Sensory Assessment Edited

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