PT EVALUATION:
SENSORY ASSESSMENT
PT EVALUATION TEAM
“Motor learning is
highly dependent on
sensory information
and feedback
mechanism”
AGING Injury to
the Body
SENSORY SYSTEM
Functional impairment Prone to injury
PURPOSE OF SENSORY ASSESSMENT
Assist in determining source of
motor deficit
Appropriate treatment and
safety precaution
Determine integrity of sensory
integration
Establish prognosis and
diagnosis
PROTOCOLS IN SENSORY
ASSESSMENT
1. Check Mental Status
2. Check for Vision, Hearing Acuity
3. Testing Environment and
Equipment
4. Patient preparation and
Instruction
PROTOCOLS IN SENSORY
ASSESSMENT
5. Implementation of Test
6. Documentation
GUIDELINES IN SENSORY
ASSESSMENT
• Explain the procedure to the pt
• Do a trial run
• Test Superficialdeepcombined
cortical
• Distal Proximal
• Random application of stimulus
• Avoid applying stimulus to scarred
tissues
CLASSIFICATION OF
SENSATION
SUPERFICIAL DEEP COMBINED
CORTICAL
•PAIN •PROPRIOCEPTION • STEREOGNOSIS
•TEMPERATURE •KINESTHESIA •2-PT.
• LIGHT TOUCH •VIBRATION DISCRIMINATION
•PRESSURE •DOUBLE
SIMULTANEOUS
STIMULATION
•GRAPHESTHESIA
SUPERFICIAL SENSATIONS
Pain
Temperature
Light Touch
Pressure
PAIN (sharp/dull discrimination)
TEST: Sharp end of pin, or
reshaped paper clip, blunt end
of neurohammer
RESPONSE:Patient able to
identify if stilumulus is applied
TEMPERATURE
TEST: test tubes with stoppers are
used filled with hot water (40-45 C)
and cold water (5-10 C)
RESPONSE: Patient indicate when
stimulus is felt as “hot”, “cold” or
“unable to tell”
LIGHT TOUCH
TEST: The area to be tested is
lightly touched or stroked using a
camel brush, piece of cotton or
tissue
RESPONSE: Patient indicate when
he or she recognizes the stimulus
by responding “yes” or “now”
PRESSURE
TEST : PT’s thumb or fingertip
to apply firm pressure on skin
RESPONSE: Patient indicate
when he/she recognizes that a
stimulus has been applied
DEEP SENSATIONS
Kinesthesia
Proprioception
Vibration
KINESTHESIA
TEST: PT moves joint/extremity
passively through relative small ROM
(holds patient over bony
prominences)
RESPONSE: Patient indicates verbally
the direction of movement while
extremity is in motion
PROPRIOCEPTION
TEST: The joint or extremity is moved
through a ROM and held in a static
position
RESPONSE: Patient describe the
position verbally or duplicate the
position with opposite extremity
VIBRATION
TEST: Base of a vibrating tuning
fork is placed on a bony
prominence
RESPONSE: Patient identifies the
stimulus as vibrating or non-
vibrating
COMBINED
CORTICAL
SENSATIONS
Stereognosis
Tactile Localization
Two-Point Discrimination
Double Simultaneous Stimulation
(DSS)
Barognosis
Graphesthesia
Recognition of Texture
Stereognosis
TEST: PT uses different familiar
objects
(e.g. keys, coins, comb, etc.)
placed at the patient’s hand
RESPONSE: Patient is asked to
name the objects verbally
Tactile Localization
TEST: PT touches patients using
fingertips in diff. skin surfaces
RESPONSE: Patient identify the
location of the stimuli by touch or
verbal response
2-POINT DISCRIMINATION
TEST: PT uses either a reshaped
paper clip, aesthesiometer or ECG
caliper
2 ends are applied simultaneously
& brought closer to each other
until stimuli are perceived as one
2-POINT DISCRIMINATION
Applied in the digit of hand in
longitudinal axis or sides of
digit
Starts with a distance of 15 cm
RESPONSE: Patient identify
perception of 1 or 2 stimuli
Interpretation of
Findings:
Total sensory loss – (>15 cm)
Partial sensory loss – (7-15
cm)
Normal sensibility – (= or < 6
cm)
Barognosis
TEST: Series of small objects of
same size but of graduated
weight is used and places weight
on same hand or both hands
RESPONSE: Compare weight of
objects indicating if it is “heavier”
or “lighter”
Graphesthesia
TEST: Recognition of letters,
numbers or designs traced in the
palm by the use or eraser end of
pencil
RESPONSE: identify verbally figures
drawn on the skin
Recognition of Texture
TEST: Items (e.g. cotton, wool,
silk) are placed individually in the
hand,Pt allowed to manipulate the
sample texture
RESPONSE: identify individual
textures by name or texture
CONDITIONS
CONDITIONS TECHNIQUE SENSATIONS
STROKE RANDOM Superficial
Deep
Combined
SCI DERMATOMAL Superficial
Deep
PNI AREA OF Superficial
ISOLATED
SUPPLY
SCI
28 dermatomes are used summarized
through Sensory Index Score
Grading system:
0 – absent sensation
1 – impaired sensation
2 – normal sensation
SCI
Sensory level is based on
the last key dermatome to
have 2/2 sensation
Pain & light touch are
assessed on both sides
5.07 MONOFILAMENT
Protective pain sensation (usually done in
pts with PNI or DM)
DOCUMENTATION (SCI)
SAMPLE CASE: SCI, Complete,
Secondary to a Gunshot Wound,
T10, Sensory Index Score 70/112,
(SIS on both side is 35/56)
TASK: EVALUATE & Document
using ASIA SCI classification
DOCUMENTATION
(STROKE, RIGHT MCA)
TASK: EVALUATE THE PATIENT
Sample Documentation
STD used: pin for pain, brush for light
touch & finger for deep pressure
50% sensory deficit on the (L) UE & LE
as to pain, light touch & deep pressure
DOCUMENTATION (PNI)
TASK: EVALUATE THE PATIENT
Sample Documentation
STD used: pin for pain, brush for LT &
finger for deep pressure
100% sensory loss in the area of
isolated supply of the R median nerve
distal to the wrist as to pain, light
touch & deep pressure
THE END
