Clinical Examination of Proprioception Flashcards
Specific modalities of sensation are carried in the ______________ of the cord.
Posterior columns
Specific modalities carried in the posterior columns of the cord
- Position sense
- Vibration
- Pressure
- Texture movement
- Localization of touch
- 2 point discrimination
- Weight
- Ability to decipher letters or numbers written on the skin
Best tool used to evaluate vibration sense
128 or 256 Hz tuning fork
How to test vibration sense in a patient.
- Have patient close their eyes and instruct them that you are going to place the tuning fork on their angle and to describe what they feel
- Patient should report a “buzzing” or “vibration feel”
- Should they report nothing, move to the knees.
- Should they still feel nothing, move to the hip
Loss of vibratory sensation
Pallanesthesia
Romberg Test
- Patient stands erect , looking straight ahead, first with eyes open
- Patients feet are approximated
- Doctor stands near the patient
- Patient then closes his or her eyes and stands erect
Normal and abnormal findings for Romberg Test
Normal = patient maintains posture and has little or no swaying Abnormal = patient takes a step to maintain posture or the patient falls.
If a patient falls during the Romberg test with their eyes open, what does that indicate?
Cerebellar defect and/or Vestibular Mechanism Defect
If a patient falls during the Romberg test with their eyes closed, what does that indicate?
Dorsal column pathology
Test requires intact function of the nervous system. The long motor and sensory tracts, cerebellum, basal ganglia, and peripheral nerves.
Hopping on one foot
Squatting on one foot
Hopping on one foot test
Patient hops on one leg with eyes open and closed and then hops on the other leg with eyes open and closed
Normal and abnormal findings for Hopping on one foot test
Normal = patient maintains posture with eyes open and closed Abnormal = patient takes a step to maintain posture of the patient falls
If a patient has an abnormal findings with the Hopping on one foot test with their eyes open and closed, what does this indicate?
Cerebellar defect and/or Vestibular Mechanism Deficit
If a patient has an abnormal finding with the Hopping on one foot test with their eyes closed only, what does this indicate?
Dorsal column pathology
Good test to find minor weakness in the lower extremities
Squatting on one foot
Squatting on one foot
Patient squats on one leg with eyes open and closed and then squats on the other leg with eyes open and closed
Normal and abnormal findings for squatting on one foot
Normal = Patient maintains posture with eyes open and closed Abnormal = Patient takes a step to maintain posture or the patient falls
If a patient fails Squatting on one foot with their eyes open and closed, it indicates a :
Cerebellar deficit or Vestibular mechanism deficit
If a patient fails Squatting on one foot with eyes closed only, this indicates a:
Dorsal column pathology
Finger to Nose test
Patient has his or her arms straight out to the side and attempts to touch the tip of his or her finger bilaterally with eyes open and closed.
Normal and abnormal findings for Finger to Nose test
Normal = Should see smooth and accurate movement Abnormal = Uncoordinated movement and/or inaccuracy in measuring distance
Uncoordinated movement
Dyssynergia
Inaccuracy in measuring distance
Dysmetria
Finger to Finger Test
Patient has his or her arms straight out to his or her side and attempts to touch the tips of their index fingers together, straight out in front of them, with eyes open and closed
Normal and abnormal findings for Finger-to Finger test
Normal = Should see smooth and accurate movement Abnormal = Dyssynergia and/or Dysmetria
Only proprioceptive test done with only the eyes open
Finger to Nose to Finger Test
Finger to Nose to Finger Test
The Dr. stands with his finger about 2 feet from the patient and has the patient alternate touching his or her finger from his or her nose to the doctor’s finger with the doctor changing finger positions constantly
Normal and abnormal findings for Finger to Nose to Finger test
Normal = should see smooth and accurate movement Abnormal = Dyssynergia only
Heel to Shin test
Patient attempts to run his heel from one side down the anterior shin from the knee to the ankle of the opposite leg. This is performed bilaterally with eyes open and closed.
Normal and abnormal findings of Heel to Shin test
Normal = Should see smooth and accurate movement Abnormal = Dyssynergia and Dysmetria
Testing for the ability to perform rapid alternating movements
Patting knees rapidly, tapping forefinger to thumb, pronation/supination of the hands performed with eyes open and closed
Normal and abnormal findings for Testing the ability to perform rapid alternating movements
Normal = performing actions properly Abnormal = Inability to perform actions properly
Performing actions properly
Diadochokinesia
Performing actions improperly
Dysdiadochokinesia
What does Dysdiadochokinesia indicate?
Possible cerebellar dysfunction
Holmes Rebound Phenomenon
Patient contracts the flexors of the forearm against resistance by the doctor. The doctor releases the arm quickly. This is performed with eyes open and closed
Normal and Abnormal findings of the Holmes Rebound Phenomenon
Normal = should see a "check reflex" Abnormal = Dyssnergia and/or Dysmetria
Tandem Gait
Person walk along a straight line on the floor by placing one heel directly in front of the opposite toe with the eyes open and closed
Normal and abnormal findings for Tandem Gait
Normal = Patient is able to perform both tasks with eyes open and closed Abnormal = dyssynergia and/pr dysmetria
Joint Position Test
Dr. examines one digit of the patients hand or foot by stabilizing the hand and/or foot and grabbing a single digit from the sides and flex or extend that digit without placing any pressure on the top or bottom of the digit. Ask the patient to inform you whether you are moving the toe or finger up or down. This is performed with eyes closed
Abnormal findings of the Joint Position Test
Patient cannot determine accurately whether his finger or toe is being moved up or down
What would an abnormal finding on the Joint Position Test indicate?
Possible posterior column disease
Abadie’s sign
Pinching the Achilles tendon
Pitres’ sign
Pinching the testicles
Biernacki sign
Pinching or striking the ulnar nerve
Besides the Achilles tendon, testicles, and ulnar nerve, where can deep pain also be tested by placing pressure on?
Eyeballs
When any of the signs (Abadie’s, Pitres’, Bernacki, or eyeball pressure) are diminished, this indicates what pathology?
Posterior column disease (Tabes dorsalis is the classic example)
Combination of both superficial and deep sensations which are then subject to integration with higher cortical functions and memory.
Multimodal sensations
Examples of multimodal sensations
Stereognosis Barognosis Topognosis Graphognosis 2-point discrimination
May be assessed by placing a common object (pin, cap, key, button, etc.) in the patients hands with their eyes closed. Patient should be able to identify the object within a few seconds without switching hands
Stereognosis
Patient assesses the relative weight of similarly sized and shaped objects that have different weights
Barognosis
Touch the patient somewhere on the skin and have him or her point to the area just touched
Topognosis
Test the patient by writing a letter or number on their chest, back or palm of the hand and have them identify it
Graphognosis
Is determining at which point a patient can determine 2 objects separate from one another
2 point discrimination
2 point discrimination varies depending on the location on the body. For example, normal ranges for the finger tips are _____mm while the dorsum of the fingers are ____mm, the palm of the hands ____ mm, and the dorsum of the hand up to ____mm
Tips = 2-4 mm
Dorsum fingers = 4-6 mm
Palm = 8-12 mm
Dorsum hand = 20-30 mm
This is the ability for the patient to know a body part is his own body part.
Somatognosis
Test for Somatognosis
Placing your arm next to the patient’s arm and askin him to “touch your arm with your finger”
The ability for the patient to know that he is ill
Nosognosis
Test for Nosognosis
In light of overwhelming and obvious evidence of neurological disease such a hemiplegia, the patient will deny that there is a problem
