Sensory

Examination

DR. EBAD UR REHMAN GHOURI (PT)

Objectives

At the end of this session you will be able to explain

 Examination
❖ Mental Status
❖ Sensory
❖ Motor

 Upper motor Neuron

 Lower motor Neuron
ASCENDING TRACTS OF THE SPINAL CORD

• Dorsal Column
• Fasciculus Gracilis
• Fasciculus Cuneatus

• Lateral Column
• Lateral Spinothalamic tract
• Dorsal Spinocerebellar tract
• Ventral Spinocerebellar tract
• Spinotectal tract
• Spinoreticular fibers
• Spino-olivary pathway
• Spinovestibular tract

• Ventral Column
• Anterior Spinothalamic tract
Assessment of Mental Status

 Arousal
 Attention span
 Orientation
 Cognition
 Memory
Arousal

Arousal is the physiological readiness of the human system for activity. It

involves activation of the ascending reticular activating system (ARAS) in
the brain, which mediates wakefulness, the autonomic nervous system, and
the endocrine system, leading to increased heart rate and blood pressure
and a condition of sensory alertness, desire, mobility, and readiness to
respond.
It has different Levels.
 Alert
 Lethargic
 Obtunded
 Stupor
 Coma
Arousal

 Alert: The patient is awake and attentive to normal

levels of stimulation. Interactions with the therapist
are normal and appropriate.

 Lethargic: The patient appears drowsy and may fall

asleep if not stimulated in some way. Interactions
with the therapist may get diverted. Patient may
have difficulty in focusing or maintaining attention
on a question or task.
Arousal

 Obtunded: the patient is difficult to arouse from a

somnolent state and is frequently confused when
awake. Repeated stimulation is required to maintain
consciousness.

 Stupor (semi coma):the patient responds only to strong,

generally noxious stimuli and returns to the unconscious
state when stimulation is stopped.

 Coma (deep coma): the patient cannot be aroused by

any type of stimulation. Reflex motor responses may or
may not be seen.
Attention

Attention is selective awareness of the environment or

responsiveness to a stimulus or task without being
distracted by other stimuli.
For example, the patient might be asked to repeat a
series of numbers, letters, or words.
Another approach to examining attention is to ask the
patient to spell words backwards (e.g., book, fork,
bottle, garden).
 Orientation

Orientation refers to the patient’s

awareness of time, person, and place.
In medical record documentation the
results of this mental status screening are
often abbreviated “oriented × 3,”
referring to the three parameters of time,
person, and place.
Cognition

Cognition is defined as the process of knowing and

includes both awareness and judgment.

Three areas for testing cognition-dependent functions

are:
(1) fund of knowledge,
(2) calculation ability,
(3) proverb interpretation
 Cognition

 Fund of knowledge is defined as the sum total of an individual’s

learning and experience in life, which will be highly variable and
different for each patient.

 Calculation ability examines foundational mathematical

Abilities.
 Acalculia=?
 Dyscalculia=?

 Proverb interpretation examines the patient’s ability to interpret use of

words outside of their usual context or meaning.
 E.g. A rolling stone gathers no mass.
Memory

 Memory is the faculty of the mind by which data or information is encoded,

stored, and retrieved when needed. It is the retention of information over time
for the purpose of influencing future action.
Memory

Types of memory
➢ Long Term
➢ Short Term
Long term memory can be examined by asking
questions like, name of school, birth place etc.
Short-term memory can be addressed by verbally
providing the patient with a series of words or numbers.
For example, a series of words might include “car,
book, cup”
Superficial Sensations

Pain Perception
This test is also referred to as sharp/dull discrimination and
indicates function of protective sensation.
To test pain awareness, the sharp and dull ends of a large
headed safety pin, a single-use protected neurological pin
is used.

Response:
The patient is asked to verbally indicate
sharp or dull when a stimulus is felt.
All areas of the body may be tested.

Single use protected neurological pin

 Superficial Sensations

Pain Perception
 Superficial Sensations

Temperature Awareness
This test determines the ability to distinguish between warm and cool
stimuli.
Two test tubes with stoppers are required for this examination; one
should be filled with warm water and the other with crushed ice.
Ideal temperatures for cold are between 41°F (5°C) and 50°F (10°C) and
for warmth, between 104°F (40°C) and 113°F (45°C).

Response:
The patient is asked to reply to hot or cold after each stimulus
application.
Superficial Sensations

Temperature Awareness
Superficial Sensations

Touch Awareness
This test determines perception of tactile touch input. A
camel-hair brush, piece of cotton (ball or swab), or
tissue is used. The area to be tested is lightly touched or
stroked

Response:
The patient is asked to indicate when he or she
recognizes that a stimulus has been applied by
responding “yes” or “now”.
Superficial Sensations

Touch Awareness
Superficial Sensations

Pressure Perception
The therapist’s fingertip or a double-tipped cotton swab
is used to apply a firm pressure on the skin surface. his
pressure should be firm enough to indent the skin and
to stimulate the deep receptors. This test can also be
administered using the thumb and fingers to squeeze the
Achilles tendon.

Response:
The patient is asked to indicate when an applied stimulus
is recognized by responding “yes” or “now”.
 Superficial Sensations

Pressure Perception
Deep Sensations

Kinesthesia Awareness
This test examines awareness of movement.
The extremity or joints is moved passively through a
relatively small range of motion (ROM).
Patient is ask to Identify the movement (up , down, in, out).

Response:
The patient is asked to describe verbally the direction and
range of motion in terms previously discussed with the
therapist while the extremity is in motion.
Deep Sensations

Kinesthesia Awareness
Deep Sensations

Proprioceptive Awareness
This test examines joint position sense and the awareness of joints
at rest.
The extremity or joint(s) is moved through a ROM and held in a
static position. Again, small increments of range are used.
Patient is ask to locate the extremity or duplicate the position by
contralateral extremity.

Response:
While the extremity or joint is held in static position by the therapist,
the patient is asked to describe the position verbally or to
duplicate the position with contralateral extremity.
 Deep Sensations

Proprioceptive Awareness
 Deep Sensations

Vibration Perception
This test requires a tuning fork that vibrates at 128 Hz. The ability to
perceive a vibratory stimulus is tested by placing the base of a vibrating
tuning fork on a bony prominence (such as the sternum, elbow, or
ankle).

Response:
The patient is asked to respond by verbally
identifying or otherwise indicating if the stimulus
is vibrating or non-vibrating each time the fork
makes contact.
 Deep Sensations

Vibration Perception
Combined Cortical Sensations

Stereognosis Perception
This test determines the ability to recognize the form of
objects by touch (stereognosis).
A variety of small, easily obtainable, and culturally
familiar objects of differing size and shape are required
(e.g., keys, coins, combs, safety pins, pencils)

Response:
The patient is asked to identify the object.
 Combined Cortical Sensations

Stereognosis Perception
 Combined Cortical Sensations

Stereognosis Perception
 Combined Cortical Sensations

Tactile Localization
This test determines the ability to localize touch sensation
on the skin (topognosis). The patient is asked to
identify the specific point of application of a touch stimulus (e.g., tip of
ring finger, lateral malleus)
and not simply the perception of being touched.
Tactile localization is typically not tested in isolation and frequently
examined in combination with similar tests such as pressure perception
or touch awareness
Response:
The patient is asked to identify the location of the stimulus by pointing to
the area or by verbal description.
Combined Cortical Sensations

 Tactile Localization
Combined Cortical Sensations

Two-Point Discrimination
This test determines the ability to perceive two points
applied to the skin simultaneously.
It is a measure of the smallest distance between two
stimuli (applied simultaneously and with equal pressure)
that can still
be perceived as two distinct stimuli.
Two-point discrimination values vary for different
individuals and body parts. As this sensory function is
most refined in the distal upper extremities, this is the
typical site for testing.
 Combined Cortical Sensations

Response:
The patient verbally states when he or she perceives a touch stimulus
and the number of stimuli felt.
 Combined Cortical Sensations

Two-Point Discrimination
Combined Cortical Sensations

Graphesthesia
This test determines the ability to recognize letters,
numbers, or designs “written” on the skin. Using a
fingertip or the eraser end of a pencil, a series of letters,
numbers, or shapes is traced on the palm of the
patient’s hand.

Response:
The patient is asked to identify verbally
the figures drawn on skin.
 Combined Cortical Sensations

Graphesthesia
Combined Cortical Sensations

Recognition of Texture
This test determines the ability to differentiate among
various textures. Suitable textures may include cotton,
wool, burlap, or silk. he items are placed individually in
the patient’s hand. he patient is allowed to manipulate
the sample texture.

Response:
The patient is asked to identify the individual textures as
they are placed in the hand.
 Combined Cortical Sensations

Recognition of Texture
 Combined Cortical Sensations

Barognosis
This test determines the ability to recognize different
weights. A set of discrimination weights consisting of small
objects of the same size and shape but of graduated
weight is used.

Response:
The patient is asked to identify the comparative weight of
object in a series. (I.e to compare the relative weight of
the object with the previous one)
is asked to identify the comparative weight of objects in a
series.
Combined Cortical Sensations

Barognosis
Discrimination Weights
 Reference: Physical rehabilitation / [edited by]
Susan B. O’Sullivan, Thomas J. Schmitz, George D.
Fulk.