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Sensation

Sensation. PHT 1261C Tests and Measurements Dr. Kane. 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.

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Sensation

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  1. Sensation PHT 1261C Tests and Measurements Dr. Kane

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

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

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

  5. 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

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

  7. 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

  8. 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

  9. 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

  10. 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

  11. The Somatosensory Cortex • Post Central Gyrus • Sensory Homonculus

  12. Treatment Approaches • Sensory Integration Approach • Compensatory Approach

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

  14. 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

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

  16. 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

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

  18. 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

  19. 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

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