PHT 1261C Tests and Measurements Dr. Kane Sensation

Definitions Somatosensory Sensory Integration Purposes (3) Feedback vs. Feed forward

Why do we test for Sensation? Pattern Completeness CNS vs. PNS Dermatomal, glove and stocking = PNS CVA, SCI = CNS

When do we test for Sensation? Prior to motor function Initial Evaluation Progress Discharge Other

What is considered prior to sensation testing? Arousal Alert Lethargic Obtunded Stuporous Comatose Attention Span Orientation (x3) Cognition Fund of knowledge Calculation ability Proverb interpretation

Considerations prior to sensation testing? Memory Short term Long term Hearing Visual Acuity Peripheral vision Depth perception

What are you testing with sensation testing? Classification of Sensory System By stimulus type/location of receptors Mechanoreceptors Thermoreceptors Nocioreceptors Chemoreceptors Photic Receptors By Spinal pathway mediating information to higher centers Spinothalmic tract Dorsal Column Medial Lemniscus Pathway

Types of Sensory Receptors Cutaneous Receptors Free nerve endings Hair follicle Endings Merkel’s discs Ruffini Endings Krause’s end-bulbs Meissner’s corpuscles Pacinian Corpuscles

Types of Sensory Receptors (cont.) Deep Sensory Receptors Muscle Receptors Muscle Spindles Golgi Tendon Organs Free Nerve Endings Pacinian Corpuscles Joint Receptors Golgi Type endings Free nerve endings Ruffini endings Paciniform Endings

Spinal Pathways for Sensory Signals Spinothalmic Pathway – nondiscriminatory; Anterior spinothalmic tract Lateral spinothalmic tract Spinoreticular tract Dorsal Column Medial Lemniscus Pathway Discriminitive sensation from specialized mechanoreceptors Stereognosis Tactile pressure Barognosis Graphesthesia Texture recognition Kinesthesia 2 point discrimination Proprioception Vibration

The Somatosensory Cortex Post Central Gyrus Sensory Homonculus

Treatment Approaches Sensory Integration Approach Compensatory Approach

Sensory Examination Occlude vision (if possible) Conduct a demonstration to familiarize your patient

Superficial Sensation Testing Pain Perception – paper clip; sharp/dull Temperature Awareness – test tubes; hot/cold Touch Awareness – cotton, tissue, brush; yes/now Pressure Perception – fingertip, cotton tip; yes/now

Deep Sensation Testing Kinesthesia – describe movement; Proprioception – describe position; Vibration – Tuning Fork; yes/no

Combined Cortical Sensation Testing Stereognosis – object recognition Tactile Localization – cotton swab or finger tip 2 Point Discrimination – aesthesiometer or paper clip Double Simultaneous Stimulation Opposite sides of body Proximal and distal on opposite sides of body Proximal and distal on same side of body

Combined Cortical Sensation (cont) Graphesthesia – tracing finger ID Texture Recognition – cotton, silk, wool; rough/smooth Barognosis – weight recognition; heavier/lighter

Cranial Nerve Screening – see Table 5.3 pg. 151 & Box 5.5 pg. 152 I – Olfactory – non noxious odor II – Optic – Snellen Chart; Peripheral Vision III – Oculomotor – see below IV – Trochlear – see below V – Trigeminal – Sensory of face; Motor – jaw motions VI – Abducent – see below Note: III, IV, & VI are tested together – pupil equality & size; presence of strabismus; eye tracking; presence of ptosis of eyelid

Cranial Nerves - continued VII Facial – facial expressions & symmetry VIII Auditory – hearing; tuning fork IX Glossopharyngeal – taste posterior 1/3 of tongue; gag reflex X – Vagus – swallowing; uvula & soft palette symmetry XI – Accessory – SCM and Trapezius XII – Hypoglossal – tongue movements