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Sensation Ax Adapted

The document outlines a sensation assessment template for evaluating dermatomal and peripheral nerve distribution, as well as non-dermatomal sensations. It includes keys for indicating the status of various sensory modalities such as pain, temperature, light touch, and two-point discrimination. The template is designed for use by occupational therapists to document client information, diagnosis, and assessment results.

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oelofsenadine
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199 views3 pages

Sensation Ax Adapted

The document outlines a sensation assessment template for evaluating dermatomal and peripheral nerve distribution, as well as non-dermatomal sensations. It includes keys for indicating the status of various sensory modalities such as pain, temperature, light touch, and two-point discrimination. The template is designed for use by occupational therapists to document client information, diagnosis, and assessment results.

Uploaded by

oelofsenadine
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

SENSATION ASSESSMENT DERMATOMAL NERVE DISTRIBUTION

CLIENT:
DIAGNOSIS:
DATE:
OCCUPATIONAL THERAPIST:

KEY: KEY:

 INTACT o PAIN
 ABSENT o TEMPRETURE
| DIMINISHED o LIGHT TOUCH
o NOT APPLICABLE o TWO-POINT DISCRIMINATION
SENSATION ASSESSMENT PERIPHERAL NERVE DISTRIBUTION

CLIENT:
DIAGNOSIS:
DATE:
OCCUPATIONAL THERAPIST:

KEY: KEY:

 INTACT o PAIN
 ABSENT o TEMPRETURE
| DIMINISHED o LIGHT TOUCH
o NOT APPLICABLE o TWO-POINT DISCRIMINATION
SENSATION ASSESSMENT NON-DERMATOMAL

CLIENT:
DIAGNOSIS:
DATE:
OCCUPATIONAL THERAPIST:

DEEP SENSATION: COMBINED SENSATION:

o PROPRIOCEPTION o TOUCH LOCALISATION


o PRESSURE o STEREOGNOSIS
SUPERFICIAL SENSATION: KEY:

o PAIN  INTACT

o TEMPRETURE  ABSENT
o LIGHT TOUCH | DIMINISHED
o TWO-POINT DISCIMINATION o NOT APPLICABLE

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