What is two-point discrimination test?

The two-point discrimination test is used to assess if the patient is able to

identify two close points on a small area of skin, and how fine the ability to
discriminate this are.
It is often tested with two sharp points during a neurological examination and is
assumed to reflect how finely innervated an area of skin is.

Can the two-point discrimination be impaired?

The posterior column-medial lemniscus pathway is responsible for carrying
information involving fine, discriminative touch. Two-point discrimination can
be impaired by damage to this pathway or to a peripheral nerve.

What is the meaning of threshold for discrimination?

The minimal distance with which the patient can distinguish between two
stimuli is found by moving from proximal to distal. 

What can be done for accurate results?

 The area being tested must not be seen by the patient and the patient
must concentrate on feeling the points.
 the hand must be immobile on a hard surface and it must be ensured
that the two points are simultaneously touching the skin. 
 There must be no skin blanching as it indicates too much pressure
being applied.

What causes different parts of the body to have different sensory level?
What causes the different results?
The ability to distinguish between one point or two points of sensation depends
on how dense mechanoreceptors are in the area of the skin being touched. You
most likely found that certain areas of your body are much more sensitive to
touch than other areas. Highly sensitive areas such as the fingertips and tongue
can have as many as 100 pressure receptors in one cubic centimeter. Less
sensitive areas, such as your back, can have as few as 10 pressure receptors in
one cubic centimeter. Because of this, areas such as your back are much less
responsive to touch and can gather less information about what is touching it
than your fingertips can.
The pathway on how we sense the stimuli
Neurons (which are specialized nerve cells that are the smallest unit of the
nervous system) receive and transmit messages with other neurons so that
messages can be sent to and from the brain. This allows the brain
to communicate with the body. When your hand touches an object, the
mechanoreceptors in the skin are activated, and they start a chain of events by
signaling to the nearest neuron that they touched something. This neuron then
transmits this message to the next neuron which gets passed on to the next
neuron and on it goes until the message is sent to the brain. Now the brain can
process what your hand touched and send messages back to your hand via this
same pathway to let the hand know if the brain wants more information about
the object it is touching or if the hand should stop touching it.

What receptor is involved in the two-point discrimination?

The tactile system, which is activated in the two-point discrimination test,
employs several types of receptors. A tactile sensory receptor can be defined as
the peripheral ending of a sensory neuron and its accessory structures, which
may be part of the nerve cell or may come from epithelial or connective tissue.

Which test area has the best two-point discrimination?

Different areas of the body have receptive fields of different sizes, giving
some better resolution in two-point discrimination. The tongue and finger
pads have very high resolution, while the back has very low. This is illustrated
as the distance where the two points can be felt as separate.

Which area of the body was most sensitive? Why?

My cheek and bottom lip were most sensitive. It might be really sensitive
because its on the face or because they have more nerve endings. Smaller, more
dense sensory fields.

Which area of the body was least sensitive? Why?

My forearm and back of hand were least sensitive. It might be because it has
thicker skin than other body parts or less nerves.

Will loud music affect the two-point discrimination test?

The loud music will be very distracting while trying to determine the two-point
discrimination. Loud music affects our ability to concentrate on the senses.

What is tactile location?

Tactile localization is the ability to determine which portion of the skin has been
touched.

What is a reflex?
The automatic response of a muscle to a stimulus 

Why is the knee-jerk reflex very fast?

There is only one connection (a synapse) needed for the information from the
sensory neuron to get to the motor neuron and cause a muscle contraction.
Because of this single synapse, this can happen very fast.
What is the knee-jerk reflex?
Knee-jerk reflex, also called patellar reflex, sudden kicking movement of the
lower leg in response to a sharp tap on the patellar tendon, which lies just below
the kneecap.

If the knee-jerk reflex works, what does this indicate?

The kick simply indicates that a section of your spinal cord, and the nerves
extending from it, are working properly. Testing a series of different reflexes
gives an indication of the health of your whole nervous system.

Path of the knee jerk reflex

The tendon below your kneecap connects to the quadriceps muscle on top of
your thigh. When the patellar tendon is hit, the hammer's rap on the tendon
slightly stretches the muscle. Sensory nerves in the muscle are stimulated by the
stretching and send an impulse to the spinal cord. Motor nerves in the spinal
cord then conduct the impulse right back to the quadriceps, triggering a muscle
contraction that makes you kick.

Reflex arc
Reflexes are mediated over simple nerve pathways called reflex arcs. Reflex
arcs have five essential components:
The receptor at the end of a sensory neuron reacts to a stimulus.
The sensory neuron conducts nerve impulses along an afferent pathway towards
the CNS.
The integration center consists of one or more synapses in the CNS.
A motor neuron conducts a nerve impulse along an efferent pathway from the
integration center to an effector.
An effector responds to the efferent impulses by contracting (if the effector is a
muscle fiber) or secreting a product (if the effector is a gland).

What to do if no reflex is elicited?

• Are you striking in the correct place? Confirm the location of the tendon by
observing and palpating the appropriate region while asking the patient to
perform an activity that causes the muscle to shorten, making the attached
tendon more apparent.
• Make sure that your mallet strike is falling directly on the appropriate tendon.
If there is a lot of surrounding soft tissue that could dampen the force of the
strike, place a finger firmly on the correct tendon and use that as your target.
• Make sure that the muscle is uncovered so that you can see any contraction
(occasionally the force of the reflex will not be sufficient to cause the limb to
move).
• Sometimes your partner is unable to relax, which can inhibit the reflex even
when all is neurologically intact. If this occurs during your assessment of lower
extremity reflexes, ask the patient to interlock their hands and direct them to
pull, while you simultaneously strike the tendon. This sometimes provides
enough distraction so that the reflex arc is no longer inhibited.

How is the reflex helpful?

The knee jerk can be helpful in recognizing thyroid disease and damage in the
central nervous system.

What's the point of this reflex?

When we stand upright, our muscles constantly stretch and contract slightly,
just to keep us balanced. The knee jerk reflex is part of this system. Let's say
you're standing, and start to lean back too much. Leaning back stretches your
quadriceps and triggers the reflex. However, the muscle contraction won't kick
your leg upward this time, because you're standing on it. Instead, the contraction
simply brings you back to center, preventing you from falling backward.

What is pupillary light reflexes and its importance?

The pupillary light reflex is a reflex that controls the diameter of the pupil, in
response to the intensity (luminance) of light that falls on the retinal ganglion
cells of the retina in the back of the eye, thereby assisting in adaptation of vision
to various levels of lightness/darkness.
What is direct and consensual pupillary reflex?
A direct pupillary reflex is pupillary response to light that enters the ipsilateral
(same) eye. A consensual pupillary reflex is response of a pupil to light that
enters the contralateral (opposite) eye.

How does the consensual/direct pupillary reflex occur?

The pupillary light reflex is an autonomic reflex that constricts the pupil in
response to light, thereby adjusting the amount of light that reaches the retina.
Pupillary constriction occurs via innervation of the iris sphincter muscle, which
is controlled by the parasympathetic system. 
Pupillary reflex is under what type of system and reflex?
It is under the autonomic reflex and the parasympathetic system.

What happens when the pupil is in dark? How does this occur? What other
situations may cause the pupil to dilate?
The dark reflex dilates the pupil in response to dark. It can also occur due to a
generalized sympathetic response to physical stimuli and can be enhanced by
psychosensory stimuli, such as by a sudden noise or by pinching the back of the
neck, or a passive return of the pupil to its relaxed state.

How is pupillary reflex important?

The pupillary light reflex allows the eye to adjust the amount of light reaching
the retina and protects the photoreceptors from bright lights.

What will happen to the right eye when light is shone to the left eye? Why?
Light shone into one eye will cause both pupils to constrict. The consensual
response results in pupillary constriction of the eye not directly stimulated by
light, although the response is slightly reduced compared to the eye being
directly tested.

What is observed when light is shone and not shone on the eye?
A greater intensity of light causes the pupil to constrict (thereby allowing less
light in), whereas a lower intensity of light causes the pupil to dilate (expansion
thereby allowing more light in).