PT 606 - Sensory Perceptual Lecture

Sensation includes basic awareness of what?

* stimuli, such as
* touch
* pain
* identification of body parts

What does sensation involve?

peripheral receptors that respond to different stimuli and send info into the SC

The DCML system controls what function?

localization, proprioception, kinesthesia, and vibration

The anterolateral spinal thalamic tract controls what functions?

pain and temp, light touch

The spinocerebellar tract controls what functions?

fine coordination of posture and kinesthetic sense of limbs

What is perception?

ability to organize, process, and interpret incoming visual, tactile-kinesthetic or both in order to act appropriately based on the info received

Deficits in perception/awareness are seen with lesions in what area?

right parietal lobe

What functions does the frontal lobe have?

involved in planning, abstract reasoning and foresight in addition to containing the premotor supplemental motor and primary motor cortices

If a pt has a lesion in the frontal lobe, this would lead to what kinds of problems and how are they perceived?

* problems with starting = appear lazy
* problems in stopping = impulsive, habitual, continually forgets to lock w/c
* difficulties in making mental or behavioral shifts = appears inflexible
* lack of self awareness = doesn’t recognize errors
* Concrete thinking is a problem = lacks insight, takes everything at face value

What are other problems that impact perception?

* memory loss (short-term)
* lack of attention
* distractibility
* diplopia
* homonymous hemianopsia
* aphasia

What is a subjective way to test for sensation?

ask pt where sensation does not feel normal

What do we test first when testing for sensation?

superficial and proprioceptive sensations

* pain/temp and touch (localization)

If superficial and proprioceptive sensations are intact, what do we test for next when testing sensation?

combined sensations

* require communication between various areas of the cortex

What else should be done when testing for sensation?

* ensure comprehension of instructions
* occlude vision
* apply stimulus at random
* can pose a choice (hot vs cold)
* consider skin conditions (callus, trauma, hair loss, color changes)

Why should PT’s be aware of perceptual deficits?

because they will limit how the pt can functionally perform tasks

What should be ruled out when examining perception?

* language impairment
* hearing loss or visual disturbance
* psychological/emotional and/or cognitive issues

Perceptual testing includes examining what three things?

* visual field impairments
* body scheme/image disorders
* spatial relations syndromes

When examining for body scheme/image disorders, what conditions should be looked for?

* somatognosia (lack of body awareness of body structure and recognize own body parts)
* visual spatial neglect - does pt ignore one side of their body?
* R/L discrimination
* Anosognosia - severe denial, neglect or lack of awareness of severity of condition

When examining for spatial relations syndromes, what things should be looked for?

* figure-ground deficit
* form constancy
* position in space
* topographical disorientation
* depth and distance imperceptions
* vertical disorientation

Figure-ground deficit

have pt pick out an object from an array of objects

Form constancy

have pt pick out an object from an array of similar shaped but different sized objects

Position in space

pt to demonstrate different limb positions (put arm overhead, foot under chair)

Topographical disorientation

can pt navigate a familiar route (travel from bathroom to clinic)

Depth and distance imperceptions

can pt judge depth (navigate stairs, curbs, sitting into a chair)

Vertical disorientation

can pt identify when something is upright (can, or their own body)

What do we look for when examining for agnosia?

inability to recognize familiar objects with one sensory modality

* cannot identify clock by sight but can identify tracking)

What do we look for when we examine for apraxia?

inability to perform voluntary, learned movements

Ideomotor apraxia

pt can not perform the task on command but can do the task when left alone

Ideational apraxia

pt can not perfrom the task at all, either on command or on own

What does apraxia correlate with?

damage to the prelateral frontal cortex and somatosensory association cortex

Describe the functional abilities of a pt with a left hemisphere lesion.

* R sided hemiplegia/sensory loss
* aphasia - lack of functional speech
* ideomotor and ideational apraxia
* number alexia - difficulty recognizing symbols/do computations
* R-L discrimination
* slow in organization and performance
* aware of deficits = depression/anxiety

Describe the functional abilities of a pt with a right hemisphere lesion.

* L sided hemiplegia/sensory loss
* L sided neglect - unaware of objects to the L
* dressing apraxia - applies clothing to R but not left side
* Constructional apraxia - difficulty with 2D vs 3D
* Visuospatial deficits - cannot orient self to changes in environment
* rapid performance, short attention span = impulsive behavior DECREASED SAFETY
* impaired judgement/insight into condition

Describe the treatment of a sensory impairment.

progressive postural challenges starting with good sensory input and removing input as pt improves

What is a progression example for sensory impairment treatment?

* sit to stand - 2 hand push off, WBOS on even surface with visual focus
* 0 hand push off, normal BOS with VF
* 0 hand push off, normal BOS on foam with VF
* 0 hand push off, normal BOS with eyes closed
* 0 hand push off, normal BOS on foam with eyes closed

What kind of training should be included for sensory perceptual treatment?

visually searching for and attending to environmental cues