356 Exam 1 - Sensory Interventions

true

True or false: sensation is important for motor output.

nonuse, control, hospital, independence, recovery

Sensory impairment after ABI often leads to:

• learned ____

• impaired motor ____, including difficulty grading force production, difficulty with fine motor tasks, etc.

• longer ____ stays,

• less ____ with functional tasks

• overall slower motor ____

paresthesia

an abnormal sensation (such as tingling, “pins and needles,” or prickling) that occurs without an apparent external stimulus and is typically not painful

hyperalgesia

an increased sensitivity to pain, where a stimulus that is not normally painful is perceived as more intense or exaggerated than expected

dysesthesia

an unpleasant, abnormal sensation, often described as burning, electric, or sharp, which may occur spontaneously or in response to a stimulus

allodynia

a condition in which normally non-painful stimuli (such as light touch) are perceived as painful

hyperesthesia

a generalized increase in sensitivity to sensory stimuli (especially touch), meaning sensations are perceived more intensely than normal, but not necessarily as painful

posterior column medial lemniscus (PCML)

Which ascending pathway carries sensory information about tactile discrimination and proprioception: posterior column medial lemniscus (PCML) or spinothalamic tract

spinothalamic tract

Which ascending pathway carries sensory information about pain and temperature: posterior column medial lemniscus (PCML) or spinothalamic tract

proprioception, tactile discrimination

Select the two types of sensory information carried by the posterior column medial lemniscus (PCML) ascending pathway:

• pain

• proprioception

• tactile discrimination

• temperature

pain, temperature

Select the two types of sensory information carried by the spinothalamic tract ascending pathway:

• pain

• proprioception

• tactile discrimination

• temperature

primary somatosensory cortex (S1)

Name the cortex found on the postcentral gyrus in the parietal lobe.

middle cerebral artery (MCA)

Name the artery supplying the (lateral) anterior parietal lobe.

posterior cerebral artery (PCA), posterior communicating artery

Name the arteries supplying the thalamus.

protective sensation

ability to appreciate painful stimuli

compensation, desensitization, passive sensory training, active sensory training (sensory re-education)

Name 4 intervention strategies for treating a patient with somatosensation impairments.

compensation

Which somatosensation intervention strategy would be appropriate for a patient with diminished or los protective sensation (i.e., pinprick, temperature, deep pressure)?

• Compensation

• Desensitization

• Passive sensory training

• Active sensory training (sensory re-education)

desensitization

Which somatosensation intervention strategy would be appropriate for a patient with hypersensitivity (allodynia + hyperesthesia)?

• Compensation

• Desensitization

• Passive sensory training

• Active sensory training (sensory re-education)

passive sensory training

Which somatosensation intervention strategy would be appropriate for a patient with absent or impaired sensation which is expected to return to some extent?

• Compensation

• Desensitization

• Passive sensory training

• Active sensory training (sensory re-education)

active sensory training

Which somatosensation intervention strategy would be appropriate for a patient with some sensation and movement and potential for better sensation or better interpretation of sensory input?

• Compensation

• Desensitization

• Passive sensory training

• Active sensory training (sensory re-education)

sensory substitution

intervention in which one sensory system (e.g., vision) is used to compensate for impairment in another (e.g., somatosensation)

compensation

What type of intervention is sensory substitution?

compensation

• general intervention strategy used for patients with diminished or lost protective sensation

• patient/caregiver education, proper skincare, and tools/devices/environmental modifications are paramount

• example interventions

  • continuous low pressure → frequent position changes, wheelchair cushions

  • concentrated high pressure → knife safety, check splint straps, care with AFOs, UE positioning in wheelchair

  • excessive heat or cold → insulated coffee mugs, oven mitts, shower safety, appropriate cold weather gear

  • repetitive mechanical stress → avoid repetitive motions and excess friction

  • pressure on infected tissue → care for blisters, bruises, etc.; rest infected areas to keep free from pressure

desensitization

• general intervention strategy used for patients with hypersensitivity (allodynia + hyperesthesia)

  • hypersensitivity not common after ABI, but more common after nerve trauma, soft tissue injuries, burns, and amputation

• basis of intervention strategy is habituation

  • exposure to stimuli in hierarchical manner (massage → textures → daily activities)

• may consider using in combination with mirror therapy

• limited evidence for effectiveness

habituation

progressive exposure to stimuli in a hierarchical manner (massage → textures → daily activities) over time to allow progressive tolerance when patients are experiencing hypersensitivity

habituation

____ is the basis of desensitization.

desensitization

Habituation is the basis for which somatosensation intervention strategy?

• Compensation

• Desensitization

• Passive sensory training

• Active sensory training (sensory re-education)

sensory training

• interventions used for people with conditions involving either PNS or CNS sensory impairments

• based on neuroplasticity

• goals are to maintain or restore cortical representation of the body in the somatosensory cortex and regain sensation in the body

  • desired outcomes: improve quality of motor output and improve patient safety

• integrated into occupation and functional activities

• two phases: passive and active

neuroplasticity

Sensory training is based on the science of ____.

passive sensory training

• general intervention strategy used for patients with absent or impaired sensation which is expected to return to some extent

• requires no attention from patient

• involves repeated stimulation to denervated body part

• example interventions: electrical stimulation at the sensory level, pneumatic or mechanical compression, thermal stimulation, massage or self-massage, vibration, kinesiotape

• mixed evidence with no superior protocol

passive sensory training

Electrical stimulation at the sensory level is an example of which somatosensation intervention strategy?

• Compensation

• Desensitization

• Passive sensory training

• Active sensory training (sensory re-education)

no

Passive sensory training requires ____ attention from the patient.

false

True or false: passive sensory training requires active participation from the patient

active sensory training (sensory re-education)

• general intervention strategy used for patients with some sensation and movement and potential for better sensation or better interpretation of sensory input

• requires active participation from client, including attention, repeated practice, and use of alternative senses to enhance learning

• involves repeated stimulation to denervated body part via sensory-rich functional activities

• example interventions: ID# of touches, graphesthesia tests, “find your thumb” with vision occluded, stereognosis, passive drawing and writing, mirror therapy

task-specific sensory training

sensory training that occurs concurrently with motor learning by cueing patient to attend to the task and tactile qualities of objects and to use more involved hand in bimanual tasks

edema

• excess accumulation of fluid in the interstitium caused by increased venous congestion related to prolonged dependency and loss of muscle pumping function in the paretic limb

• linked to loss of muscle activity, hyposensibility, and hypertonia

• limits movement, sensation, dexterity, and function

• may cause soft tissue contracture, generalized pain, or complex regional pain syndrome (CRPS, shoulder-hand syndrome)

• three types: dependency, combined, minor trauma

hypertonia

What is the most significant predictor of post-stroke edema?

complex regional pain syndrome (CRPS, shoulder-hand syndrome)

• a rare, chronic neurological condition that causes severe, prolonged pain, swelling, and skin changes

• symptoms: hand edema, severe pain disproportionate to injury or condition, stiffness/decreased ROM, hypersensitivity, vasomotor disturbances of the hand (skin color changes, skin becomes shiny, nail bed changes, etc.)

• intervention: avoid pain and PROM, encourage active movement, scrub and carry

scrub and carry

• intervention that may be used CRPS and is designed to desensitize the nervous system and promote functional movement

• scrub: apply weight and compression directly through the affected limb by using hard bristled brush and applying firm pressure on hard surface in continuous back-and-forth motion

• carry: provide heavy feedback through the joints without moving the limb unnecessarily by carrying weighted objects on affected side

dependency edema, combined edema, minor trauma edema

Name the 3 types of post-stroke hand edema.

dependency edema

• early post-stroke edema

• soft, spongy feel

• reduces fairly easily with basic interventions (e.g., elevation, exercise/ROM/functional activities, light retrograde massage, light compression)

• caused by decreased motor function

combined edema

• post-stroke edema + congestion of lymphatic system

• viscous feel with slow rebound

• requires additional interventions

• caused by increased stress on lymphatic system when venous system is compromised

minor trauma edema

• edema caused by wound or injury

• triggers an inflammatory, healing response

dependency

Which type of post-stroke edema has a soft, spongy feel?

• dependency edema

• combined edema

combined

Which type of post-stroke edema has a viscous feel with slow rebound?

• dependency edema

• combined edema

dependency

Which type of post-stroke edema is caused by decreased motor function?

• dependency edema

• combined edema

combined

Which type of post-stroke edema is caused by increased stress on lymphatic system when venous system is compromised?

• dependency edema

• combined edema

dependency

Which type of post-stroke edema reduces fairly easily with basic interventions?

• dependency edema

• combined edema

combined

Which type of post-stroke edema requires additional interventions?

• dependency edema

• combined edema

education

The first intervention to use for all types of post-stroke edema (dependency, combined, minor trauma) is patient/caregiver/staff ____ on safe handling and positioning.

handling, positioning

The first intervention to use for all types of post-stroke edema (dependency, combined, minor trauma) is patient/caregiver/staff education on safe ____ and ____.

elevation, compression, retrograde massage, exercise/functional activities

Name 4 interventions for post-stroke dependency edema.

elevation

• intervention for post-stroke dependency edema in which edematous extremity is placed above level of heart via pillows, over-bed sling, elevated arm trough, etc., to allow gravity to facilitate venous flow

• precautions should be taken for patients with vascular insufficiency or cardiac conditions such as Reynaud disease or right-sided heart weakness as fluid in heart with increase as it drains from the limb

retrograde massage

• intervention for post-stroke dependency edema in which fluid is manually assisted out of edematous limb

• edematous hand is elevated; light stroking massage is performed from distal to proximal, massaging each finger before moving to hand then wrist

compression

• intervention for post-stroke dependency edema in which external pressure (e.g., edema gloves, TED hose) restricts accumulation of subcutaneous fluid

• precautions should be taken for patients with impaired sensation or circulatory issues, as too much pressure may cause secondary injury

distal to proximal

In retrograde massage for post-stroke dependency edema, the therapist uses light strokes from distal to proximal or proximal to distal. (Select the correct answer)

active

____ (active or passive) ROM is preferred for treating post-stroke edema.

manual edema mobilization (MEM), compression with low stretch bandages, exercise/functional activities

Name 3 interventions for post-stroke combined edema.

rest, ice, compression, elevation

Name 4 interventions for minor trauma edema.

manual mobilization edema (MEM)

• intervention for post-stroke combined edema in which light massage promotes lymphatic system to remove excess large plasma proteins that cause prolonged edema

• begins in the trunk and moves distally

passive

There is moderate evidence that pneumatic compression devices are not effective for post-edema stroke, but they may be used for ____ sensory training.

acute, subacute, chronic

Name the 3 stages of edema.

acute

• fluid and mobile stage of edema

• tissue often pits and rebounds quickly; edema can be moved with pressure or massage

• interventions: elevation to improve venous and lymphatic flow, light compression

subacute

• more viscous stage of edema

• protein accumulation causes increased viscosity; tissue pits but rebounds slowly

• interventions: AROM, PROM, light isometric exercise, kinesiotape, manual edema mobilization (MEM)

chronic

• stage of edema defined by fibrotic adhesions

• tissue pits minimally; feels like leather

• interventions: AROM, PROM, light isometric exercise, kinesiotape, manual edema mobilization (MEM), low stretch, short stretch bandaging techniques

acute

Which stage of edema is defined as fluid and mobile?

• acute

• subacute

• chronic

subacute

Which stage of edema is defined as more viscous?

• acute

• subacute

• chronic

chronic

Which stage of edema is defined by fibrotic adhesions?

• acute

• subacute

• chronic

mental practice, action observation, virtual reality, mirror therapy

Name 4 cognitive strategies to augment motor-based therapy techniques.

mirror neuron

The ____ ____ system is the basis for mental practice, action observation, and mirror therapy.

mirror neuron system

• responds to both observation of an action and physical execution of an action

• located in parietal and frontal lobes

• basis for mental practice, action observation, mirror therapy

mental practice

• training method during which a person cognitively rehearses a physical skill in the absence of actual movements

• usually coupled with actual physical task-oriented training, though not necessarily simultaneously

• no risk to patient, easy, inexpensive, appropriate for home program, physical fatigue not a limiting factor

• patient must be able to cognitively attend

• appropriate for FUEL scale levels nonfunctional to functional assist

• create client-centered audio recording to guide patient through rehearsal

• suggested dosage: 10-20 min 1-3x/day

action observation

• an intervention in which patient observes a healthy person performing a task either in a video or a live demonstration, with the intention of imitating the task performance

• patient can simply observe or attempt to move more involved limb during observation

• followed by actual task practice

• no risk to patient, easy, inexpensive, appropriate for home program, physical fatigue not a limiting factor

• patient must be able to see and cognitively attend

• appropriate for FUEL scale levels nonfunctional to functional assist

• create client-centered video programs filmed from client’s perspective

• suggested dosage: 10-20 min 1-3x/day

virtual reality

• intervention that allows for simulated practice of functional activities in a computer-based, interactive, and simulated environment designed to replicate the real world environment

• allows patient to engage in goal-directed tasks in enriched environment, allows for massed practice, and allows patient to practice tasks that might be unsafe in “real world”

• patient must be able to see, cognitively attend, and have enough awareness to tolerate altered reality environment

• appropriate for FUEL scale levels nonfunctional to functional assist

• find client-centered programs, typically filmed from client’s perspective

• suggested dosage: 10-20 min 1-3x/day

mirror therapy

• intervention in which mirror or mirror box is placed in midsagittal position between upper and lower extremities, with mirror facing less involved side, while patient concentrates on mirror reflection of less involved extremity performing movement or receiving sensory stimulation while involved extremity remains hidden out of sight behind mirror

• creates a visual illusion whereby activities of uninvolved extremity are attributed to the involved extremity

• active engagement of involved, unseen limb is often, but not always encourage during treatment

• no risk to patient, easy, inexpensive, appropriate for home program, physical fatigue not a limiting factor, can be very motivating when paired with meaningful occupations

• patient must be able to see and cognitively attend

• appropriate for FUEL scale levels nonfunctional to functional assist

• suggested dosage: 10-20 min 1-3x/day

uninvolved

In mirror therapy, the mirror is placed in the midsagittal plane facing the ____ (involved or uninvolved) extremity.

false

True or false cognitive strategies such as mental practice, action observation, virtual reality, and mirror therapy can be used in place of task-oriented therapy.

music therapy

• clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy degree program

• protocols for intervention do exist but are controversial and difficult to research due to personal nature of subject

• at most basic level, can be used to connect with patients, improve their mood, reduce agitation, etc.

rhythm training

use of rhythmic auditory cues (e.g., interactive metronome) to engage the body’s internal timing mechanism hypothesized to improve effectiveness in cognition and motor response