Sensory Examination LECTURE 1 Flashcards
1
Q
Sensory Integration: What is it?
A
CNS takes in all sensory information
- Environmental input
- Movement, touch, body in space, sight, sound and smell
- The brain must take in and analyze the sensory input so the reaction to it can be appropriate
- Definition: “is the ability of the brain to organize, interpret, and use sensory information”
2
Q
Movement
- Motor task is _______
- Learn to anticipate what will happen?:
- Feedback IS ?
- Feed forward IS?
A
- practiced
- correct movement will occur
- learning in the moment
- learning in the moment
3
Q
- Guides the motor response to interact with the environment
- Adapt movements
- Protect the person from injury
A
Sensation
4
Q
- Sensation received from skin and musculoskeletal system
- Test the sensory system: need to determine the patients ability to interpret and discriminate incoming sensory info
A
Somatosensory
5
Q
If abnormal motor behavior, could be from poor______ ________.
A
sensory input
6
Q
What does the brain do with the information??
A
- Correlate sensory input with motor output
- Assess and control body’s interaction with the environment
7
Q
Clinical Indications for sensory testing
A
- Depends on information provided in the intake
- Symptoms described by the patient
- Signs elicited during other testing and observations
- Other information
8
Q
- Associated with pathology or injury
- May affect peripheral nervous system or central nervous system, or both
- Can affect ANY PART of the nervous system
- Injury, infection, compression, nutritional deficiency, injuries to nerves, CVA, TIA, MS, TBI
- Look at the PATTERN of sensory involvement
- Does it follow a peripheral or central pattern??
A
Sensory dysfunction
9
Q
Crosses more than one dorsal root
Examples: ulnar nerve injury vs C-8
Supraclavicular nerve vs C 5,6,7
A
Peripheral nerve innervation
10
Q
Specific nerve injuries
A
- Diabetic: glove and stocking distribution
- Multiple Sclerosis: scattered pattern of involvement
- Spinal Cord Injury: diffuse pattern of sensory involvement
- Can by symmetric or asymmetric
- Guillen barre syndrome
11
Q
Spinal cord tracts
A
- Anterolateral tract
- Dorsal column
- Nerve root
- CNS lesion
Spinal cord tracts carry somatosensory and special sense information- can have damage at the tract which will manifest into various signs and symptoms
12
Q
Age related changes
A
- Normal age related changes versus changes specific to illness/pathology
- Normal aging affects vision, hearing and somatosensory system
- Changes affect the health of the elderly patient
13
Q
With aging what might you see due to sensory changes?
A
- Postural instability
- Increased body sway
- Balance issues
- Wide based gait
- Decrease in fine motor abilities
- Can’t recognize body positions
- Decrease in muscle mass
14
Q
How do we accurately test a patient?
A
Testing for sensory problems
- Do preliminary testing to determine if sensory testing will be accurate
- What do you need to know?
15
Q
What are the states of arousal?
A
Alert:
Lethargic:
Stupor/semicoma:
Coma:
16
Q
Alert and attentive
A
- If alert: can obtain reasonable information about somatosensory system
- Attention: selective awareness of environment
- can respond to a task without being distracted by other stimuli
Increase attention by having patient repeat longer lists of items
17
Q
Orientation
A
- Is the patient aware of time, person and place (A&Ox3)
- If not completely oriented, list what person is not oriented to
What is the 4th orientation? WHY THEIR THERE
18
Q
Memory
A
- Long term memory: ask questions about remote past
- Short term memory: difficult to remember directions or follow any directions
- Test short term memory by asking pt to repeat a series of words. Have them repeat it a few minutes later (less than 5 minutes)
- Can ask again 30 min later: get 2 items of 3 right
19
Q
Hearing
A
How do they respond to your voice?
Note if you alter the volume or pitch
20
Q
Vision
A
- Make sure pt uses glasses
- Peripheral field: sit in front of patient and bring fingers in from side toward midline
- Depth perception: hold two items in front of patient, which is closer?
21
Q
Sensory testing
A
- Patient needs to be able to respond
- Needs to be alert and oriented; have good attention, cognition and memory
22
Q
Modality of sensation
A
- A general class of stimulus
- Determined by type of energy transmitted by the stimulus and receptors specialized to sense that energy
23
Q
Modalities of sensation include:
A
- vision
- taste
- hearing
- smell
- pain
- temperature
- proprioception
24
Q
Superficial and Deep sensation:
Extrareceptors: describe
A
- Superficial stimuli
- Located in skin and subcutaneous tissue
- Perceive light, pain, temperature, touch, pressure
25
_Superficial and Deep Sensation_
Proprioceptors: describe
* Deep sensations
* From muscles, tendons, ligaments, joints, fascia
* Position senses, kinesthesia, vibration
26
_Combined cortical sensation_
* Combines the information you get from superficial and deep information
* Information is combined and analyzed in cortical sensory association areas of brain
These include:
1. stereognosis
2. two-point discrimination,
3. Barognosis,
4. graphesthesia,
5. tactile localization,
6. analyze texture,
7. double simultaneous stimulation
27
_Spinal Pathways_
Information from sensory receptors-through nerveenter spinal pathwayto brain
what are the 2 pathways
1. Anterolateral spinothalamic tract
2. Dorsal column-medial lemniscal system
28
Types of sensory receptors
name 5 types
1. Mechanoreceptors
2. Thermoreceptors
3. Nociceptors
4. Chemo receptors
5. Photic/electromagnetic receptors
29
_Cutaneous Receptor Review
_
what do Free nerve endings do?
1. perceive pain,
2. touch,
3. temp.,
4. pressure,
5. tickle,
6. itch
30
Cutaneous Receptor Review
Hair follicle endings
* mechanical movement
* touch
31
Cutaneous Receptor Review
Merkyl’s discs: below epidermis in smooth skin
1. low intensity touch,
2. velocity of touch,
3. constant pressure on skin (important in 2 pt discrimination,
4. localizing touch
32
Cutaneous Receptor Review
Ruffini endings
1. deep layers of dermis:
2. touch and pressure,
3. adapt slowly,
4. signal continuous skin deformation,(position sense)
33
Cutaneous Receptor Review
Krause’s End-Bulb: located in dermis
touch and pressure
34
Cutaneous Receptor Review
Meissner’s Corpuscles:located in dermis,
discriminative touch (texture), adapt rapidly, found the most where? Lips, toes, fingertips
35
Cutaneous Receptor Review
Pacinian Corpuscles: located in subcutaneous tissue and deep tissue (tendons, around joints)
1. deep touch
2. vibration,
3. stimulate by rapid movement,
4. adapt quickly
36
* Located in muscles, tendons and joints
* Muscle and joint receptors
* Affect posture, position sense , proprioception and direction of movement
* Includes muscle spindle, golgi tendon organs, free nerve endings, pacinian corpuscles and joint receptors
what receptors?
Deep Sensory Receptors
37
Joint receptors
* Golgi type endings: ligaments: detect rate of joint movement
*
free nerve endings: joint capsule and lig., pain and crude awareness of jt movement
* Ruffini endings: joint capsule and lig., direction and velocity of jt mvment
Pacinian ending: jt capsule, monitors rapid jt mvmnt
38
Muscle Receptors
_Muscle spindles_
Monitors: change in muscle length, velocity of change
_Golgi tendon organs_
Prevent structural damage with extreme tension
(inhibits contracting muscle, facilitates antagonist)
_Free Nerve Endings_
Pain and pressure
_Pacinian Corpuscles_
Vibratory stimuli
Deep pressure
39
_Pathways to transmit signals_
Carried through ascending pathways in the spinal column
Comes into the \_\_\_\_\_\_\_\_\_root of the spinal cord
Ascends to higher centers
\_DORSAL\_
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