Transcript
PT EVALUATION:SENSORY ASSESSMENT
PT EVALUATION TEAM
“Motor learning is highly dependent on sensory information and feedback mechanism”
SENSORY SYSTEM
Functional impairment Prone to injury
AGING Injury to the Body
PURPOSE OF SENSORY ASSESSMENTAssist in determining source of motor deficit
Appropriate treatment and safety precaution
Determine integrity of sensory integration
Establish prognosis and diagnosis
PROTOCOLS IN SENSORY ASSESSMENT
1. Check Mental Status2. Check for Vision, Hearing Acuity
3. Testing Environment and Equipment
4. Patient preparation and Instruction
5. Implementation of Test6. Documentation
PROTOCOLS IN SENSORY ASSESSMENT
GUIDELINES IN SENSORY ASSESSMENT
• Explain the procedure to the pt• Do a trial run• Test Superficialdeepcombined cortical• Distal Proximal• Random application of stimulus• Avoid applying stimulus to scarred tissues
CLASSIFICATION OF SENSATION
SUPERFICIAL DEEP COMBINED CORTICAL
•PAIN•TEMPERATURE• LIGHT TOUCH•PRESSURE
•PROPRIOCEPTION•KINESTHESIA•VIBRATION
• STEREOGNOSIS•2-PT. DISCRIMINATION•DOUBLE SIMULTANEOUS STIMULATION•GRAPHESTHESIA
SUPERFICIAL SENSATIONS
PainTemperatureLight TouchPressure
PAIN (sharp/dull discrimination)
TEST: Sharp end of pin, or reshaped paper clip, blunt end of neurohammer
RESPONSE:Patient able to identify if stilumulus is applied
TEMPERATURE
TEST: test tubes with stoppers are used filled with hot water (40-45 C) and cold water (5-10 C)
RESPONSE: Patient indicate when stimulus is felt as “hot”, “cold” or “unable to tell”
LIGHT TOUCH
TEST: The area to be tested is lightly touched or stroked using a camel brush, piece of cotton or tissue
RESPONSE: Patient indicate when he or she recognizes the stimulus by responding “yes” or “now”
PRESSURE
TEST : PT’s thumb or fingertip to apply firm pressure on skin
RESPONSE: Patient indicate when he/she recognizes that a stimulus has been applied
DEEP SENSATIONS
KinesthesiaProprioception
Vibration
KINESTHESIA
TEST: PT moves joint/extremity passively through relative small ROM (holds patient over bony prominences)
RESPONSE: Patient indicates verbally the direction of movement while extremity is in motion
PROPRIOCEPTION
TEST: The joint or extremity is moved through a ROM and held in a static position
RESPONSE: Patient describe the position verbally or duplicate the position with opposite extremity
VIBRATION
TEST: Base of a vibrating tuning fork is placed on a bony prominence
RESPONSE: Patient identifies the stimulus as vibrating or non-vibrating
COMBINED CORTICAL SENSATIONSStereognosis
Tactile LocalizationTwo-Point Discrimination
Double Simultaneous Stimulation (DSS)
Barognosis Graphesthesia
Recognition of Texture
Stereognosis
TEST: PT uses different familiar objects
(e.g. keys, coins, comb, etc.) placed at the patient’s hand
RESPONSE: Patient is asked to name the objects verbally
Tactile Localization
TEST: PT touches patients using fingertips in diff. skin surfaces
RESPONSE: Patient identify the location of the stimuli by touch or verbal response
2-POINT DISCRIMINATION
TEST: PT uses either a reshaped paper clip, aesthesiometer or ECG caliper
2 ends are applied simultaneously & brought closer to each other until stimuli are perceived as one
Applied in the digit of hand in longitudinal axis or sides of digit
Starts with a distance of 15 cm
RESPONSE: Patient identify perception of 1 or 2 stimuli
2-POINT DISCRIMINATION
Total sensory loss – (>15 cm)
Partial sensory loss – (7-15 cm)
Normal sensibility – (= or < 6 cm)
Interpretation of Findings:
Barognosis
TEST: Series of small objects of same size but of graduated weight is used and places weight on same hand or both hands
RESPONSE: Compare weight of objects indicating if it is “heavier” or “lighter”
Graphesthesia
TEST: Recognition of letters, numbers or designs traced in the palm by the use or eraser end of pencil
RESPONSE: identify verbally figures drawn on the skin
Recognition of Texture
TEST: Items (e.g. cotton, wool, silk) are placed individually in the hand,Pt allowed to manipulate the sample texture
RESPONSE: identify individual textures by name or texture
CONDITIONSCONDITIONS TECHNIQUE SENSATIONS
STROKE RANDOM SuperficialDeep
Combined
SCI DERMATOMAL SuperficialDeep
PNI AREA OF ISOLATED SUPPLY
Superficial
SCI 28 dermatomes are used summarized through Sensory Index Score
Grading system: 0 – absent sensation1 – impaired sensation2 – normal sensation
SCI
Sensory level is based on the last key dermatome to have 2/2 sensationPain & light touch are assessed on both sides
5.07 MONOFILAMENT
Protective pain sensation (usually done in pts with PNI or DM)
DOCUMENTATION (SCI) SAMPLE CASE: SCI, Complete, Secondary to a Gunshot Wound, T10, Sensory Index Score 70/112, (SIS on both side is 35/56)
TASK: EVALUATE & Document using ASIA SCI classification
DOCUMENTATION(STROKE, RIGHT MCA)TASK: EVALUATE THE PATIENT
Sample DocumentationSTD used: pin for pain, brush for light touch & finger for deep pressure50% sensory deficit on the (L) UE & LE as to pain, light touch & deep pressure
DOCUMENTATION (PNI)TASK: EVALUATE THE PATIENTSample DocumentationSTD used: pin for pain, brush for LT & finger for deep pressure 100% sensory loss in the area of isolated supply of the R median nerve distal to the wrist as to pain, light touch & deep pressure
THE END
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