Sensory Function

• Fatigues quickly
– Efficiency
– Special attention to areas of:
• Symptomology
• Motor or reflex abnormalities
• Trophic changes
– Confirm with repeat testing!!
• Patterns of testing:
– Symmetrical
– Distal vs. proximal: scattered stimuli
– Vary pace
 Sensory Function Testing
• Look for abnormality
– map out boundaries in detail
• Source of lesion
• Distribution of sensory abnormalities
and kinds of sensations affected
• +/- motor/reflex abnormality
• Demonstrate to patient before testing
 Spinothalamic Tract

• Pain and temperature

• Crude touch (light touch
without localization)
• Fibers cross & pass
upward into thalamus
 Pain Sensation
• Sharp safety pin or other tool
• Demonstrate sharp & dull
• Test by:
– Alternating sharp & dull w/ pt’s eyes closed
• Ask patient:
– Sharp or dull?
– Does this feel same as this?
– Lightest pressure needed - do not draw blood
 Temperature
• Often omitted if pain sensation normal
• Two test tubes
– filled with hot & cold water
– or tuning fork heated or cooled by water
Light Touch
• Wisp of cotton
• Touch lightly -
avoid pressure
• Ask patient:
– To respond when
touch is felt
– Compare one
area with another
 Posterior Columns
• Position and
vibration
• Fine touch
• Synapse in
medulla,
cross &
continue on
to thalamus
 Vibratory Sense

• 128 or 256 Hz
Tuning fork
• If impaired,
proceed
proximally
 Proprioception

Grasp toe by
sides - pull
away from
other toes
Demonstrate
“up” &
“down”
Tactile Localization
• Have pt close
eyes
• Touch pt on R
cheek & L arm
• Ask patient
where touch
was felt
 Discriminative Sensations
• Stereognosis, graphesthesia, two-point
discrimination
• Test ability of sensory cortex to correlate,
analyze, & interpret sensations
• Dependent on touch & position sense
• Screen first with stereognosis - proceed to
other methods if indicated
 Stereognosis
• Ability to identify an
object by feeling it
• Place familiar object in
patient’s hand & ask
patient to identify it
• Normally patient
manipulates it skillfully &
identifies it correctly
Graphesthesia

• Perform if inability
to manipulate
object
• Ability to identify
numbers written in
hand
• Use patient’s
orientation
Two-Point Discrimination

• Touch two places

simultaneously
• Alternate stimuli
• Avoid pain
• Determine distance
 Spinal Reflexes: DTRs
• Segmental levels of DTRs:
– Supinator reflex C5, 6
– Biceps reflex C5, 6
– Triceps reflex C6, 7
– Abdominal reflexes - upper T8, 9, 10
– - lower T 10, 11, 12
– Knee (Patellar) L2, 3, 4
– Plantar responses L5, S1
– Achilles reflex S1 primarily
Deep Tendon Reflexes: Grading
Grade DTR Response
4+ Very brisk, hyperactive, with
clonus
3+ Brisker than average, slightly
hyperreflexic
2+ Average, expected response;
normal
1+ Somewhat diminished, low
normal
0 No response, absent
Reflex Hammer - Incorrect Usage
Jendrassik’s Maneuver

• Reinforcement
technique
• Upper extremities
– clench teeth
– squeeze thigh
• Lower extremities
– lock fingers and pull
one against the other
Biceps Reflex

C5,C6
Elbow Flexion
 Triceps Reflex

C6, C7, C8
Elbow Extension
 Brachioradialis Reflex
C5, C6
Forearm semiflexion/semipronation
(NO wrist/hand flexion)
Patellar Reflex

L2, L3, L4
Knee Extension
 Achilles Reflex
S1, S2
Ankle Plantar Flexion
 Plantar Reflex

L5, S1, S2 Babinski Sign

Abdominal Reflexes

T8, T9, T10:

ABOVE umbilicus
T10, T11, T12:
BELOW umbilicus
 Anal Reflex
• Superficial reflex
• Loss of anal reflex suggests lesion of S2,3,4
reflex arc
• Possible lesion of cauda equina
 Clonus

• Rhythmic Oscillation

• Flexion/Extension

• UMN Lesion
 Cerebellar Function
• Requires • Assessed by:
integration of: – Rapid alternating
– Motor system movements
– Cerebellar system – Finger-to-Nose /
– Vestibular system Heel-to-Knee Test
– Sensory system – Romberg’s Test
– Gait
 Finger-to-Nose Test
• Finger-to-nose
with moving
target

• Stationary
finger-to-nose
with eyes closed
Heel-to-Knee Test
 Rapid Alternating Movements

• First with hands

• Repeat with feet
• Diadochokinesia = ability to perform RAM
• Dysdiadochokinesis = slow, irregular, clumsy
movements
Station, Stance & Romberg’s Test
• Station & Stance
– Pt stand with feet together
– First, eyes open
• Romberg Test
– Then, close eyes
– If okay with eyes open, but sways
w/ eyes closed = + Romberg
– Mainly tests position sense
• Vision can compensate for loss of
position sense
Pronator Drift

• Often performed in
conjunction with
Romberg test

• Pronator drift
– Muscular strength
– Coordination
– Position sense