Sensory Re-Education Activities And Techniques
Domlur, Bengaluru Feb 9, 2017
Sensory re-education is a remedial program that uses sensory stimulation to assist the sensory-impaired recoup functional sensibility in the area that suffered the damage and for them to assimilate adaptive functioning.
Patients suffering from different types of sensory impairment and loss due to an accident or illness are able to rehabilitate their sensory pathways, regain function, and adjust to altered abilities, with the help of sensory re-education.
Sensory nerve injury is either caused by nerve inflammation, stretching, or compression, or accident.
It can also be because of surgically related injuries to the PNS or peripheral nervous system.
For sensory re-education, it is important to clarify the procedures that affect the momentum of peripheral nerve rebuilding. It is especially important for patients who have experienced dissatisfactory recovery of their sensory function or have developed neuropathic pain after a traumatic or iatrogenic injury to the peripheral nerve.
Symptoms of Sensory Peripheral Nerve Trauma
The extent of sensory loss can be determined by how the patient describes the features of his changed sensations while undergoing stimuli induced testing measures.
The range of neuropathic pain can be identified by:
• Partial or complete loss of sensation known as hypoesthesia or anaesthesia,
• Tingling sensations that are not painful otherwise known as paresthesia,
• Increased sensitivity to pressure or touch. It can be accompanied by pain or numbness. This is known as dysesthesia or hyperesthesia,
• Hypersensitivity – in this ordinary stimuli results in an unpleasant or exaggerated sensation.
• Allodynia – stimuli that are not painful produces painful sensations.
• Graphesthesia – one can identify letters or numbers outlined on the skin.
• Deliberate non-use – capacity loss happens when one learns to overcompensate the affected area by using only the unaffected side.
• Protective sensation – slightly dangerous stimuli like excessive tissue stress, pressure, or temperature evokes painful sensations,
Sensory re-education is basically divided into two phases; early and late.
The early phase is intent on re-learning the difference between static and in motion touch perceptions.
The stimulus intensity required in this phase of re-education is much higher, but not to the degree that it leads to pain. The objective of late phase re-training is to re-orient the patient’s directivity towards movement perception. In this the patient would be asked to identify in which direction the object on his skin is moving, left or right?
Therapists use sensory re-education to either retrain the sensory pathways or stimulate previously unused pathways. They also train the patients in adaptive techniques that will help them offset the sensory loss. Techniques for sensory education include:
? Touching various textured and differently shaped objects,
? Applying pressure,
? Getting a massage,
? Stroking the area with friction-producing, textured items like Velcro or with specially modified instruments and tools.
? Identifying joint positions,
? Electrical stimulation,
?Using different types of tactile and movement stimulation or activities that demand attention and use of the senses, and
The following exercises can be performed to improve sensory perceptions.
Attempt to identify the various types of textures like wool, velvet, rubber, velcro, satin, sandpaper, cotton, etc.
Hide a few objects like coins or marbles in a bowl full of sand, dry beans, rice, etc. Now close your eyes and try finding these items with your hand.
Feel a particular item and then try to find a similar object inside the bowl with just your hands.
Keep your eyes open and have someone else touch you on a particular spot. Repeat the same procedure with your eyes closed. Now try associating your vision of the object touching your skin with the sensation of how it felt while it touched your skin.
Watch as the other person keeps the pressure on your skin and then rotate it around. Now close your eyes and try to distinguish when the pressure is on just a point and when it is in motion.
With your eyes closed feel as vibrations are applied to your skin through a massager. Try identifying when the vibrations are being applied. Try to determine when the massager is still and when it is moving on your skin.
Pay attention when objects like a paper clip, keys, cotton balls, etc. are being placed in your hand. Now close your eyes and try to recognize these objects as they are being placed in your hand again.
Fill half a Dixie cup with water. Try to grasp the cup without either smashing it or spilling the water. See to regulate the pressure you are exerting on the cup. For example, if you are squeezing it too hard, loosen your grip and if the cup is slipping, exert more pressure.
Do the same exercise again but this time try moving the cup to another spot. Ensure that you maintain an even and steady grip on it, i.e., neither too loose nor too tight.
Get someone to apply warm and cold to your skin. Check if you can identify the temperature difference.
Keep your eyes closed as another person re-positions your affected leg or arm. Check if you can identify what position your leg or arm is in. Open your eyes to confirm your answer.
Keep your eyes closed and let someone else place a light object then a heavy object on your hand. With your eyes closed identify which object was light and which was heavy.
Hold a pencil in your hand and close your eyes. Let someone else hold your hand and move the pencil. Now try identifying what letter you have written or drawn.
Compensatory Techniques for Adapting to Changed Abilities
There are a number of adaptive techniques that you can employ to retrain your sensibilities. Techniques for sensory re-education include:
? Observe the location and movement of body parts.
? Use the side that is unaffected by a sensory loss to check temperature of the water before washing items or taking a bath.
? Use the unimpaired side to conduct sharp objects.
? Do not put too much pressure on the affected side, frequently change positions.
? Protect the skin by sitting on cushions.
? Apply only necessary force when gripping an item.
? Take care of the skin. Be on the lookout for warmth, redness, or swelling
For optimum benefit, perform these exercises 2 to 4 times a day for a minimum of 10 minutes and in a quiet room.
Sensory Rehabilitation Area of Interest
Over several decades, sensory re-education has been used for patients suffering from nerve damage to the hand as well as stroke patients.
The nerves re-training teaches the patient to understand the object perception in a functional and meaningful way. They are also able to learn to identify and discriminate shapes of tiny objects like keys, buttons, coins, etc. They are able to perform tasks without the help of visual cues, like buttoning the shirt. Even after re-education, the touch perception remains abnormal. But sensory re-education makes the patient more accepting of his limitations and be comfortable with his situation because rehabilitation of nerves makes him functionally able.
Sensory re-education utilizes a variety of educational, rehabilitative, and therapeutic techniques to assist the patients suffering from a sensory loss to recover sensibility, fine tune their discrimination abilities, and provide them with the ability to perform tasks related to their everyday work and living activities. Sensory re-education can be done as a distinct and independent therapy, or it can be part of a bigger therapeutic program.
But one needs to understand that the effectiveness of sensory re-education is dependent on the age of the patient and differs in accordance with his verbal learning capability as well as his visuospatial intellectual skills. Recovery and improvement in neural injury are also dependent on the positive reinforcement and external motivation that the patient receives!
Also, the therapeutic approach is successful only when it is incorporated meaningfully with graded stimuli, there is active participation, and correct feedback.