Divina Mahtani

October 7, 2020
Neurological Rehab
Dr. Lorie Lawrence

1. Define a dermatome and describe a precaution with using published dermatome maps.
• A dermatome is the area of skin that is supplied by one dorsal root.
• Precaution- inconsistencies exist in the dermatome maps that are used. Also
variations exist in the clinical presentation of sensory impairments.

2. Describe the five terms used to document a patients level of consciousness

• Alert- patient is awake and attentive to normal levels of stimulation.
• Lethargic- patient appears drowsy and falls asleep easily. Patient may have difficulty
in focusing or maintaining attention. Loud voice needed to keep patient engaged and
awake.
• Obtunded- patient is difficult to arouse from “sleep” and requires repeated
stimulation. Often needs a loud voice or/and a gentle shake to open their eyes.
• Stupor (semicoma)- patient responds only to noxious stimuli and returns to the
unconscious state when stimulation is stopped. When aroused, the patient is unable to
interact.
• Coma (deep coma). The patient cannot be aroused by any type of stimulation (even
noxious). Reflex motor responses may or may not be seen. Glasgow Coma Scale- 8
or less.

3. Describe four purposes of screening the sensory system.

• to determine the need for a more detailed examination of sensory function
• to determine if referral to another health-care practitioner is necessary
• to focus the search for the origin of symptoms to a specific region of the body
• to identify system-related impairments (body functions or structure) that contribute to
activity limitations and participation restrictions.

4. What type of finding from an examination of sensory function would indicate that a
referral is warranted?
• A referral is warranted if findings are inconsistent with the diagnosis or if findings
suggest that the patient has an undiagnosed condition/pathology.

CASE STUDY
A 68-year-old woman presents for outpatient physical therapy with an improperly fitted cane.
You escort her to the examination room while observing her gait pattern, which is characterized
by a slower self-selected walking speed, wide base of support, and increased time spent in
double limb support. She has a long-standing history of hypertension (15 years),
hypercholesterolemia (10 years), such as testing bath water with a thermometer or body part with
intact sensation before entering; not going barefoot; regularly checking insensitive skin areas for
cuts or bruises ( particularly important for patients with diabetes); adaptations (“compensations”
for the sensory loss) that can include substituting vision and diabetes (25 years). In addition to
reporting several falls in the past 6 months, none of which resulted in injury serious enough to be
hospitalized, the patient describes increasing pain in her lower extremities that is deep, sharp,
and burning, that is symmetrical, and occasionally wakes her up at night. The patient lives alone
in a one-bedroom apartment in a building with an elevator and level entrance to the lobby.

1
1. Of all the sense, which one is the most often affected by the patient’s medical
conditions and how would you assess it?
• Vision
• Vision can be assessed by examining the cranial nerves CNII and CNIII.
• CNII- Examine visual acuity using a Snellen chart; both central and peripheral vision
is tested.
• CNIII- The oculomotor nerve is most affected by diabetes.

5. How would you examine pain sensation and what findings would you expect given the
longstanding history of diabetes?
• Pain sensation can be examined by testing sharp/dull by touching the patient’s skin
with sharp and dull objects (pin and back of neuro pin) and asking the patient to
distinguish between the two sensations.
• Patients with a history of diabetes may present with hypalgesia, hyperalgesia, and
hyperesthesia.

6. Why is it important to examine pain sensation?

• It is important to examine pain sensation because if a patients has a sensory deficit
they may be at risk for tissue damage.

7. The test findings indicate mild loss of proprioception and vibration in the lower
extremities (distal more than proximal). What receptors are responsible for these
sensory modalities?
• Proprioceptors.

8. Where are the receptors from question 4 located?

• The skin, joints, tendons, and specialized mechanoreceptors

9. Identify the ascending pathway that mediates proprioception and vibration.

• The dorsal column- medial lemniscal system mediates proprioception and vibration.