Sensory Testing

Question 1

What are sensory abilities?

Answer 1

Pain - differentiation between sharp and dull
Light touch
- localization
- moving touch
- stationary
Temperature
Vibration
Proprioception
Reflexes

Question 2

Why do we do sensory testing?

Answer 2

Individuals with muscle weakness often have peripheral nerve problems.
Decreased sensation is often a safety issue and may not be apparent to the client.
Can interfere with function
May be a problem we can impact
- assist in the diagnosis
- accommodate
- rehabilitate

Question 3

What types of injuries cause sensory issues?

Answer 3

Peripheral nerve injury
- you will see sensory loss along the distribution of that nerve, usually unilateral
Nerve root
- loss of sensation in the dermatome of the affected nerve root, typically unilateral
Spinal cord
- depends on all or part of the cord is damaged
- based on the tracts that are damaged
Brainstem
- sensory loss of the contralateral side and cranial nerve sensory disturbances on the ipsilateral side
Cerebral cortex - strokes
- sensory loss in the contralateral limbs

Question 4

Lesion to posterior column

Answer 4

Leads to bilateral loss of proprioception, vibratory sense, and two point discrimination below the lesion

Question 5

Damage to anterolateral tract

Answer 5

Loss of pain and temperature sensation on the contralateral side below the level of the lesion

Question 6

Complete spinal cord injury

Answer 6

Lose all sensory modalities bilaterally

Question 7

Hyperesthesia

Answer 7

Abnormal pain
A heightened response to sensory input

Question 8

Hyperpathia

Answer 8

Overly sensitive to pain

Question 9

Neuralgia

Answer 9

Shock like pain along a dermatome or peripheral nerve distribution

Question 10

Dysesthesia

Answer 10

Numbness, tingling, or burning in the absence of stimulation
Sometimes called parethesia

Question 11

When do we assess sensation

Answer 11

General overview as part of client interview
When directed by a client’s history, diagnosis, or disease
If it is expected to be an issue with the diagnosis.

Question 12

General principals of sensory testing

Answer 12

Testing is specific to the client
- not typically compared to a norm (Semmes Weinsten is the exception)
Client should be comfortable
Explain the procedures to the client
Vision should be obscured
Test from normal to impaired area (move from center out)
Area of “normal” should be the standard
Keep careful notations
Equipment should be sterilized or disposed of after each use.

Question 13

Possible problems with sensory evaluation

Answer 13

Tactile agnosia - inability to recognize objects through touch
- PNS
- CNS
- cognition
- fear
- desire to please

Question 14

Hierarchy of sensation

Answer 14

1. Deep pressure
   - this is not completely cutaneous
2. Protective sensations
   - pain and temperature
3. 30 Hz vibration
4. Moving touch
5. Constant touch
6. 256 Hz vibration (smaller tuning fork)
7. Touch localization
8. Two point discrimination
   - moving
   - constant
9. Stereognosis

Question 15

Sensory retraining

Answer 15

Therapist does it
Client does it
Therapist does it while client closes eyes

Question 16

LEAP testing

Answer 16

Lower extremity amputation prevention
5 steps:
1. Annual foot exam with 5.07 monofilament
2. Patient education
3. Daily inspection
4. Footwear
5. Management of small issues
- barefoot
- toenails

Question 17

Testing of protective sensation: pain

Answer 17

Most basic
Tested subjectively by asking client, often use analog scale
Tested by sharp/dull
- use safety pin
- test an undisturbed area first so they know what to expect
- have patient cover their eyes
- follow sensory map to assess area of disruption
- if you get conflicting info back up and retest
- dispose of safety pin

Question 18

Testing of protective sensation: temperature

Answer 18

Hot/cold
Use glass tubes or a testing kit
- can use spoons in a pinch
Test exactly like you do for pain, but allow contact for 2-4 seconds
Map areas carefully

Question 19

Vibration

Answer 19

Using a tuning fork
- 30 Hz is felt first
- 256 Hz comes in later
“Tell me STOP when you feel vibration stop”
Test on chin or sternum for practice
Have them close their eyes
Strike fork and touch boney prominence, when they say “stop,” immediately go to the other side. If they feel the vibration for more than 1-2 seconds on unaffected side, the test is positive for sensory loss.
Move proximal to distal

Question 20

Typical test pattern for vibration

Answer 20

LE - distal phalanx of big toe, medial malleolus, knee, ASIS, spinous process of lumbar vertebra
UE - DIP of index, ulnar styloid, olecranon process, acromion process, spinous process of cervical vertebra

Question 21

Test for light touch

Answer 21

You feel moving before you feel static
Use a piece of cotton
“Say yes each time you feel a touch.”
- moving first
Start at suspected area, move toward normal
Carefully map and compare to dermatome and peripheral nerve charts
Check moving and constant

Question 22

Test for touch localization

Answer 22

Use the eraser end of a pencil
Use about as much pressure as if you were mashing a key on a keyboard
Have the client close their eyes
- touch spot and then have the client touch the same spot with their other hand
The client should be within 1-2cm

Question 23

Agraphagnosia

Answer 23

inability to recognize letters traced on the skin

Question 24

Test for two point discrimination

Answer 24

Also called the Dellon Two Point Test
Moving and constant, moving comes first
Primarily used to assess the UE, specifically fingertips.
Use a disK-criminator
- spaced from 1-15mm apart, as well as 20 and 25mm
The

Question 25

Moving two point distcimination test

Answer 25

Norms:
Normal ~ 2-3mm
Fair ~ 4-6mm
Poor ~ 7-9mm

“Tell me if you feel one or two points.”
Place one peg on the DIP joint and drag toward the end of the digit, roll between the 1 and others until you get the lowest consistent number
Keep perpendicular to the surface

Question 26

Static two point discrimination test

Answer 26

Just like the moving, except you don’t move
Make sure points are perpendicular to the surface
Norms:
Normal~1-5
Fair~6-10
Poor~11-15
Non functional~16+

Question 27

Stereognosis

Answer 27

The ability to identify items with out looking
Use a screen to block vision
Use 5-10 items that are similar in size
Have client tell you what it is

Question 28

Proprioception

Answer 28

Where the body is in space
Can be done with any body segment
Grasp the segment on the boarder opposite of what you are testing
Have the patient watch you move the segment and tell you “up or down.” Then have the client close their eyes and repeat.

Question 29

Semmes Weinstein Monofilament Test

Answer 29

Short and long version
Used primarily with the hands and feet
Make the patient comfortable
Explain the procedure, tell them to say “yes” when touched
Press the monofilament at a 90º angle, enough to bow it
- hold for 1.5 seconds
- can repeat up to 3x
Map clearly the problem areas
Risk of injury

Question 30

Semmes Weinstein Categories

Answer 30

Question 31

Patellar tendon reflex

Answer 31

Neurological integrity of L4
- supine or seated
- knee is flexed and quads relaxed
- with broad side of hammer, whack the patellar tendon, slightly below the patella
- should see knee extension
- Distract by having them hold hands and pull

Question 32

Achilles tendon reflex

Answer 32

Integrity of S1
- prone, supine, or seated
- flex knee to 90º, gently stretch the foot into dorsiflexion
* holding too hard will mask the effect
- tap the achilles tendon with the broad end of hammer
- should see plantar flexion

Question 33

Bicep brachii reflex

Answer 33

Integrity of C5
Forearm rested over your arm, your thumb over the biceps tendon
Strike your thumb with the small end of the hammer
Should see elbow flexion
Clench teeth

Question 34

Brachioradialis reflex

Answer 34

Integrity of C6
Position just like biceps
Strike the radial side of forearm, just above the radial styloid
Should get elbow flexion

Question 35

Triceps reflex

Answer 35

Integrity of C7
Basically the same as biceps
With small end hit the triceps tendon
Should see extension