Assessing sensations

Illustrates the popular methods of assessing sensations both superficial and deep sensations clinically along with appropriate illustrations and equipments used in assessing the sensation among clients(Adults)

1. Assessing sensations: Vinodhini.C Occupational Therapist

2. Sensation: Sensation (also called sensibility) is a body function, a component of the client factors that influences both the motor and processing aspects of performance skills . The somatosensory system handles sensory input from superficial sources such as the skin and from deep sources such as the musculoskeletal system.

3. Superficial sensations:

4. Pain: Pain is an unpleasant sensory and perceptual experience that is associated with either actual or potential cellular damage. The experience of pain is subjective and multidimensional . Test for Pain (Protective Sensation) Procedure Using a sterilized safety pin, assess the amount of pressure required to elicit a pain response on the uninvolved hand. This is the amount of pressure that the examiner will use on the involved side . Response The client indicates “sharp” or “dull” following application . Scoring A correct response to both sharp and dull indicates intact protective sensation. An incorrect response to both sharp and dull indicates absent protective sensation.

5. Pain: Sharp pain Dull pain

6. Temperature awareness: Temperature awareness is a test for protective sensation. Thermal receptors detect warmth and cold . Test for Temperature Awareness (Protective Sensation) Procedure Apply test tubes or metal cylinders filled with hot or cold fluid randomly to areas of the involved hand Response The client indicates “hot” or “cold” following application. Scoring A correct response to both cold and hot indicates intact temperature awareness. An incorrect response to either or both indicates impaired temperature awareness.

7. Temperature awareness

8. Two-point discrimination: Two-point discrimination is a test for receptor density and is a good test to use for mapping improvement following nerve repair . Types : Static two pd Moving two pd

9. Test for Static Two-Point Discrimination: Procedure Use a device such as the Disk- Criminator or Boley gauge with blunt testing ends Test only the fingertips because this is the primary area of the hand used for exploration of objects. Begin with a distance of 5 ¯mm between the testing points . Randomly test one or two points on the radial and ulnar aspects of each finger for 10 applications Pressure is applied lightly; stop just when the skin begins to blanch. Response The client will respond “one” or “two” or “I don’t know ” following application.

10. Scoring The client responds accurately to 7 of 10 applications at that number of millimeters of distance between the two points. Norms are as follows: 1 to 5╯mm indicates normal static two-point discrimination . 6 to 10╯mm indicates fair static two-point discrimination . 1 to 15╯mm indicates poor static two-point discrimination . One point perceived indicates protective sensation only. No points perceived indicates an anesthetic area.

11. Two point discrimination: Boley gauge Disk criminator

12. Touch pressure: Light touch is perceived by receptors in the superficial skin. Pressure (or deeper touch) is perceived by receptors in the subcutaneous and deeper tissues . Procedure Begin with monofilament 1.65. Apply the monofilament for 1 to 1.5 seconds at the pressure needed to bow the monofilament ( applied perpendicularly ) Hold the pressure for 1 to 1.5 seconds. Lift the monofilament in 1 to 1.5 seconds. The proper amount of pressure is achieved when the filament bends.

13. Response The client says “touch” when he feels the monofilament . Scoring The client responds to at least one of the three applications of the monofilament. Norms are as follows: Green (1.65 to 2.83) indicates normal light touch. Blue (3.22 to 3.61) indicates diminished light touch. Purple (3.84 to 4.31) indicates diminished protective sensation . Red (4.56 to 6.65) indicates loss of protective sensation . Untestable indicates an inability to feel the largest monofilament .

14. Monofilament

15. Proprioception: Conscious proprioception derives from receptors found in muscles , tendons, and joints and is defined as awareness of joint position in space . Test for Proprioception Procedure Hold the lateral aspect of the elbow, wrist, or digit. Move the body part into flexion or extension Response The client indicates whether the body part is being moved “up” or “down .” Scoring An accurate response indicates intact proprioception.

16. Testing proprioception of the finger.

17. Stereognosis Stereognosis is the use of both proprioceptive information and touch information to identify an item with the vision occluded. The Dellon Modification of the Moberg Pickup Test Procedure Begin with a group of 12 standardized items: wing nut, large nut, hex nut, small square nut, screw, key, nickel, dime , washer, safety pin, paper clip, and nail . With client’s vision occluded, the examiner places the items into the client’s radial three digits one at a time.

18. Response The client manipulates the objects and attempts to identify them as quickly as possible. Scoring the time that it takes to identify all the items.

19. The Dellon Modification of the Moberg Pickup Test

20. Thank you