Hum Occ II CH 9

Light touch and pressure

- critical to performance of all ADLs

- tactile sensitivity

- Pressure sensation

Tactile sensitivity

recognizing there is an object in one's hand, ability to feel clothes on body and whether they are correctly adjusted

Pressure sensation

occurs continuously in activities like sitting, pushing drawers and doors, crossing knees, wearing belts and collars

Temperature sense

- Thermal

- Contributes to enjoyment of food and detection of environmental temperatures

- Clients with impaired thermal discrimination must be taught compensatory burn protection strategies and precautions against injury

- Changes in sensory status may be used to measure recovery or degeneration, depending on dx

Thermal

ability to detect temperature essential for injury prevention during ADL (e.g., bathing, cooking, ironing)

Superficial Pain Sensation

- Pain is critical to avoidance of injury during occupational performance and prevention of skin breakdown while wearing splints and braces, using wheelchairs, crutches, and other adaptive devices

- Clients with absent or impaired pain sensation must learn sensory compensation and safety awareness as part of treatment program

Olfactory Sensation (small)

- Associated with pleasure of taste 

- Connected to neuronal circuits influencing emotional states and evoking memories 

- Important for detection of noxious and pleasant odors 

- Anosmia (loss of smell)

Anosmia

is a safety concern, as it can interfere with detection of household gas, chemicals, smoke, car exhaust or noxious environmental odors

Gustatory Sensation (taste)

- Contributes to enjoyment of food and helps trigger salivation and swallowing

- Connected to neural circuits that control emotional states and trigger specific memories

Proprioception (position and motion sense)

- unconscious information about joint position and motion that arises from receptors in the muscles, joints, ligaments and bone

- Kinesthesia- conscious sense of motion

- Partial or complete loss of proprioception impairs movement, even when mm function is WNL

- Evaluation requires specific training and development of sensitivity in handling/positioning the client

Perceptual functions: Stereognosis  

- Ability to identify an object through proprioception, cognition and sense of touch

- Essential to everyday living

- Allows use of hand tools and activity performance using hands without visual concentration

Perceptual functions: Graphesthesia  

- Ability to recognize numbers, letters or forms written on the skin

- Test involves occluding vision and tracing letters, numbers, or geometric forms on client's palm with dull, pointed pencil or other instrument

- Client tells examiner which symbol was traced; if aphasic, pictures of symbols may be used to indicate response after each stimulus

Perceptual functions: Body Scheme  

- Awareness is ability to identify the position of the body and its parts in relation to themselves and the environment

Perceptual functions: Praxis

ability to plan and perform purposeful movement

Body scheme includes knowledge of

- Body construction

- Anatomic elements

- Spatial relationships

- Ability to visualize the body in movement and its parts in positional relationships

- Ability to differentiate between right and left

- Recognize body health and disease

Apraxia 

- deficit in ability to perform purposeful movement despite normal motor power, sensation, coordination, and general comprehension

- Evaluation of these disorders is reserved for the OT

- A client can demonstrate a single form of apraxia or a combination of types

Ideomotor Apraxia 

– inability to perform a motor act on command despite ability to perform it automatically 

Constructional Apraxia 

- deficit in ability to copy, draw, or construct a design (whether on command or spontaneously); inability to organize or assemble parts into a whole (i.e. copying a block design or drawing)

Dressing Apraxia

 – inability to plan and perform motor acts necessary to dress oneself; linked to problems of body scheme, spatial orientation, and constructional apraxia 

Memory 

- allows a person to retain and recall information

- Breakdown can occur at any step of the memory process; if client can't attend to information it may not enter the system

Declarative or Explicit Memory

- ability to recite or reproduce information

Episodic Memory 

- individual's personal history and lifetime of experiences

Semantic Memory 

- general knowledge shared by groups of people such as language, rules of social behavior

Procedural Memory

-memory for a skill or a series of actions (i.e. a client may not be able to verbalize the steps of making sandwich, but can still perform the activity of making a sandwich)

Everyday Memory

- ability to remember information pertinent to daily life such as learning the names of people working with pt in rehab daily

Prospective Memory

 – ability to remember events that will occur in the future 

Clients with memory deficits may confabulate

which is to fill in memory gaps with imaginary material

Executive Functioning 

higher-order reasoning and planning functions such as goal formation, planning, implementing the plan, and effective performance

Principles of cognitive evaluation

1. cognition should always be seen in relation to other potential deficit areas. the clients sensory, language, visual, and perceptual systems affect the observable qualities of cognition.

2. Cognition is best assessed by engaging a client in occupation or utilizing an occupation-based assessment tool.

3. Discussions of the OT evaluation results with health professionals from other disciplines will enhance the OTPs understanding of the clients capacity.

4. The testing environment involves a selection of tests- standardized and normed for the population- and a variety of occupations.

6. When introducing a cognitive test to a client, the examiner should avoid a condescending attitude or a too cheerful, falsely positive approach.