Sensory Examination
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Sensory Examination
من طرف Shamsology الأربعاء يوليو 21, 2010 12:42 pm
Sensory Examination
ملاحظات
:
1- يعرض هذا الموضوع sensory examination من ناحيتين مرة
normal والاخرى abnormal ويوجد فيديو يوضح الشرح ولمشاهدته اضغط على
الرابط بعد كل حالة .
2- هناك بعض الاختلافات في طريقة الفحص الموجودة في هذه الفيديوهات وما
درسناه لكنها قليلة .
3- جميع الفيديوهات مرفوعة على اليوتيوب .
4- لمن يرغب بتحميل جميع الفيديوهات اضغط هنا
5- لتشغيل الفيديوهات بعد تحميلها انت بحاجة الى برنامج Quick time player لتحميله اضغط هنا
: Normal
1- Light ( Crude ) Touch :
Light touch (thigmesthesia) is used as a screening test for
touch. Both the spinothalamic and DCML systems serve this
sensation so it is not specific for either one. A cotton tip
applicator or fine hair brush is used. Select areas from
different dermatomes and peripheral nerves and compare right
versus left
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
2-
Pain – Upper Extremities :
Pain is one of the principle sensory modalities of the
spinothalamic system. The sharp end of a broken wooden cotton tip
applicator can be used then discarded. It is important for the
patient to be able to identify the sensation as sharp and then
compare between dermatomes, distal versus proximal and right
versus left for the upper extremities
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
3- Pain – Lower Extremities :
Pain is one of the principle sensory modalities of the
spinothalamic system. The sharp end of a broken wooden cotton tip
applicator can be used then discarded. It is important for the
patient to be able to identify the sensation as sharp and then
compare between dermatomes, distal versus proximal and right
versus left for the lower extremities
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
4-
Temperature :
Temperature is the other sensory modality that is used to test
the spinothalamic system. Tubes or vials of hot and cold water
can be used but this is usually impractical. Using a tuning fork,
which is normally perceived as cool or cold to the touch,
compare between dermatomes and right versus left
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
5- Vibratory
:
Vibratory sensation (pallesthesia) is one of the sensory
modalities of the DCML system. It is tested by using a 128 Hz
tuning fork and placing the vibrating instrument over a bone or
boney prominence. By varying the force of vibration and comparing
the patient to yourself you can detect any deficits. Compare
distal versus proximal and right versus left
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
6- Position
Sense :
Position sense (proprioception), another DCML sensory
modality, is tested by holding the most distal joint of a digit
by its sides and moving it slightly up or down. First,
demonstrate the test with the patient watching so they understand
what is wanted then perform the test with their eyes closed. The
patient should be able to detect 1 degree of movement of a finger
and 2-3 degrees of movement of a toe. If the patient can't accurately
detect the distal movement then progressively test a more
proximal joint until they can identify the movement correctly
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
7- Tactile
Movement :
Tactile movement as well as the remaining sensory tests are
discriminatory sensory tests that examine cortical somatosensory
(parietal lobe) function and require an intact DCML system.
Tactile movement tests the patient's ability to detect the
direction of a 2-3 cm cutaneous stimulus
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
8- Two-Point
Discrimination ( TactileDiscrimination ) :
Two-point discrimination is tested by using calipers or a fashioned
paper clip. The smallest and most dense sensory units are located
in those areas that have the greatest somatosensory cortical
representation. The patient should be able to recognize two-point
separation of 2-4 mm on the lips and finger pads, 8-15 mm on the
palms and 3-4 cm on the shins
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
9-
Stereognosis :
Stereognosis is the ability to identify objects that are placed in
the hand when the eyes are closed. The patient is given common
objects and asked to identify them without looking at them. The
inability to do this called astereognosis and indicates
parietal lobe dysfunction
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
10- Double
Simultaneous Stimulation :
The patient should be able to attend to and identify a tactile
stimulus that is applied to both sides of the body at the same
time. Double simultaneous stimulation (DSS) is tested by
touching homologous parts of the body on one side, the other side
or both sides at once with the patient identifying which side or
if both sides are touched with their eyes closed. If the patient
neglects one side on DSS (extinction or simultanagnosia)
this indicates dysfunction of the contralateral posterior
parietal lobe
click
here to watch video
11- Romberg
Test :
The Romberg test is a test of proprioception. This test is
performed by asking the patient to stand, feet together with eyes
open, then with eyes closed. The patient with significant
proprioceptive loss will be able to stand still with eyes open
because vision will compensate for the loss of position sense but
will sway or fall with their eyes closed because they are unable
to keep their balance
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
Abnormal Examples
1- Light Touch :
With light touch the patient indicates that the perception of
the stimulus is different over the left side of the face. The
feeling has an abnormal quality to it described as different,
uncomfortable or burning. This would be called paresthesia
or dysesthesia. Light touch causing pain would be allodynia
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
2-
Pain – Upper Extremities :
A sharp wooden stick is used to delineate the area of
decreased sharp sensation. There is loss over the ulnar side
of the right hand as well as the ulnar aspect of the forearm
but the arm is normal. This loss is constant with a C8-T1
dermatome distribution
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
3- Pain –
Lower Extremities :
This patient has a sensory level at T3 with decreased pain
sensation below the level including the leg. The sensory level
is one to two spinal cord segment levels below the actual
anatomical cord lesion because the spinothalamic axons ascend
several spinal cord levels prior to crossing. The left sided T3
sensory level combined with this patient's upper extremity sensory
finding indicates a lesion of the right side of the spinal cord at
the C8-T1 level
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
4-
Temperature :
The patient is unable to distinguish the difference
between a hot and cold test tube simultaneously applied to the
ulnar side of the right hand and arm and the left leg. This
deficit is in the same distribution as the pain deficit noted
when testing sharp sensation. Pain and temperature sensation are
tests for spinothalamic tract function
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
5- Vibratory :
Vibratory
sensation is decreased on the right great toe compared to the left.
This could be due to a peripheral neuropathy but it also could
be secondary to DCML deficit, which is actually the case for
this patient
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
6- Position
Sense :
The patient
makes more mistakes identifying the correct direction of toe
movement on the right then left indicating a proprioceptive
loss. For this patient this is secondary to a lesion effecting
the dorsal column on the right side of the spinal cord
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
7- Tactile
Movement :
When comparing
left vs. right, the patient has more difficulty on the right
side again indicating dorsal column dysfunction. If the dorsal
column pathways are intact, then tactile movement is a
sensitive test of parietal cortical function
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
8- Two-Point
Discrimination :
Patients with a lesion of the primary somatosensory cortex will have
difficulty with two-point discrimination on the opposite side
of the body. The peripheral nerve and DCML pathway must be
intact for this test to be a test of parietal cortical function
للاسف لم اعثر على فيديو لهذه الحالة
9-
Stereognosis :
The
patient is asked to identify objects placed in both the right and
left hand with his eyes closed. He knows that something is in his
right hand but he is unable to identify it while he readily
identifies the same object placed in the left hand. This is
called astereognosis. The patient has a lesion involving the
left parietal lobe
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
10-Double
Simultaneous Stimulation :
When the
patient is touched on the right or left he correctly identifies the
side touched but when both sides are touched simultaneously he
neglects the stimulus on the right. This is extinction or
simultanagnosia and indicates a lesion in his left parietal
cortex
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
11- Romberg
Test ( ve romberg's sign ):
With his
eyes open, the patient is able to hold still but when his eyes are
closed he sways and loses his balance. He has a significant
loss of propioception
click here to watch video
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
شكرا لكم جميعا واتمنى ان ينال الموضوع اعجابكم وان تعم الفائدة
Shamsology- مـشــرف عــام
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تاريخ التسجيل : 16/07/2010
المود :
The Editor- الإدارة
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تاريخ التسجيل : 24/08/2010
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