neurological assessment

Question 1

what is hypoesthesia

Answer 1

decreased perception of innocuous (painful) stimuli

Question 2

what is hypersensitivity

Answer 2

Sensations amplified. In this regard to light touch – things like contact with clothes may evoke an irrational sensory experience and an inappropriate motor response.

Question 3

what is hyposensitivity

Answer 3

abnormally decreased sensitivity to sensory input
Allodynia = pain due to a stimulus that does not normally provoke pain.” An example would be a light feather touch resulting in pain

Question 4

what is paraesthesia

Answer 4

abnormal sensation, typically tingling or pricking (‘pins and needles’), sometimes burning, another is ants are crawling over/under the skin

Question 5

what is dysaesthesia

Answer 5

an unpleasant, abnormal sense of touch; such as burning, wetness, itching, electric shock, tingling, stinging or a cold sensation

Question 6

how to perform the light & crude touch test

Answer 6

-Appropriate dressing / undressing
-Patient in comfortable position , eyes closed
-Light touch = Use cotton wool ball – brief dab only. Note - Don’t drag cotton ball for light touch (evokes sensory receptors in hair follicles which give extra stimulation)
-Ask patient to state “yes” every time they feel you touch them.
Test CNS in body segments (ant, post, lat, medial) for localized area or entire body
-Begin to randomize
-Compare sides ?does it feel the same?
Ask does it feel normal / strange?
-Begin to ask them to state where they are being touched (if can, DCML intact, if can’t but feels it, Ant spinothalamic intact)
Document any findings

Question 7

how to perform the pain/nociception test

Answer 7

-As per light touch assessment but use sharp end of a neurotip as the instrument for producing the stimulus for pain.
-Do not apply too much force or pierce the skin.
-Use tip at 45 degree angle.
Can then move onto “sharp or blunt” which assesses quantification related to different characteristics of pain.
-Use sharp and blunt end of neurotip.
-Patient reports whether sharp or blunt.
-Document findings.

Question 8

how to perform the temperature awareness test

Answer 8

-As per light touch / pain assessment, but should use thermo controlled test tubes.
-One cold – 6-10 degrees C.
-On hot – 44-48 degrees C.
-Test both separately.
-Can move onto discrimination.
-Test using both but randomised. Patient identifies whether hot or cold stimulus.
- Document findings.

Question 9

how to perform the stereognosis test

Answer 9

-The therapist places a familiar object in the patients hand allowing manipulation of the object
-The patient is requested to identify the object with eyes closed.
-Complete with both upper limbs.
-Document findings.

Requires integration of all somatosenses and involves other higher centres (such as object memory, perception of shape).

Question 10

how to perform the proprioception - mirroring test

Answer 10

-The patient may be sitting or supine and comfortable.
-Explain and demonstrate the procedure.
-Ask the patient to close their eyes.
-The therapist places and holds the affected limb into a set position.
The patient is requested to copy the position with the opposite limb and the therapist makes judgement on the accuracy of the response.
-An inaccurate response may indicate a deficit of joint position sense (not movement sense).

Note: patient needs to have a certain level of motor ability in the limb being moved by the patient to complete this accurately.

Question 11

how to perform the proprioception - joint position sense test

Answer 11

-The patient should ideally be supine and comfortable.
-Explain and demonstrate the procedure.
-Use layman’s explanations – not flexion / extension but bent / straight.
-Ask the patient to close their eyes.
-The therapist places and holds one limb into a set position (extreme of one position, e.g elbow flexion).
-Patient indicates if elbow if straight or bent.
-Repeat / compare on both sides.
-Can progress moving the joint and asking patient to identify if “more bent” or “more straight” then original position.
-Start over larger ranges (gross position sense).
-Progress to shorter ranges. (fine position sense).
-Progress to identifying while movement taking place (movement sense).

Question 12

how to perform the ataxia/coordination test (finger to nose test)

Answer 12

1. Patient should be either supine on a plinth or
   sitting on a chair
2. Therapist sits Infront of patient facing them
3. Therapist holds their finger in front of the
   patients at eye level
4. With eyes open the patient is asked to touch
   their own nose with their index finger and then
   touch the therapists finger
5. This is completed several times and should be
   accomplished smoothly and easily
6. If the performance is accurate, ask the patient
   to repeat this faster
7. Modify the position of the therapist finger and
   repeated the test, to test the different planes
   of movement.

Question 13

how to perform the ataxia/coordination test (shin to heel test)

Answer 13

1. Patient should be either supine on a
   plinth or sitting on a chair
2. The patient is asked to place the heel of
   one lower limb to touch the knee of the
   opposite leg
3. The patient is requested to run the heel
   down the shin towards the ankle joint.
   This should be accomplished smoothly
   and easily
4. If the performance is accurate, ask the
   patient to repeat this several times with
   increasing speed.
5. Repeat with eyes closed.