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Table 4-16 outlines rhe method of sensarion resting by stimulus.

Table 4-16. Sensation Testing

Sensation

Modality and Method

Superficial pain

Touch a pin or pen cap over the cxuemities or trunk.

Deep pain

Squeeze rhe parienr's forearm or calf bulk.

Light touch

Apply Iighr pressure with rhe finger, a cotton ball, or

washcloth over rhe extremities or trunk.

Proprioceprion

Lightly grasp the distal inrerphalangeal joinr of the

patienr's finger or great tOC, and move the joint slowly

up and down. Ask the patient to state in which direction the joinr is moved. Test distal to proximal

(e.g., roe ro ankle to knee).

Vibrarion

Activate a tuning fork and place on a bony prominence.

Ask the patient to state when the vibration slows and

stops. Proceed distal co proximal.

Temperacure

Place test tubes filled with warm or cold water on [he

area of the patient's body to be tested. Ask the patient

to state the temperature. ( Rarely done in the acute care

serring.)

Stereognosis

Place a familiar object in the patient'S hand and ask the

patient to identify it.

Two-poinr

Place two-point caliper or drafting compass on area ro be

discriminarion

tested. Ask the patient to distinguish whether it has

one or two points.

Graphesrhesia

Trace a lerrer or number in the patient's open palm and

ask the patient co state what was drawn.

Double

Simultaneously couch tViO areas on the same side of the

simultaneous

patient's body. Ask patient to locate and distinguish

stimulation

both points.

Sources: Data from KW Lindsay, I Bone, R Callander (cds). Neurology and Neurosurgery

lIIustr:ned (2nd cd). Edinburgh, UK: Churchill Livingstone, 1991; S Gilman, SW Newman (cds). Manter and Gatt's Essentials of Clinical Neuroanatomy and Neurophysiology (7th ed). Philadelphia: FA Davis, 1 989; and JV Hickey (cd). The Clinical Practice of Neurological and Neurosurgical Nursing (4th ed). I)hiladelphia: Lippincon, 1 997.

NERVOUS SYSTEM

299

Clinical Tip

Before completing the sensory examination, the physical

therapist should be sure that the patient can correctly identify stimuli (e.g., that a pinprick feels like a pinprick).

Coordination

Although each lobe of the cerebellum has its own function, cootdination tests cannot truly differentiate among them. Coordination tests evaluate the presence of ataxia (general incoordination), dysmetria

(overshooting), and dysdiadochokinesia (inability to perform rapid

alternating movements) with arm, leg, and trunk movements, as well

as with gait.8 The results of each test (Table 4- 1 7) are described in

tetms of the patient's ability to complete the test, accuracy, tegularity

of rhythm, and presence of tremor."

Another test is the prol1ator drift test, which is used to qualify loss

of position sense. While the patient is sitting or standing, he or she

flexes both shoulders and extends the elbows with the palms upward.

The patient is then asked to close his or her eyes. The forearm is

observed for 1 0-20 seconds for ( 1 ) pronation or downward drift,

which suggests a contralateral corticospinal lesion, or (2) an upward

or sideward drift, which suggests loss of position sense H

Diagnostic Procedures

A multitude of diagnostic tests and procedures is used to evaluate, differentiate, and monitOr neurologic dysfunction. Each has its own cost, accuracy, advantages, and disadvantages. For the purposes of

this text, only the procedures most commonly used in the acute care

setting are described.

X-Ray

X-rays can provide anterior and lateral views of the skull that are

used to assess the presence of calcification, bone erosion, or fracture,

especially after head or facial trauma or if a tumor is suspected. Anterior, lateral, and posterior views of the cervical, thoracic, lumbar, and sacral spine are used to assess the presence of bone erosion, fracture,