Professional Documents
Culture Documents
& Desensitization
SENSATIONS…
Moberg – “Hands without sensation is like
eyes without vision”
Dorsal Horn
“the gate”
Lamina I-VI
- Substantia gelatinosa – lamina 2 (what
gives it distinction?)
3 Types of Primary Afferent Fibers:
Thermal sensation
Superficial Pain
Stereognosis
Kinesthesia
Sensory Evaluation & Testing
Light touch
Pressure
Position/Motion Sense
Thermal
Superficial Pain
Functional Tests
Functional
Implications?????
Two-Fold Objective
Sensory acuity – potential to function
Function with acuity – actual ability to function
Principles of Treatment
Treatment is always based on Learning Principles
Loss of Sensation
Compensation Techniques
Diminished
Sensory Re-Ed/Retraining
Hypersensitive
Desensitization
COMPENSATION TECHNIQUES
Compensation Techniques
Skin care
prevention – cushions, in-soles, straps, protective mitts
wound care
Methods of Compensation
Brand (1979)
Avoid exposure of the involved area to heat, cold, and sharp
objects.
Avoid tasks that require use of one tool for long periods of time,
especially if the hand is unable to adapt by changing the manner
of grip.
Methods of Compensation
Brand (cont’d)
Change tools frequently at work to rest tissue areas.
May begin when the patient first can appreciate deep, moving touch
Matching sensory perception with visual perception
Discrimination:
Gross to fine discrimination
Moving/exploring
Use of grid
Progression:
Matching - Same or different?
In what way?
Identify texture, object, etc…
Sensory Modalities Used
Eraser end of pencil - graphesthesia
Fabrics
1. Dellon
2. Wynn Parry
3. Turner
4. La Croix and Helman
5. Callahan
6. Nakada and Uchida
SR Protocols - PNI
Dellon (Pedretti, 5th ed, p.440; Trombly, 5th Ed, p.589)
Early phase
Reeducation of moving touch, constant touch, pressure, and touch localization
Use of pencil eraser
4x a day at least 5 mins each
Procedure: 1. Patient observes the stimulus
2. Vision occluded (verbalizes sensation felt)
3. Eyes open to verify
Late phase
Initiated when moving and constant touch are perceived at the fingertips with good
localization
Usually 6-8 months after nerve repair at the wrist
Goal: recovery of tactile gnosis
Procedure: Same as above
Progression:
1. Large objects different from one another (common household items)
2. Objects with more subtle differences
3. Different textures
4. Smaller objects requiring discrete discriminations
5. Incorporate activities that simulate occupational roles
SR Protocols - PNI
Wynn Parry (Pedretti, 5th Ed., p.441)
Initial phase
a. Place block in affected hand with vision occluded – feel block,
describe shape, compare weight with block in UA
b. Look at the block and repeat manipulation if incorrect/different
c. Compare sensory experience with UA hand
d. Continue until various shaped blocks have been mastered
e. Differentiate textured from wooden surfaces – blocks with
sandpaper or velvet
SR Protocols - PNI
Next phase
a. Identification of several textures with vision occluded
b. Identification of common objects with vision occluded
Goal: gain larger cortical representation for the areas from which
sensory feedback is crucial to performance of daily tasks
Progression:
soft => coarse => rough
Increase in force, duration, and frequency of application
Sensory Modalities Used
Massage
Percussion/tapping or
rolling/stroking with different
textures
Vibration
Immersion in materials - styrofoam
balls, rice, beans, popcorn and
plastic squares
Weight-bearing
Pressure/Compression
TENS
Heat
Fluidotherapy
Therapy putty
Treatment Protocols
Hardy, Moran and Merritt Desensitization Protocol
Treatment Protocols
Principles of treatment
- Suggest treatment intervention
- progression?
- possible functional activity/activities in outpatient clinic