Info

the vibration through the patient's finger to determine the accuracy of the patient's response. After the fingers are tested, test the big toes, as demonstrated in Figure 21-51B. If there is no loss of vibration sense, proceed with the next examination. If a loss is present, determine the level.

Test Proprioception

Position sense, or proprioception, is tested by moving the distal phalanx. Hold the distal phalanx at its lateral aspects, and move the digit up while telling the patient, ''This is up.'' Move the distal phalanx down and tell the patient, ''This is down.'' With the patient's eyes closed,

Figure 21-48 Technique for testing light touch.

Figure 21-49 Segmental distribution of the spinal nerves. A, Distribution in the front. B, Distribution in the back.

Figure 21-50 Technique for testing pain sensation. A and C, The examiner should hold the pin as demonstrated and say, "This is sharp.'' B and in D, The examiner should hold the other end of the pin and say ''This is dull.''

Figure 21-50 Technique for testing pain sensation. A and C, The examiner should hold the pin as demonstrated and say, "This is sharp.'' B and in D, The examiner should hold the other end of the pin and say ''This is dull.''

move the distal phalanx up and down and finally stop and ask, ''What is this, up or down?'' This is demonstrated in Figure 21-52A. Grasp only the sides of the digit so that the patient cannot be clued by the pressure exerted on the digit. It is routine to test the terminal phalanx of a finger on each hand and the terminal phalanx of the toes (see Fig. 21-52B). If no loss of position sense is detected, continue with the rest of the examination. A loss of proprioception necessitates further evaluation to determine the level of loss.

Test Tactile Localization

Tactile localization, also known as double simultaneous stimulation, is assessed by having the patient close his or her eyes and identify where your touch was felt. Touch the patient on the right cheek and the left arm. The patient is then asked, ''Where did I touch you?'' This is demonstrated in Figure 21-53. Normally, patients have no problem identifying both areas. A patient with a lesion in the parietal lobe may feel the individual touches but may ''extinguish'' the sensation on the side contralateral to the side of the lesion. This is the phenomenon termed extinction.

Test Two-Point Discrimination

Two-point discrimination tests the patient's ability to differentiate one stimulus from two. Gently hold two pins 2 to 3 mm apart, and touch the patient's fingertip. Ask the patient to state the number of pins felt. This is demonstrated in Figure 21-54. Compare this finding with that from the corresponding area on a fingertip of the other hand. Because different areas of the body have different sensitivities, you must know these differences. At the fingertips, two-point discrimination is 2 mm apart. The tongue can discriminate two objects 1 mm apart; the toes, 3 to 8 mm apart;the palms, 8 to 12 mm apart;and the back, 40 to 60 mm apart. A lesion in the parietal lobe impairs two-point discrimination.

Hearing Aids Inside Out

Hearing Aids Inside Out

Have you recently experienced hearing loss? Most probably you need hearing aids, but don't know much about them. To learn everything you need to know about hearing aids, read the eBook, Hearing Aids Inside Out. The book comprises 113 pages of excellent content utterly free of technical jargon, written in simple language, and in a flowing style that can easily be read and understood by all.

Get My Free Ebook


Post a comment