Week 4: Sensory Assessment

Integrity

Integrity

state of being complete or having unimpaired condition.

Sensory Integration

• neurological process that organizes sensation from one own body and from the environment which makes it possible to use the body effectively within the environment.

• it occurs automatically without conscious effort

Sensory Examination

within the intact human system, sensory information taken in the body and the environment.

CNS

will process and integrate the information that can be used for planning and organizing behavior.

Somatosensation

sensation received from skin and musculoskeletal system.

Theoretical Construct

an unobservable event.

Joint Position Sense

• measures the individual's ability to perceive the position of a joint with his/her vision occluded and minimal exteroceptive cues

• proprioception

Feedback Control

uses sensory information received during the movement to monitor and adjust output.

Feedforward Control

proactive strategy that uses sensory information obtained from experience.

Sensory Receptors

highly sensitive to the type of stimulus that it's designed for.

Label Line Principle

specificity to a single modality of a sensation.

Exteroceptors

for superficial sensation.

Proprioceptors

for deep sensation.

Mechanoreceptors

responsible for detecting mechanical deformations.

Thermoreceptors

for temperature changes.

Nociceptors

for noxious stimuli or pain.

Chemoreceptors

• for chemical substances

• responsible for taste, smell, oxygen, and carbon dioxide levels.

Photic Receptor

for light within the visible spectrum

Mechanoreceptors Thermoreceptors Nociceptors

receptors found in skin, muscles, fascia, and joints

Free Nerve Endings

• for pain, temperature, touch, pressure, tickle, and itch sensations

• found throughout the body

Hair Follicle Endings

• mechanical movement and touch

• found at the base of each hair follicle

Merkel's Disk

for low intensity touch, velocity of touch, ability to perceive continuous contact of object with skin, 2 point discrimination and localization of touch.

Ruffini Endings

for perception of touch and pressure, signaling continuous state of skin deformation and heat perception.

Krause's End-Bulb

for touch, pressure, and cold perception.

Meissner's Corpuscle

• for discriminative touch and texture recognition

• increase concentration in the fingertips and toes

Pacinian Corpuscle

• deeper part of the skin

• responsible for perception of deep touch and vibration

Muscle Spindle

• monitor changes in the muscle length and velocity on muscle length change

• intrafusal fibers parallel to extrafusal fibers

Golgi Tendon Organ

• monitors tension in the muscle

• protective

• lies in distal and proximal tendinous insertion of the muscle

Free Nerve Endings

responds to pain and pressure in the muscle.

Pacinian Corpuscle

• respond to vibratory stimuli and deep pressure

• lies within the fascia of the muscle

Golgi-Type Endings

• function it to detect rate of joint movement

• located in the ligaments

Free Nerve Endings

• for pain and crude awareness of joint motions

• found in joint capsule and ligaments

Ruffini Endings

• for direction and velocity of joint movements

• located in the joint capsule and ligaments

Paciniform/Pacinian Endings

• monitors rapid joint movements

• found in joint capsule

Anterolateral Spinothalamic Tract

• self protective reaction and responds to stimuli that are potentially harmful

• ventrolateral tract

• responsible for pain, temperature, tickle, itch, or sexual sensation

Dorsal Column-Medial Lemniscal System

• discriminative sensation

• touch, pressure, vibration, movement, position sense, awareness of joint condition at rest

Somatosensory Cortex

region of the brain which is responsible for receiving and processing sensory information from across the body such as touch and pain.

Sensory Homunculus

represents a map of brain areas dedicated to sensory processing for different anatomical divisions of the body.

Arousal

physiological readiness of the human system for activity.

Alert

• patient is awake and attentive to normal levels of stimulation

• interactions with the therapist are normal and appropriate

Lethargic

• patient appears drowsy and may fall asleep if not stimulated in some way

• interactions with the therapist may get diverted

• patients may have difficulty in focusing or maintaining attention on a question or task

Obtunded

• patient is difficult to arouse from a somnolent state and is frequently confused when awake

• repeated stimulation is required to maintain consciousness

• interactions with the therapist may be largely unproductive

Stupor

• semi coma

• patient responds only to strong, generally noxious stimuli and returns to the unconscious state when stimulation is stopped

• when aroused, the patient is unable to interact with the therapist

Coma

• patient cannot be aroused by any type of stimulation

• reflex motor responses may or may not be seen

Orientation

• patient's awareness of time, place, and person

• who, when, and where questions

Cognition

process of knowing awareness and judgement.

Fund of Knowledge

sum of an individual's learning and life's experience (story).

Calculation Ability

foundational math skills.

Proverb Interpretation

ability to interpret beyond context or meaning.

Documentation

serves as a basis to see whether improvement or regression occurs.

Pain

• tested through any pointed objects like ballpens

• do not apply too much as some patients can have sensory impairments that cause hypersensitivity to pain

• compare affected area with unaffected area or proximal part to see whether pain sensation is normal

Temperature

• use anything with heat

• check whether they sense correct temperature

Light Touch

• use cotton

• compare affected area with unaffected area or proximal part to see whether pain sensation is normal (same with pain)

Pressure

use thumbs to apply pressure to the area.

Proprioception

testing (R) UE, you can test with eyes open and then eyes closed, flex (L) UE and ask pt. to repeat action with affected part.

Kinesthesia

• imitate movements of the unaffected area

• ask patient to flex (L) elbow and repeat with the (R) elbow

Vibration

gibe vibration to part needed to be tested

Tactile Localization

location of object or "alam niya kung saan ang paghawak"

Two-Point Discrimination

whether the patient can identify where the tested part is pointed at.

Barognosis

• check which object is heavier than the other

• have the pt. identify the lightest to heaviest among three objects

Graphesthesia

have the patient draw a figure and see whether they can correctly acknowledge and draw the correct representation.

Texture Recognition

• inability to recognize correct texture indicates deficit

Abarognosis

inability to recognize weight.

Allesthesia

sensation experienced at a site remote from point of simulation.

Allodynia

pain produced by a non-noxious stimulus (e.g. touch).

Analgesia

complete loss of pain sensitivity.

Astereognosis

• inability to recognize the form and shape of objects by touch

• tactile agnosia

Atopognosia

inability to localize a sensation.

Causalgia

painful, burning sensations, usually along the distribution of a nerve.

Dysesthesia

touch sensation experienced as pain.

Hypalgesia

decreased sensitivity to pain.

Hyperalgesia

increased sensitivity to pain.

Hyperesthesia

increased sensitivity to sensory stimuli

Hypesthesia

decreased sensitivity to sensory stimuli.

Pallanesthesia

loss or absence of sensibility to vibration.

Paresthesia

abnormal sensation such as numbness, prickling, or tingling, without apparent cause.

Thalamic Syndrome

• vascular lesion of the thalamus resulting in sensory disturbances and partial or complete paralysis of one side of the body

• associated with severe, boring-type pain; sensory stimuli may produced an exaggerated, prolonged, or painful response

Thermanalgesia

inability to perceive heat.

Thermanesthesia

inability to perceive sensations of heat and cold.

Thermhyperesthesia

increased sensitivity to temperature.

Thermhypesthesia

decreased temperature sensibility.

Thigmanesthesia

loss of light touch sensibility.