sensory re-education problem ,please help
(Jordan , Amman)
Question: My patient had a left CVA, and her right hand is affected, the sensation and localization in fingers is impaired, the palm sensation good but not much, her manipulation also. My long term goal is sensory re-education. Can you give me a strategies how to do it in different ways in the first phase???
: I would first explain to the patient what is going on and talk to the patient about safety precautions such as avoiding hot surfaces, hot water, and sharp objects. I would also tell the patient to do a visual check of the hand frequently to make sure it is not in a bad position. I would see if the patient can feel vibration on the various fingers. I like to use a small vibrator/massager like this one: mini massager
. If the patient can feel vibration on each finger, then you can move on to other forms of sensory re-education, but if they cannot feel vibration very well, then I would work on the patient identifying what finger the vibration is being applied to while their eyes are closed. I would also work on trying to find objects hidden in rice. They would have to do this with their eyes closed or looking away from the rice as you don't want them compensating with their vision to find the object. I usually try various sizes and shapes of objects. If they have trouble with this, then I try bigger objects. I have even put objects as big as a bottle of lotion in rice for people that have severely impaired sensation.
Normally, I would
use things like marbles, blocks, clothespins, but if these are too hard to find, then try much larger objects. Sometimes people have better luck finding metal objects because they are colder to the touch and they can feel the cold. You can also try placing heavy and lighter objects in their hand when their eyes are closed and see if they can identify which object is heavier. I also will have them close their eyes and apply various textures to the hand and see if they can feel the difference between something rough (like sandpaper) and smooth (like a silk cloth).
In addition to trying to identify touch/vibration with eyes closed, I also test for proprioception. I will have the patient close their eyes and see if they can tell what I am doing to their fingers (e.g. bending the ring finger, straightening the index finger, making an entire fist). I will also put the non-affected hand in different positions and see if they can imitate the position with the affected hand (eyes still closed). If they do not have good position sense of the affected hand, then I will give my patients a sign language hand out of the alphabet and have them try imitating the pictures first with eyes opened and then with eyes shut.
If you need further ideas, feel free to contact me. Please note that when you work with a patient during a session, do the vibration activities last as this may impair their ability to locate objects in rice or feel light touch. Also, always do sensory re-education before strengthening and fine motor activities. For more ideas, you can visit http://www.stroke-rehab.com/sensory-re-education.html