Week 8 (parts 1 and 2) Flashcards
(9 cards)
part 1
sensory training
what are the types of sensation
- Pain
- Proprioception
- Muscle strength and tension
- Fine pressure/ light touch
- Deep pressure
- Temperature
- 2-point discrimination
- Vibration
what is the anatomy of sensation
- Sensory receptor sends action potential up peripheral nerves/ neurones is sent down the arm and joins onto spinal cord at C8/T1.
- Light touch is received by dorsal column and interpreted by somatosensory primary cortex
what are the sensory cortexes
primary somatosensory cortex, secondary somatosensory cortex, primary visual cortex, secondary visual cortex, primary + secondary cortex, primary + secondary offactory cortex
Why is Treatment of Sensory Loss or impairment important?
Treatment:
Up until recently treatment of sensory loss was based on:
◦ Clinical experience
◦ Prevention of injury
Sensory stimulation/bombardment with differing textures was best practice but there was no evidence to support this
what is sensory bombardment/ sensory stimulation
- Passive approach providing different sensory modalities to the affected area.
- Techniques like rubbing, different textures, heat/cold exposure, pressures, vibrations, i.e. hand may be submerged in hot then cold water (but not too hot/cold to burn)
- Theoretical underpinning is that by providing high levels of stimulation to sensory receptors, there is increase in messages being transmitted to cortex and promotion of neuroplasticity to open or create new pathways.
- Some therapists will use this as a form of ‘Sensory Priming’ in the hope to increase sensory awareness within the cortex before undertaking motor relearning approach.
what is sensory Re-regulation/ De-stimulation
- Used particularly in severe brain injuries.
- This intervention utilises both sensory information from sensory pathways but also sensory information from the other 4 senses (what are these?).
- If there is significant environmental stimuli the severely injured brain is unable to filter out sensory information and respond.
- This intervention aims to reduce external environmental and physical stimuli before then providing targeted stimulus to try and elicit a response or change in behaviour from the patient.
- I.e., Patient on busy noisy ward, take them to a quiet gym, allow to settle in environment and then use different sensory stimuli (I.e. bell, temperature, pin prick, visual, strong flavour) to see if elicits a change in behaviour from baseline (I.e. increase in tone, limb movement, eye movement)
- If elicited, then would reduce stimulation in the environment and continue to utilise that stimulation to try and increase the behaviour.
what is the SENSe programme
- Recently Leeanne Carey and her team at the Florey Institute in Australia (I want to work there; they have Julie Bernhardt too!) have developed the SENSe programme to help rehabilitate sensation
what treatment can you use for limbs that need sensory training
o Select
o Choose the sensory modality to be trained
o Base this on the assessment and what you found to be impaired
o Use graded stimuli to treat the chosen sensory modality, but add variety
o Examples of modalities: texture, limb position sense, object recognition, occupation-based sensation – how can we grade these?
o Attentive Exploration
o Work with vision occluded
o Patient to provide response to what they can feel
o Feedback
o Provide feedback that is immediate and accurate
o Can be oral or visual
o Feedback on the best method of exploration for that patient
o Calibrate
o Allow the patient to calibrate with what is ‘normal’
o Via other hand, via vision or imagination
o Anticipate
o Let the patient know what to expect
o Use a limited number of anticipation trials
o Repeat and progress
o Training should be intensive
o Progress from easier to more difficult tasks
o Transfer
o Use a variety of stimuli so the patient can use what they have learnt in similar situations
o Give feedback on transfer to other skills
