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Sensory

Integrity Tests
Components

Testing Procedures (all done blindfolded)


Superficial Sensations

Light touch

Apply touch with cotton ball, gauze, or monofilament


Have patient answer yes when touched, or gesture if unable to speak

Pressure

Apply firm, deep touch with finger tip


Have patient answer yes or gesture when touched; can ask for locale

Sharp / dull

Use clean pin and end of pencil or similar object


Deep Sensations

Kinesthesia

Test each joint individually


Place joint in a position well within available ROM (avoid end-ROM stretch) and hold in place
CONTACT ONLY BONY LANDMARKS
Ask patient to mimic or describe position

Proprioception

Test each joint individually


Move limb/joint well within available ROM (avoid end ROM stretch)
CONTACT ONLY BONY LANDMARKS
Ask patient to mimic or describe position
Test both large- and small-arc motions
Alternatively, observe quality of movement when patient is not observing limb
Combined Cortical Sensations

Tactile
Localization

Apply touch with cotton ball, gauze, or monofilament


Have patient answer yes when touched, or gesture if unable to speak, and identify location of touch
Can be tested simultaneously with light touch

Double
Simulataneous
Stimulation

Touch simultaneously and equally on: 1. Opposite sides of body at identical location, 2. Proximal and distal on
opposite side of body, 3. Proximal and distal on same side of body
Ask patient to describe where s/he is being touched
Extinction phenomenon: when client identifies touch only on intact side, but not on involved side

Stereognosis

Place a small object (e.g., coin, key) in the patients palm; ask patient to identify object
Often tested by OT
Difficult to assess in patients with fine motor incoordination

2-point
discrimination

Caliper administered; see Appendix 3-A in O'Sullivan for normal values


Often tested by OT

Reflex Integrity
Components
Observation

Testing Procedures
Observe limb and body
position in various postures

Palpation

Palpate various muscles and


feel for degree of stiffness

Move limb through range
of motion
Apply quick stretch to
assess presence of
spasticity
Pendulum test

Muscle positioned at mid-
range
Patient instructed to relax
Tap sharply over tendon

PROM

Deep tendon
reflexes

Modified
Ashworth Scale

Move limb through ROM and


quantify the degree of
spasticity using the Modified
Ashworth Scale

Results & Indications


Low muscle tone: floppy appearance, limb hangs loosely
High muscle tone: may see synergistic posturing

Low muscle tone: soft, pliable
High muscle tone: stiff, rigid, immobile

Low muscle tone: excessive ROM, no resistance through ROM


High muscle tone: stiffness, rigidity, decreased ROM
If spastic: resistance when moving out of spastic pattern; when
moving into pattern
If rigid: resistance into both flexion and extension
Use Ashworth Scale (below) to rate spasticity
0 = absent
1+ = present but depressed
2+ = normal
3+ = brisk (but may not be abnormal)
4+ = very brisk reflex, abnormal, clonus

0 = no increase in tone
1 = slight increase in tone; catch & release or minimal resistance at end
range
1+ = slight increase in tone; catch followed by resistance throughtout
range
2 = more marked increase in tone through most of range, but affected
parts moved easily
3 = considerable increase in tone, passive movment difficult
4 = affected parts rigid in flexion or extension