These tests are dependent on the patient having a normal sense of touch, or only minimally impaired. Three tests used to evaluate these abilities are: two-point discrimination, stereognosis and graphesthesia. The sensory cortex is involved in correlating, analyzing, and interpreting sensations. tabes dorsalis, Vitamin B12 deficiency, multiple sclerosis) or demyelinating neuropathies. Clinical consistency of vibration sense testing: development of a manikin great toe with embedded accelerometer for testing and training. With aging, vibratory sense may be diminished or lost in the feet and ankles.Ī disproportionate loss of vibratory sense and proprioception (compared to pain sensation) tends to suggest disease of the dorsal columns (e.g. If there is impaired vibratory sense, test a more proximal bony prominence. Then ask him to tell you when he no longer feels the vibration. He should report this sensation as a vibration. Ask the patient to tell you what he feels. Test vibratory sense on each side, using a 128 Hz or 256 Hz tuning fork, by placing the vibrating fork on the boney prominence of a finger or toe. Test a more proximal joint (for example ankle or wrist) if an abnormal response is obtained. Repeat several times on each side, and in upper extremities using the thumb. This is because pressure sensation on the top or bottom of the digit will help the patient determine position sense, even if proprioception is impaired. When moving a digit, it is important to grasp it on both sides, rather than on the top and bottom. With the patient's eyes closed, test his ability to determine the direction of movement as you move the great toe upward or downward. To test warm sensation, use a glass tube or other container filled with warm water.
Vibration sensation tuning fork skin#
To test cold sensation, apply the cool tines of your tuning fork to the skin in the areas outlined above. Usually, if pain sensation has been tested and is normal, there is no need to test temperature sensation. Using your fingertips or a wisp of cotton, lightly stroke the skin and determine if the patient feels this symmetrically in all areas tested. In any area where the patient complains of sensory loss or hypersensitivity, more detailed testing may be required. At minimum, test the shoulders, arms and legs, comparing side to side and proximal to distal areas. Using the sharp point, apply light pressure to the skin. Take care not to puncture the skin, and remember that universal precautions require you to discard the instrument after examination. Objects frequently used include the point of a safety pin or a wooden tongue depressor broken to create a sharp edge. Compare symmetrical areas on both sides of the body and compare proximal to distal areas. Therefore, your exam should not be rushed, but must proceed efficiently. This portion of the exam is very subjective, and may become unreliable if repeated in quick succession. The sensory exam involves evaluation of pain (or temperature), light touch, position sense, vibration, and discriminative sensations.
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