Professional Documents
Culture Documents
Neuro Sensory Assessment
Neuro Sensory Assessment
Assessment
For Patients with Diabetes
Precious Santayana
My feet tingle.
I feel pins and needles in my feet.
I have burning, stabbing or shooting pain in my feet.
My feet are very sensitive to touch.
My feet and legs hurt at night.
My feet get very cold or very hot.
My feet are numb and feel dead.
I dont feel pain when I get a blister or another injury to my foot.
I cant feel my feet when Im walking.
The muscles in my feet and legs are weak.
I am unsteady when I stand or walk.
I have trouble feeling heat or cold in my feet.
I have open sores on my feet or legs that heal very slowly.
It seems like my feet have changed shape.
Semmes-Weinstein Monofilaments
provide a non-invasive evaluation of
cutaneous sensation levels throughout the
body with results that are objective and
repeatable.
indicated in diagnoses including nerve
compression syndromes, peripheral
neuropathy, thermal injuries and
postoperative nerve repair.
each is individually calibrated to deliver its
targeted force within a 5% standard deviation.
Semmes-Weinstein Monofilaments
1. Rest the patients extremity on a stable,
surface. Testing should be done in a quiet
help the patient fully attend to the
procedure. Occlude the patients vision by
shield or by having the patient look away.
padded
area to
testing
using a
Semmes-Weinstein Monofilaments
4. It is not necessary to test every area of the
skin when performing an evaluation. Checks
may be done over areas innervated by
different nerves. For the hand, test the
palmar surface of the index finger and thumb
to evaluate median nerve function; test the
little finger and hypothenar eminence to
evaluate the ulnar nerve; and test the dorsum
of the hand to evaluate the radial nerve (see
Figure 1). For the foot, test the sites indicated
in Figure 2.
Semmes-Weinstein Monofilaments
Semmes-Weinstein Monofilaments
5. Press the filament
at a 90 angle against
the skin until it bows.
Hold in place for 1.5
seconds and then
remove (see Figure
3). A single response
indicates a positive
response.
Semmes-Weinstein Monofilaments
6. If the patient responds to the stimulus in all sites,
normal cutaneous sensation can be documented
and the examination is complete. If the patient
does not respond to the stimulus, choose the next
largest monofilament and repeat the process.
7. When the patient indicates a response, record
the result using the colored pencil that corresponds
to the color on the handle. When representing
monofilaments of the same color, notate which
monofilament size was used (see Figure 4).
Threshold levels indicated in Figure 5 can be used
to interpret test results.
Semmes-Weinstein Monofilaments
VPT Testing
Vibration perception threshold testing
(VPT) is performed using a handheld
device (Bio-Thesiometer, Bio-medical
Instrument Company, Newbury, OH)
The clinical technique employed is
similar to the tuning fork, where the
probe is placed at the distal hallux.
The amplitude on the device is adjusted
until the patient can distinctly sense a
vibratory stimulus.
Reflex Testing
To screen for sensory neuropathy
primarily focuses on examining the
ankle reflex.
The clinician aligns the ankle into a
neutral position and strikes the Achilles
tendon with a neurological hammer.
An abnormal result is demonstrated by
complete
absence
of
ankle
plantarflexion.
Compared to other lower extremity
reflexes, the ankle reflex is the most
sensitive for detecting early signs of
neuropathy.
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
Reflex Testing
PSSD
Pressure Specified Sensory Device (PSSD)
most accurate way of testing the lower
extremity for sensory deficits.
This computer-based device is able to quantify
and record both specific peripheral nerve
threshold levels and peripheral nerve
innervation density (which reflects axonal
degeneration).
As a result, the PSSD is able to identify
pathologic changes in nerves at subclinical
levels and it is pain free.
1 Remove socks and shoes and rest the subject with their feet
laying on a sofa or bed.
2. Remind them which is their RIGHT and LEFT leg, pointing this
out by firmly touching each leg, saying this is your right when
the right leg is touched and this is your left side when the left is
touched. If you face the soles of their feet their right is on your left.
3. Ask them to close their eyes and keep them closed until the end
of the test.
4. Inform them that you are going to touch their toes and ask them
to say right or left as soon as they feel the touch and depending on
which foot was touched.
5. Perform the touch, using your index (pointing finger) as shown
in the photos and diagrams.