Karen Hiezl Monique P.
Patricio
BSPT-4A
SENSORY EXAMINATION
Steps:
The superficial (exteroceptive) sensations are usually examined first because they consist of
more primitive responses
Deep (proprioceptive)
Combined cortical sensations
NOTE: IF A TEST INDICATES IMPAIRMENT OF THE SUPERFICIAL RESPONSES, SOME
IMPAIRMENT OF THE MORE DISCRIMINATIVE SESANTIONS WILL BE NOTED AND MAY BE
CONTRAINDICATION
For each sensory test, the following data will be generated:
The modality tested
The quantity of involvement or body surface areas affected (pattern identification
The degree or severity of involvement
Localization of the exact boundaries of the sensory impairment
The patients subjective feelings about changes in sensation
The potential impact of sensory loss on function
SUPERFICIAL SENSATIONS
Pain perception
Also referred to as sharp/dull discrimination
Large-headed safety pin
A reshaped paper clip
single-use protected neurological pin
Randomly applied perpendicular to the skin
Avoid summation of impulses
Maintain a uniform pressure with each successive application of stimuli
RESPONSE: the patient is asked to verbally indicate sharp or dull when a stimulus is felt.
TEMPERATURE AWARENESS
To determine the ability to distinguish between warm & cold stimuli
Two test-tubes with stoppers are required for this examination
Warm: 40-45C
Cold: 5-10C
The side of the test tube should be placed in contact with the skin
RESPONSE: The patient is asked to reply HOT OR COLD after each stimulus application
Touch awareness
Determines perception of tactile touch input
A camel hair brush, piece of cotton ( ball or swab) or tissue
The are to be tested is lightly touched or stroked
RESPONSE: The patient is asked to indicate when he or she recognizes that a stimulus has been
applied by responding YES OR NO
Pressure perception
The therapist fingertip or a double-tipped cotton swab is used apply a firm pressure on the skin
surface.
This pressure should be firm enough to indent the skin and to stimulate the deep
receptors
RESPONSE: The patient is asked to indicate when an applied stimulus is recognized by
responding yes or no
DEEP SENSATIONS
Kinesthesia – is the awareness of movement
Proprioception – includes position sense and the awareness of joints at rest
Vibration- refers to the ability to perceive a rapidly oscillating or vibratory stimuli
Kinesthesia awareness
This test examines awareness of movement
The extremity or joint(s) is moved passively through a relatively small ROM
The therapist should identify the ROM being examined
demonstration of the procedure should be performed prior to actual testing
RESPONSE: The patient is asked to describe verbally the direction and range of movement in
terms of up, down, in, out, or the patient may also respond by simultaneously duplicating the
movement with the opposite extremity
Proprioceptive awareness
This test examines joint position sense and the awareness of joints at rest.
The extremity or joint is moved through a ROM and held in a static position.
Small ROM
RESPONSE: while the extremity or joint is held in static position by the therapist, the pt. is asked to
describe the position verbally or duplicate it with the contralateral extremity
Vibration perception
This test requires a tuning fork that vibrates at 128Hz.
The ability to perceive a vibratory stimulus is tested by placing the base of a vibrating tuning fork
on a bony prominence (sternum, elbow, ankle)
The handle is held between thumb and index finger
To try it, hit the tines against the opposite palm
RESPONSE: the patient is asked to respond by verbally identifying or otherwise indicating if the
stimulus is vibrating or nonvibrating each time the form makes contact
Combined Cortical Sensations
Stereognosis Perception
The test determines the tactile object recognition.
A single object is placed in the hand, the patient manipulates the
object, and then identifies them verbally.
Response: The patient is asked to name the object verbally.
Tactile Localization
This test addresses the ability to localize touch sensation on the skin.
It examines the ability to identify the specific point of application of a touch
stimulus and not simply the perception of touch.
Frequently examined in combination with similar tests such as pressure
perception or touch awareness.
RESPONSE:
The pt is asked to identify the location of the stimuli by pointing to the area or by
verbal description
Two-Point Discrimination
This test determines the ability to perceive two points applied to the skin
simultaneously.
It is a measure of the smallest distance between two stimuli that can still be
perceived as two distinct stimuli.
This is among the most practical and easily duplicated tests for cutaneous
sensation.
RESPONSE: The pt is asked to identify the perception of “one” or two”
stimuli
Double Simultaneous Stimulation
○ Examines the ability to perceive a simultaneous touch stimulus on opposite
sides of the body; prox. and dist. on a single extremity; or prox. and dist. on one
side of the body.
○ The therapist simultaneously touches:
1. Identical locations on opposite sides of the body.
2. Prox. and dist. on opposite sides of the body
3. Prox. and dist. locations on the same side of the body.
Response:The pt verbally states when he or she perceives a touch stimulus and
the number of stimuli felt
Graphesthesia
○ The ability to recognize letters, numbers, or designs traced on the skin is
examined using a fingertip or the eraser end of the pencil.
○ Bet. each separate drawing, the palm should be gently wiped with a soft cloth
to clearly indicate a change in figures to the patient.
○ This test is also a useful substitute for stereognosis when paralysis prevents
grasping an object.
RESPONSE:The pt is asked to identify verbally the figures drawn on the skin.
Recognition of Texture
○ This test examines the ability to differentiate among various textures.
○ Items are placed induvidually on the pt's hand and the pt is allowed to
manipulate the sample texture.
RESPONSE:The pt is asked to identify the individual textures as they placed
in the hand. They may be identified by name (e.g silk, cotton)
Barognosis
A set of discrimination weights consisting of small objects of the same size
and shape but of graduated weight is used.
The PT may choose to place a series of different weights in the same hand
one at a time.
RESPONSE:The pt is asked to identify the comparative weight of object in a
series ( to compare the relative weight of the object with the previous one).
The pt responds by indicating that the object is “heavier” or “lighter”.