SENSORY EVALUATION

SENSATION – ability to detect stimuli

SENSIBILITY – how you interpret stimulus

INDICATIONS FOR TESTING IN NEUROREHABILITATION

- Brain Injuries and Diseases (stroke, TBI)
- Spinal cord injuries and diseases
Affected MCA (Middle Cerebral Artery) – aphasia, speech problems
Affected PCA – vision problems
Affected Brainstem (BS: motor planning, reflexes) – Dysphagia
For clients with PNI
❖ Pain sensation generally recovers first, followed by touch
❖ Pain fibers (1.08mm/day)
❖ Touch fibers (0.78mm/day)
PURPOSE OF SENSORY EVALUATION
- To establish a baseline (IE)
- Affects splint and brace usage
- Determines need to educate

HIERARCHY OF SENSORY CAPACITY (lowest to highest level)

- Detection – client feels a single point stimulus
- Discrimination – client feels two or more stimuli
- Quantification – client can tell the characteristics of the stimulus (texture,
sharp, hard, etc.)
- Recognition – client can tell what object is even when vision is occluded

IMPLICATIONS IF THERE ARE SENSORY DEFICITS

1. Slower and less effective performance
2. Increases risk of having an injury
3. There could be increased threshold to touch or decreased threshold to pain
Hyperalgesia: increased sensitivity to pain

GENERAL PRINCIPLES IN SENSORY EVALUATION

1. Client should be comfortable and relaxed
2. Eliminate auditory cues
3. Quiet and cool environment
4. Understanding of spoken or written language (modify if needed)
5. Stabilize area of testing
6. Demonstrate with vision first then occlude
7. Be consistent with provision of stimulus, but also irregular
8. Apply at the center of the test zone
9. Note any skin differences
10. The OT who did the initial evaluation of sensation assessment should also be the one who will re-
evaluate
EVALUATION NA YEY
 SUPERFICIAL SENSATIONS
1. Light Touch and Pressure
 Use: Cotton swab, tissue, or camel hair brush
 Testing:
- Test unaffected area first
- Hand and FA are touched lightly at random
- Ask if the client felt it and localize
 Scoring: +, -, 0 (7 out of 10)
 Expected Maximal Error:
- Digital tips (10mm)
- Proximal phalanges (11mm)
- Palm (20mm)
 OR USE Semmes Weinstein Monofilament Test
2. Thermal Sensation
 Use: 4 test tubes (2cm in diameter with a stopper: hot, warm, tepid, cold)/ Hot=Yellow;
Green=Warm; Tepid=Orange; Cold=Red
 Subtest 1
- Place the side of the test tube to the skin
- Ask if it is hot or cold
- Scoring: +, 0
 Subtest 2
- Client touches tubes and arranges them from left to right (hottest to coldest)
- Normally, hand can detect 1-5 degrees C differences in temperature
3. Superficial Pain Sensation
 Use: Large safety pin or straightened paper clip
 Test:
- Don’t apply stimuli close to one another or too fast
- Limitations
- Ask if it was sharp or dull
 Scoring: +S, -S, D, +D, -D, S
 Correct Responses
 Dull reported as sharp
 Sharp reported as dull

 DEEP SENSATIONS
1. Proprioception
- ROM, held in a static position
- Identify initial, mid, and terminal positions
- Ask client to describe or copy position
2. Kinesthesia
- Small ROM
- Ask client to describe direction or copy motion
- Larger joints first, then smaller joints
 3. Vibration
- Vibrating tuning fork
- Earphones may be used
- Ask if vibrating or non-vibrating
- Placed mostly at the sternum; bony landmarks

 COMBINED SENSATIONS
1. Stereognosis
- Small, easily obtainable, and culturally-familiar objects
- Put in client’s hand-manipulated and identified
2. 2-point Discrimination
- Re-shaped paper clip, aesthesiometer
- Alternate 1-pont and 2-point
- Static and dynamic
3. Barognosis
- Objects of the same size but different weights
- Heavier or Lighter
4. Graphesthesia
- Eraser or pencil, soft cloth
- Tracing on the client’s hand
- Wipe with a soft cloth
- Ask client to verbally say what figure was traced on their palm
5. Recognition of Texture
- Wool, cotton, silk
- Placed in client’s hand, manipulated and identified
- Ask the client to identify the texture (you can let them see the material first)
6. Olfactory Sensation
- Use: 5 small opaque bottles
o 5 IMPORTANT SCENTS: Coffee, almond, chocolate, lemon oil, peppermint
- Irritating scents avoided
- Test:
o Ask the client to compress 1 nostril (alternating), take a breath
o Two sniffs are enough (short delay)
o Detect, identify, distinguish scents
- Scoring:
o (+) = detected and identified
o (-) = detected, incorrectly identified
o (0) = no scent detected
Parosmia – distorted sense of smell; can’t identify the scent; for minus score
Anosmia – no sense of smell; for 0 score
 7. Gustatory Sensation
- Use: Small containers, wet cotton swabs, pitcher of water, small rinse basin
o 4 IMPORTANT TASTES: Sugar (sweet); Salt (salty); Vinegar (sour);
Quinine/Coffee (bitter)
- Test:
o Prepare response cards
o Ask the client to protrude tongue
o place small amount on appropriate places
o irrigate tongue per stimulus
o Ask the client to point to response card before withdrawing tongue
- Tastebuds positions:

o Sweet= at the front

o Salty= at the side front
o Sour = at the side back
o Bitter = at the back
- Scoring:
o (+) = identified
o (-) = not identified

 VISION
1. Visual Cognition
- Ability to manipulate visual information mentally and integrate with other
sensory information.
- Used to gain knowledge to solve problems, create plans, and make decisions.
2. Visual Memory
- Ability to create and retain picture of object while visual analysis is being
completed.
- Memory and cognition: Not necessary to be evaluated if other areas are
evaluated thoroughly
3. Pattern Recognition
- Identifying prominent features to distinguish from surroundings
- Deficits in left and right hemispheres are different
o Left Hemisphere Deficit – advantage in differentiating subtle differences;
strict in searching and scanning (item by item/per row)
o Right Hemisphere Deficit – Chaotic in finding differences (scattered)
- Methods:
o Star cancellation test
o Matching up to 2 decks of cards
o Sorting items with similar features (screws and bolts)
4. Visual Scanning
- Use of saccadic eye movements
- Ability to focus on a moving object
5. Visual Attention
- DISENGAGE: stops focusing on object
- MOVE: shifts to new objects
- COMPARE: comparison of similarities and differences
* Visual scanning and attention cannot be separated during evaluation and intervention*
* Visual Inattention – random and less organized in approach*
o Letter Cancellation Test
- Several rows of upper- and lowercase letters on a page
- Draw a line through a specific letter each time it appears
- R Brain Lesion – fails to cancel L side
- L Brain Lesion – symmetrical
o Numerous diagonal lines scattered on the page, ask the client to cross them
o Star Cancellation Test
- Series of large and small stars on the page, ask the client to cross out small
ones
6. Oculomotor Control
- Eye movements are completed quickly and accurately
- Refer to ophthalmologist or optometrist
- WATCH OUT FOR:
o Delays (diminished speed and range of eye movements)
o Doubling or blurring
o Difficulty focusing at different distances
o Reduced concentration/endurance
7. Visual Field
- Ensures CNS receives complete information
- Test:
o Draw a horizontal line on blackboard and ask client to bisect line
o Automated perimetry
- Confrontation Test:
o OT sits in fron of the client, ask the client to focus on your nose
o Hold up 1, 2, or 5 fingers in each of the 4 quadrants
- Deficits result to: Homonymous Hemianopsia – loss of visual field in
corresponding right or left half in each eye
 - Signs:
o Changes in head position
o Bumps into objects on 1 side
o Misplaces objects in one field
o Constant errors in reading

8. Visual Acuity
- Visual information sent to CNS is accurate
- Refer to ophthalmologist or optometrist
- Myopia – nearsightedness
- Hyperopia – farsightedness
- Astigmatism – curvature of cornea is abnormal