 32

what nerve is flexed/compressed during the phalanx test?

Answer 32

ulnar nerve

Question 33

what are examples of standardized sensory tests?

Answer 33

Innervation Density: Moving two-point discrimination (m2PD), Static two-point discrimination (s2PD) Threshold Tests: Vibration sense (30/256 cps), Touch threshold (Monofilaments) * Touch Localization: location of perceived sensation using hand grid * Stereognosis

Question 34

what is the Recovery sequence (after complete nerve transection)?

Answer 34

pain moving touch light touch localization

Question 35

what does Two-point discrimination (moving and static) require?

Answer 35

cortical integration

Question 36

what is two-point discrimination (moving and static) useful for?

Answer 36

a measurement after nerve laceration and repair

Question 37

what are monofilament tests useful for?

Answer 37

a measure if early nerve compression is suspected

Question 38

what's the interpretation for monofilament number 2.83?

Answer 38

normal (WFL)

Question 39

what the interpretation for monofilament number 3.61?

Answer 39

diminished light touch

Question 40

what the interpretation for monofilament number 4.31?

Answer 40

diminished protective sensation

Question 41

what the interpretation for monofilament number 4.56?

Answer 41

loss of protective sensation

Question 42

what is the interpretation for monofilament number 6.65?

Answer 42

loss of all sensation except deep pressure

Question 43

what is the interpretation if there is no response to number 6.65?

Answer 43

absence of all sensation

Question 44

what is the treatment plan for Diminished or lost protective sensation?

Answer 44

Education – Compensatory techniques to avoid injury * Vision * Adapted environment/devices

Question 45

what is the treatment plan for Decreased but not completely lost sensation with potential for improvement?

Answer 45

Sensory retraining/re-education

Question 46

what is the treatment plan for Hypersensitivity?

Answer 46

* Desensitization program * Scar management

Question 47

what diagnoses is Sensory Training/Re-education commonly used for?

Answer 47

* Peripheral nerve injuries (e.g., nerve lacerations, nerve compressions, injuries resulting from replantation, toe-to-thumb grafting, skin grafting) * Stroke/Brain injury

Question 48

what are the goals of sensory training?

Answer 48

to maintain or restore the cortical hand representation and to regain the optimal use of sensation of the hand

Question 49

Hypersensitivity may result from the following diagnoses:

Answer 49

* Nerve trauma * Soft tissue injuries * Burns * Amputation

Question 50

desensitization is design to what?

Answer 50

decrease the discomfort associated with touch in hypersensitive area

Question 51

what is the Rationale for Desensitization?

Answer 51

Patients with hypersensitivity tend to avoid using the affected part in functional activities. Patients typically hold the affected part protectively. Hypersensitivity can lead to disability through nonuse. Desensitization is based on idea that progressive stimulation will allow progressive sensory tolerance

Question 52

what is the desensitization hierarchy?

Answer 52

* Level 1: heat/wax/warm water, light massage/touch * Level 2: deep massage, touch pressure with pencil eraser * Level 3: deep massage, towel/facecloth * Level 4: battery operated toothbrush, tapping, denim * Level 5: Work and daily activities* can be integrated in other levels through grading of these activities

Question 53

when is vibration recommended in the hierarchy?

Answer 53

at the end as this can be very uncomfortable for many