Neuroscience Analysis of Occupational Performance (OCTH 455)
and
Neuroscience (PTRS 850)
Sensory Systems Review: Question #4

The Scenerio

Ms. Basket is a pleasent woman who is an in-patient on the rehabilitation unit. You have been treating her for three weeks. Today, for the first time and in anticipation of her discharge, she arrives for therapy dressed in street clothes. She responds in an agitated manner when you compliment her on her appearence, and she becomes more fidgety and more distracted as the session continues. She responds negatively to all the activities you suggest, and nearly falls because she is so startled when you touch her arm from behind when trying to steady her as she moves to the mat. Analyze this situation from a sensory point of view.

  1. What is her problem likely to be? What lead you to this conclusion?
    Overly sensitive to touch; Tactile hypersensitivity; Tactile defensiveness. She seems over-sensitive to touch, exhibiting aversive responses to new tactile stimuli.

  2. What will you do in treatment today to help her with this problem (a solution for the short-term)? Avoid any unnecessary touch stimuli. Approach from within her visual field (engage an alternative sensory system), so that she can anticipate your touching her arm, rather than having your touch be a surprise.

  3. Based upon these behavioral observations, describe what the neurological correlate is likely to be. Explain your reasoning. An unusually low sensory threshold for touch receptors (and maybe for other receptors of the somatosensory system).

  4. What clinical assessments whould help to identify the neurological basis of Ms. Basket's behavior? Tests of somatosensory function; dermatome testing to evaluate touch thresholds. Evaulate other somatosensory thresholds (pin prick test, hot/cold discrimination test) to determine if the lowered thresholds are specific to the touch receptors, or if thresholds of all somatosensory receptors are unusually low.

  5. What longer-term treatment strategies would you consider to help her with this problem? Why? Help her to identify this problem, and develop strategies which she could employ to deal with it effectively. Note that this may only be a temporary situation, and when she returns to her normal environment (e.g., wearing street clothes every day) her hypersentivity to touch stimuli may no longer be a problem.

  6. What treatment strategies would be contraindicated? Anything which would cause more stimulation of the touch receptors, particularly if the stimuli were unpredictable. While tight clothing might initially be disturbing, the receptors should habituate to the constant stimuli. A loose, flowing gown which would activate touch receptors occasionally and unpredictably would not cause the receptors to habituate.

  7. What suggestions or advice might you consider relaying along to Ms. Basket or to her family? Along the lines of the answer above, use strategies to reduce unpredictable stimulation of touch receptors along with strategies to habituate the receptors to predictable stimuli. Wearing tight-fitting clothing (e.g., lycra spandex) would be one approach. After a time, it may be possible to add oversize shirts and pants on top of the tighter clothes, then move to wearing the baggy clothes more and more often without the tighter clothing underneath. Cutting labels out of her clothing is another possible strategy.
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