Practical 1_Sensory Assessments, and Reflexes

Question 1

1. Demonstrate first with eyes open.
2. Ask the patient to close eyes.
3. Lightly touch the skin’s surface using a cotton tip applicator, cotton ball or fine hairbrush in an unpredictable pattern.
4. Avoid stroking across dermatomes. Avoid calloused areas.

Instructions to Patient: “I am going to touch your arm with this cotton ball in various locations. Say ‘yes’ when you feel something.”

Answer 1

Superficial Light Touch (Sensation)

Question 2

1. Randomly alternate the sharp or dull end of a sterile safety pin on the skin surface.
2. Show patient first with eye’s open to ease any concerns!

Instructions to Patient: “I am going to carefully touch you with the sharp or dull side of this safety pin. Tell me whether you feel it as a sharp or dull sensation.”

Answer 2

Sharp/Dull (Sensation)

Question 3

1. Demonstrate first with eyes open.
2. Ask the patient to close eyes.
3. Place the stem of the tuning fork against several bony prominences beginning distally.
4. Randomly alternate whether the tuning fork is vibrating or not (cease vibration by touching the fork).

Instructions to Patient: “I am going to test whether you can feel vibration. Do you feel this? What does it feel like?”
Or
Ask the client if the tuning fork feels the same comparing the involved to the uninvolved side with eyes occluded.

Answer 3

Vibration (Sensation)

Question 4

1. Demonstrate first with eyes open.
2. Ask the patient to close eyes.
3. Alternately touch skin with one point or two points simultaneously at various locations using an open paperclip, aesthesiometer or 2-point discriminator.
4. Find the distance at which the patient can no longer distinguish 2 points.

Instructions to Patient: “I am going to touch one point or two points on your hand. Tell me if I am touching with one or two.”

Answer 4

Two-point discrimination (Sensation)

Question 5

1. Demonstrate first with eyes open.
2. Ask the patient to close eyes.
3. Hand patient familiar objects to identify, such as a paper clip, key, coin.

Instructions to Patient: “I am going to place an object in your hand. I want you to tell me what it is.”

Answer 5

Stereognosis Cortical sensory function (Sensation)

Question 6

1. Demonstrate first with eyes open.
2. Ask the patient to close eyes.
3. Hold joint to be tested (great toe or finger) by lateral aspects in neutral position, then raise or lower digit (IP flex/ext).
4. Repeat 4-6 x’s, returning to neutral position after each test.

Instructions to patient: “I am going to move your finger up or down….Which way was it moved? Up or down?”

Answer 6

Proprioception (joint position) (Sensation)

Question 7

1. Flex elbow 45 degrees, then palpate biceps tendon in antecubital fossa.
2. Place thumb over tendon and fingers under the elbow.
3. Strike your thumb with reflex hammer.

Answer 7

Biceps (Deep Tendon Reflex)

Expected findings:
Visible or palpable flexion of elbow, contraction of biceps muscle.

Question 8

1. Demonstrate first with eyes open.
2. Ask the patient to close eyes.
3. Position patient’s arm in the air and ask patient to replicate that position with the opposite arm. Repeat in various positions on both sides of the body.

Instructions to patient: “I am going to put your arm into a position, and I want you to put your other arm in the same position.”

Answer 8

Proprioception (joint position) (Sensation)

Proprioception is the awareness of where the body is in space.

Question 9

1. Flex elbow 45 degrees while resting patient’s forearm on your arm, with hand slightly pronated. Strike brachioradial tendon.

Answer 9

Brachioradialis (Deep Tendon Reflex)

Expected findings:
Pronation of forearm and flexion of elbow.

Question 10

1. Flex elbow 90 degrees and rest hand against body.
2. Palpate triceps tendon and strike directly with reflex hammer, just above elbow.

Answer 10

Triceps (Deep Tendon Reflex)

Expected findings:
Visible or palpable extension of elbow, contraction of triceps muscle.

Question 11

1. Flex knee 90 degrees, allowing leg to hang loosely.
2. Strike patellar tendon just below patella.

Answer 11

Patellar (Deep Tendon Reflex)

Expected findings:
Extension of lower leg, contraction of quadriceps muscle.

Question 12

1. Flex patient’s knee and dorsiflex ankle 90 degrees, holding heel.
2. Strike Achilles tendon at level of ankle malleoli.

Answer 12

Achilles tendon (Ankle) (Deep Tendon Reflex)

Expected findings:
Plantar flexion, contraction of the gastrocnemius muscle.