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34 Cards in this Set

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Sensory integration (Jean Ayers)

is the ability of the brain to organize, interpret and use sensory information

What are the 3 things sensory integration does?

Provides an internal representation of the environment that informs and guides motor responses.


Provide foundation on which motor programs for purposeful movements are planned, coordinated, and implemented.


Occurs automatically, without conscious effort (in normals).

What's linked to sensation?

motor learning and motor performance

Feedback control:

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

Feedforward control:

(proactive) signals are sent in advance of the movement allowing for anticipatory adjustments in postural control or movement

Arousal

-physiological readiness for activity. Definitions are given in your text (know them). These will come up on both exams.


Alert:

: Pt is awake and attentive to normal levels of stimulation.


Interactions with therapist: normal and appropriate.

Lethargic:

Pt appears drowsy and may fall asleep if not stimulated in some way.


Interactions with therapist: may get diverted.


Difficulty focusing or maintaining attention on question or task


Obtunded:

Pt is difficult to arouse from somnolent state and frequently confused when awake.


Interations with therapist may be largely unproductive.


Repeated stimulus is needed to maintain consciousness.


Stupor (semicoma):

Pt responds only to strong, generally noxious stimuli and returns to uncounscious state when stimulation is stopped. When aroused, the patient is unable to interact with the therapist.


Coma (deep coma):

The patient cannot be aroused by any type of stimulation. Reflex motor responses may or may not be seen.

Attention

selective awareness or responsiveness to a stimulus or task without being distracted by other stimuli know these, on both tests.


What could you do to test attention?

Asking the patient to repeat items on a progressively more challenging list.


Cognition

process of knowing and includes both awareness and judgment


Fund of knowledge:

the sum total of an individuals’ learning and experience in life; ie: who is the president? In what state is Boston in?

Proverb interpretation

the ability to interpret use of words outside of their usual context or meaning.

cognition

fund of knowledge, calculation ability, proverb interpretation

What are the preliminary considerations?

arousal, attention, orientation, cognition, memory long and short term, hearing, visual acuity

Superficial sensation

-exteroceptors responsible for superficial sensations (pain, temp, touch, pressure)

Deep sensation

proprioceptors responsible for deep sensations (muscles, tendons, ligaments, joints, facsia for awareness of joints at rest, movement awareness, and vibration)

Somatosensory cortex:

The primary and association areas are responsible for:


1. identifying location of stimulation,


2. discerning its size, shape and texture (as appropriate),


3. analyzing and integrating somatosensory info


4. contributing to MOTOR performance

contributing to MOTOR performance because they:

Determine initial position required before a movement occurs (voluntary normal movement)


Detect errors as movement occurs


Id movement outcomes to help shape learning

What are the 3 major types of sensation that everyone should be tested?

superficial, deep, and combined

What do you have to screen for before you can do your sensory screening?

Mental status, vision, and hearing acuity

7 possible areas of sensory exam

Pain


Temperature (a new toy) so hard to do


Light touch


Vibration


Stereognosis


2 point discrim


Recognition of texture

What data should you collect?

The modality tested


Quantity of involvement or body surface areas affected


Degree or severity of involvement ( absent, impaired, delayed)


Localization of the exact boundaries of the sensory impairment


Pt’s subjective feelings about changes in sensation


Potential impact of sensory loss on function

kinesthesia :


Move joint(s) passively thru small ROM


Be sure patient knows up, down, in, out, etc;


PT id’s in notes what part of ROM is examined: initial (beginning), middle, terminal (end). Don’t go into more detail unless needing to.


Patient should tell you which way joint is moving while it’s moving; therefore, if you use a small ROM, you have to go slowly


What types of other responses are acceptable? Duplication with other arm

proprioception

* Patient described held position or places opposite extremity in same position as tested one

Vibration

have to be careful that people aren’t just hearing the vibration


Base of vibrating fork over bony prominences


Auditory cues-hit the fork each time to make it vibrate but sometimes use your hand to stop the tines before you place it on the patient

When testing combined cortical sensations, what 2 test should you always do?

stereognosis and 2 point discrim


if in tact then no further testing is needed?

If stereognosis weren't in take what are some further testing that you would do?

tactile localization


NOT usually tested in isolation


You can combine it with similar tests such as pressure perception or touch awareness.


4. double (bilateral) simultaneous stimulation


Extinction phenomena: situation in which only the proximal stimulus is perceived with extinction of the distal or when both proximal stimuli are perceived (on both upper arms) but not perceived on both distal sites (e.g., both thumbs)


5. graphesthesia


Useful when paralysis prevents grasping an object


6. recognition of texture


7. barognosis

reliability wanted?

Interrater reliability

Sensory Intgration approach

POC enhances opportunities for controlled sensory intake within a framework of meaningful functional skills. Provide guided practice in planning and organizing motor behaviors using intrinsic and augmented feedback.

compensatory

patient education to accommodate limitations imposed by sensory deficit. Also think safety! Ie testing bath water, not going barefoot, regularly checking insensitive skin areas for cuts or bruises