Key Steps:
- Work out the area/body part you wish to assess
- Are you looking at dermatomal or peripheral nerve testing site
- Neurological examination includes:
- Tone and clonus
- Power
- Reflexes
- Co-ordination
- Vibration
- Sensation - If areas of concern - continue on to POST
Sensation can be tested by light touch and pin prick
- Pain oriented sensory testing includes:
Pin prick - Punctate mechanical allodynia - Adelta
Brush - Dynamic mechanical allodynia - Abeta
Pressure testing - Pressure evoked allodynia - Adelta
Cold testing - Cold allodynia - Adelta
Light touch is Abeta
Vibration is Abeta
Sensory syndromes to watch for when completing POST:
Does the sensory change involve both sides?
- ?Polyneuropathy or spinal cord disease
Does the sensory change involve only one side?
- Contralateral brainstem, thalamus or cerebral cortex lesion
Is it a mixed picture? e.g. pain and temp loss on one side and sensory loss on the other?
- Hemisection of the spinal cord?
Is there a sensory level? (e.g. spinal cord disease or lateral medullary infarction)
Is there sensory DISSOCIATION?
- E.g. syringomyelia, spinal stroke, Brown-Sequard lesion
Is there sensory loss on the face?
- Lesion above the spinal cord most likely
- Brainstem is opposite to lesion
- Thalamus and cerebral hemisphere causes loss to same side
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