فيديوهات للsensory Examination سنه تانيه
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فيديوهات للsensory Examination سنه تانيه
من طرف 7oda الثلاثاء أغسطس 17, 2010 2:41 am
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 [/size]
compare right versus left
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
- 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
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
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
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
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
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
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
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
- 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
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
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
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
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
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
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
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
بالتوفيق
اسره شمسولوجى
عدل سابقا من قبل Dr.7oda في الخميس أغسطس 26, 2010 3:52 am عدل 1 مرات
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