METHODS OF SENSORY TESTING

Type of Test Touch Awareness Tactile Attention What the Test Measure Awareness of touch input within the CNS Awareness of two simultaneous inputs or presence of tactile inattention Spatial representation of sensory receptors in cortex Threshold of Light touch sensation Test Instrument Cotton ball, cotton swab or fingertips Finger tips Stimulus Light touch to a small area of the skin Touch on side or both side simultaneously Response Yes or nonverbal response every time each stimulus is felt one or two Scoring No of responses correct Normal or Expected Score 100%

Touch Localization

Touch/ pressure Threshold

Pen, cotton ball, Semmes Weinstein monofilament number 4.17 Semmes-Weinstein monofilaments

Apply touch on each zone (sensory mapping) once Apply then hold 1 to 1.5 sec, remove 1 to 1.5 sec. Repeat three times.

Open eyes and point area touched yes whenever stimulus is felt

Pain: Sharp/ Dull Awareness

Discrimination of Sharp-dull stimulus

Safety pins/ needle

Temperature

Discrimination of hot and cold stimulus

Vibration Awareness

Awareness of input to quickly adapting fibers

Glass tubes filled with hot and cold water, commercially available metal probes Tuning Fork; 30 cycles per second or 256 cycles per second Vibrometer

Randomly apply sharp and blunt end of safety pin, perpendicular to patients skin, at constant pressure Apply cold (40 F) or hot (115 to 120 F) stimuli to patients skin Strike tuning fork and then place prong tangentially to fingertip first on the injured and then non -injured side. Apply vibrating head to area to be tested, gradually increase

Sharp or dull

Normal if patient is correct; Sensory Extinction: if only one stimulus is felt when there had been two presented Distance between location of stimulus and location of response The number of thinnest filaments felt at least once out of the three trials, results usually recorded using colored pens or markers and a color key on a diagram Number of correct responses

Digit tips: 10mm; Prox phalanges:11 mm; Palm: 20 mm 2.83: normal 4.31: little numbness 5.46: no feeling (1.65 to 4.08)

100%

hot or cold

Number of correct responses

100%

same or different

Normal or altered

Identical perception in both hands

Vibration Threshold

Threshold of quickly adapting fibers

Pt indicates when he first felt the stimulus

Voltage is read from the vibrometer then converted into

Normal: < 0.04 ; Abnormal:

Proprioception

Unknown combination of touch receptors, muscle receptors, and joint receptors

None

Stereognosis

Ability to interpret sensory input Innervation density and interpretations of sensation of the median nerve distribution

A number of small objects known to the patient Twelve standard objects: Wing nut, screw, key nail, large nut, nickel, diem, washer, safety pin, paper clip, small hex nut, small square nut

Dellons Modification of Mobergs Pick-up test

intensity of stimulus Hold body being tested on the lateral surface and moved through varying angles (index finger flexion, middle finger extension, thumb extension, little finger flexion, wrist flexion, wrist extension) Place the small objects to the hand of the patient, he may manipulate it With vision, have pt pick up the objects and transfer it to the box (index and ring fingers should not be used.) With vision occluded, put the objects on patients three-point pinch and have him identify the object Begin with 5 mm separation points, lightly apply one or two points in a longitudinal orientation o hand, hold until patient responds, gradually adjust to find lowest level correct

up or down or duplicates position on the opposite side of the body

microns Intact, impaired or absent

> 0.09 Nearly 100% correct duplication

Patient names objects

Number of correct responses 1. Time to pick up and place all 12 items into the box

Nearly 100% correct identification 1. trial1: 10 to 19 sec trial2: 9-16 sec

1. Time to pick up all objects and deposit it in box as quickly as possible 2. Patient manipulates objects and names it as quickly as possible one or two or I cant tell

2. Time to recognize each object on each of two trials

2. 2 sec per object

Static two point discrimination

Innervation density of slowly adapting fibers

Bent paper clip, aesthesiometer, Boley gauge, compass, or calipers with end blunted, Disk-criminator

Smallest distance at which at least correct 7 out of 10 stimuli are correctly perceived

Distal phalanx: 3mm; Middle phalanx: 45mm; Prox phalanx: 67mm; Palm: 7 10mm NORMAL: <6mm FAIR: 6-10mm POOR: 11-15mm Protective: One point perceived Anesthetic: No point perceived Distal finger tip: about 2mm

Moving two point discrimination

Innervation density of quickly adapting fibers

Bent paper clip, aesthesiometer, Boley gauge,

Begin with 5 - 8mm separation points, one or two points are

one or two or I cant tell

Smallest distance at which at least correct 7 out of 10 stimuli are

compass, or calipers with end blunted, Disk-criminator

moved from proximal to distal phalanx with point side by side and parallel to the long axis of the finger

correctly perceived

Be Happee always and God bless! --Ms. Bevsz ,)