Sensory and Postural Deficits: Exam 1 Flashcards
(70 cards)
1
Q
Somato-sensory impairments
Pt may exp. LOSS of what?
A
-
Sensation
- tactile
- proprio
- pain/temp
- vis. field
- Perception
- Cognition
**MAJOR cause of disability
2
Q
Somatosensory impairs are often neglected in therapy
Implications?
A
- fork slips out of hand
- not knowing if knee will buckle
- lack of confidence
- Pt may adapt to one-handed function OR give up attemping tasks (stairs for ex.)
- NOT GOOD !!!
3
Q
Tactile Impairments include…
A
- Localization and discrimination of stimuli
- Stereognosis
- recognizing obj. in your hand
- 2-pt discrim
- 2.83, 3.22
- <5mm-5mm===normal
- correlation b/w recovery in hand and touch sensibility
4
Q
Stereognosis
A
-
Tactile ID of common objects
- recognition phys objects
- recognition nature of objs
- NOT innate ability
5
Q
What is the ABSENCE of Stereognosis ?
A
Astereognosis
6
Q
2-pt. Discrim.
Ability to recognize what?
A
2 points when simultaneously applied
VISION OCCLUDED!!!
7
Q
2-PT Discrim.
when can 2 poins be felt as 1?
A
IF they are in close proximity
8
Q
W/ ANY Sensation test OTHER THAN VISION
A
EYES CLOSED!!!
9
Q
Proprio. Impairments
impairment in recognition of……
A
Direction
Pos. in space
10
Q
Proprio impairments are most obvious where?
A
DISTALLY
ankle, wrist
11
Q
Often involved in proprio impairments
A
kinesthesia
12
Q
Proprio. is crucial for what ?
A
Balance
Manipulative actions
13
Q
Central Pain or….
A
Thalamic Pain
Awful!!!
- 2% pts following CVA
- More common in L. Hemiplegia
14
Q
Peripheral pain often comes from….
A
2* complications
15
Q
Explain Central Pain aka Thalamic Pain
A
- burning (dysesthesia), unpleasant tingling, pins, needles, numbness
-
Exaggerated by:
- mvmt
- stress
- lt. touch
16
Q
Some ways that we can examine Sensory Impairs
A
- Lt touch (DCML)/Sharp-Dull Discrim (spinothalamic)
- Heat/Cold
- Sense of passive mvmt and pos.
- Vibration
- Tactile
- stereognosis
- 2-pt discrim
-
PAIN
- Quant/Qual
17
Q
Visual Impairments can involve 2 things:
A
- Reception of input to the eye due to retinal dysf.
- Perceptual-cognitive
18
Q
Remembe w/ visual impairs that…..
A
pre-existing cond. may exist
19
Q
W/ visual impairments make sure you consider…..
A
glare
lighting
20
Q
Crucial that you distinguish visual impairments from….
A
NEGLECT
- lack of awareness 1/2 of body and proprio representation
- They Completely ignore it
21
Q
Ex. of Visual Field Defs
A
-
Homonymous Hemianopsia
- ”same side 1/2 no eye”
22
Q
Homonymous hemianopsia is NOT
A
Neglect
23
Q
In Homonymous Hemianopsia
what is lost?
temporal field vs. nasal field
A
Lose temporal field on LEFT
Lose nasal field on RIGHT
24
Q
Loss of vision in same side of ea. eye
A
Homonymous Hemianopsia
25
Visual Pathway
COME BACK TO THIS AND RE-WATCH WHAT HE SAYS !!!
SEE PICS
26
Disruptions in the visual pathway
MAKE MORE CARDS ON THIS!!!!!!!!
see pics
27
Visual Field Testing
What does that look like?
See pics!!!
28
perceptual-cognitive defs are defs in the interaction b/w.....
perception and cognition
29
**Perception** is the ability to ______ and ______ sensory info.
**process and interpret sensory info.**
30
Cognition is the ability to ______ and ______ INFORMATION
JUST information\*\*\*
process and interpret INFORMATION
just INFORMATION
31
**Perceptual-Cognitive Impairs**
4 disorders/impairments
* Body Scheme Disorders
* Spatial Relations Disorders
* Agnosia
* Apraxia
32
Perceptual-Cog Impairs
## Footnote
**Body Scheme Disorders**
Unilateral Neglect
R and L Discrimination
33
Agnosia or...
inability to recognize **familiar objects**
## Footnote
**ex. toothbrush, hairbrush**
34
Apraxia
Inability to perform **purposeful, skilled motion,** in the presence of **adequate strength, sensation, coordination**
* NOTE: **often shows when CHALLENGED** **to do activity**
* **ex. "get up and walk"**
* **cannot do it**
35
Ex's of test results w/ **unilateral neglect**
they often cannot "finish" things on the **side neglected**
see pics
36
Tx of **Somatosensory impairments**
## Footnote
**somatosensory impairs CAN improve.....**
**b/w R and L what side usually can improve more?**
L. Hemiplegia \< R. Hemiplegia
37
Somatosensory Impairments
## Footnote
**Principles of Tx:**
* Session **starts and ends** w/ **tasks the pt CAN do**
* Tasks should be **interesting** to the pt
* **Vision** and **use of UNAFFECTED hand** to teach **perception**
* **Freq. rests utilized!!!!!!!!!**
38
What would be some **suggestions for Tx. w/ Somatosensory Impairs?**
* ID # of touches or lines------read article!!!
* ID letters and #'s drawn on arm or hand
* Find your thumb when **blindfolded**
* Discrim. of **shape, wt, texture** of obj's OR **materials placed in hand**
* **Passive drawing**
39
Somatosensory Impairment Tx's
## Footnote
**Specific UE tasks**
* Discrim. common objs thru **tactile sense only**
* **Hand-eye coord.**
40
Somatosensory impairments Tx:
## Footnote
**Activities to address _Neglect_**
* FORCING USE OF LIMB
* **Wt. bear**
* **Standing**
41
Somatosensory impairments Tx
**Visual tasks**
* Reading
* Scanning
42
**Postural orientation** is the orientation of body to....
body to **environment**
43
Postural stability===Balance
2 components:
**Static** and **Dynamic EQUILIBRIUM**
44
Postural Control=====\>
Orientation + Stability
45
Postural Control
what 2 systems are involved?
MSK system
NMSK system
46
The **Neuromuscular system** specifically is ability to **coordinate what ?**
muscle synergies
47
Postural deficits can include what?
4 things
1. **Sequencing** prolems---**activate @ right time**
2. **Activation** of **postural responses**
3. **Scaling** of mm activity
4. **Adaptation** of motor responses
48
Postural orientation:
## Footnote
**Static is...**
Maintain **vertical** orientation
49
Postural Orientation:
## Footnote
**Motor Mechanisms**
* spontaneous **postural sway**
* alignment
* Postural **tone**
## Footnote
****
50
Postural Orientation:
## Footnote
**Sensory Mechanisms:**
**3**
* visual
* vestibular
* somatosensory
51
Postural orientation
Explain the **Typical Development**
* Righting rxns
* keeps you in vertical
* Protective Extension
* Equilib rxns
52
Postural orientation
what kind of **progression** should there be?
Cephalocaudal progression
"head to tail" progression
53
In terms of Postural Orientation
## Footnote
**Adult-like mvmt patterns @ when?**
7-10yrs
54
Postural orientation
Normal aging process that certain things are **lost/affected**
**Systems affected?**
* MM strength
* disproportionate loss of **fast-twitch fibers**
* **LESS amp, SLOWER rxn times**
* **ROM**
* **Sensory**
* **impaired, less info for change in pos's**
55
Postural orientation
Aging process and **Postural sway**
INC'd sway
56
Abnormal Posture
## Footnote
**Many pot. variations ....**
* lean towards INVOLVED
* lean towards UNINVOLVED
* **Dependent on patho.**
* ****PD
* CP
* CVA
* **knee hyperext, Pusher syndrome**
57
Pusher Syndrome aka...
**Contraversive Pushing**
58
Pusher syndrome
Pt pushes forcefully **w/ the non-paretic extremities** TOWARDS **paretic side**
59
Pusher syndrome is likely due to damage where?
Ventral Posterolateral Nucleus of Thalamus
60
When Pusher Syndrome is on the **RIGHT**
## Footnote
**assoc'd w/....**
Neglect
61
When Pusher Syndrome on **LEFT**
## Footnote
**assoc'd w/**
Aphasia
62
In Pusher Syndrome....
person feels that **their upright** is shifted by __________ from midline, thus they pushing to **restore their perceived midline BACK to vertical**
18-20 degrees
63
Posture: Examination
Alignment should be in what?
Sitting or standing use a **plumb line/grid**
64
Posture Exam:
Consider these things (balance support)
Foot position
BOS
65
Posture exam:
wt. scales under ea. foot
why would you do this?
See if there is even distribution of wt b/w both sides or if they are leaning/overusing one side
66
Posture Exam:
we want to attempt to **standardize measurement**
**meaning?**
Make sure that whatever we use is REPRODUCABLE
67
Posture: Tx
We want to **develop an initial position that will allow.....**
3 goals of Tx
* Develop initial position
* that is appropriate for **functional task**
* is **efficient**
* is **stable**
68
In Symmetrical/Vertical Posture
What kind of **feedback** would you give?
verbal cues
manual cues
visual cues
69
Symmetrical/vertical posture
practice this way!
* eyes open/closed
* **consider effect of AD's**
70
