NEurological Testing (Sensation and Reflexes)
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Assess reflexes
Rationale: Reflex assessment gives you an idea of neurologic integrity in the anterior horn of the spinal cord with the muscle reflex loop. Absent or diminished reflexes in the lower leg may indicate peripheral nerve compression. Hyperreflexia indicates central nervous system dysfunction in the brain or spinal cord. Procedure:
Rating scale: 0=Absent 1+=Diminished 2+=Normal 3+=Hyperreflexive 4+=Clonus present Abnormal reflexes are often found in compartment syndrome of the lower leg. Assess Sensation Rationale: adequate temperature, pain, and pressure sensation is necessary to prevent injury. Absent/altered sensation is often found in peripheral arterial disease/arterial insufficiency and compartment syndrome. Sensation should be checked if compression therapy is to be used to prevent injury. What is assessed: sensation in local area to be treated in dermatomal pattern, or sensation to local, small area being treated; specifically temperature, light touch, vibration, pressure, and pain Tools needed: Temperature: Test tubes filled with warm and cold water Light touch: piece of paper, tape folded over, feather, fingertips Vibration: tuning fork Pressure: fingers, monofilaments (10 gram especially, sensation of this amount of pressure/touch has been shown to be protective in preventing ulceration/injury) Pain: safety pin/end of a paper clip/end of a cotton swab Questions to ask: (determine risks to sensation) Are you diabetic? Do you have any sort of altered sensation in the area (numbness, tingling)? Have you been told you have peripheral neuropathy? Procedures: Temperature: Utilize the test tubes filled with cold water and warm water. 1. Place the patient in a supine or sitting position. The area to be tested should be exposed. Touch the warm test tube to the skin of the arm or hand to demonstrate what a warm sensation feels like, then touch the cold test tube to the patient's arm or hand to demonstrate what cold feels like. During the test, the patient should respond ‘warm’ or ‘cold’ each time the test tube touches the area. 2. The patient should then close his or her eyes so that the test can begin. Hold the test tube perpendicular to the skin and press either the warm or cold test tube against the first site. Make sure it does not slide over the skin. The test tube should be held in place for about 3 seconds. Ask the patient if the sensation is felt, and which one it is. After the patient responds, record the response on your form. Use a " +" for a positive response and a "-" for a negative response. Then move to the next site. 3. Remember to test sites in random order, test the sensations in random order, and vary the time between applications. That way, the patient will not be able to guess the correct response. If the patient has an ulcer, scar, callus, or necrotic tissue at the test site, apply the tuning fork along the perimeter of the abnormality, not directly on it. 4. Note the number of positive or negative responses to determine whether sensation is present or absent in the area to pain. Light touch: 1. Place the patient in a supine or sitting position. The area to be tested should be exposed. Stroke the patient’s arm with a folded over piece of tape, to demonstrate what the sensation of light touch will feel like. The patient should respond positively each time the tape touches the area. 2. The patient should then close his or her eyes so that the test can begin. Hold the piece of tape perpendicular to the skin and stroke the area to be tested lightly. The area should be stroked lightly for about 3 seconds. Ask the patient if the sensation is felt, and which one it is. After the patient responds, record the response on your form. Use a " +" for a positive response and a "-" for a negative response. Then move to the next site. 3. Remember to test sites in random order, and vary the time between applications. That way, the patient will not be able to guess the correct response. If the patient has an ulcer, scar, callus, or necrotic tissue at the test site, apply the tape along the perimeter of the abnormality, not directly on it. 4. Note the number of positive or negative responses to determine whether sensation is present or absent in the area to pain. Vibration: Utilize a tuning fork for this test. 1. Place the patient in a supine or sitting position. The area to be tested should be exposed. Strike the tuning fork on the table, and then touch the single point of the tuning fork to the patient's arm or hand to demonstrate what it feels like. During the test, the patient should respond "yes" each time the vibration of the tuning fork is felt on the area. 2. The patient should then close his or her eyes so that the test can begin. Strike the tuning fork on a hard surface to initiate the vibration. Hold the tuning fork perpendicular to the area to be tested, press the single point against the first site. Make sure it does not slide over the skin. The device should be held in place for about 3 seconds. Ask the patient if the sensation is felt. After the patient responds, record the response on your form. Use a " +" for a positive response and a "-" for a negative response. Then move to the next site. 3. Remember to test sites in random order and to vary the time between applications. That way, the patient will not be able to guess the correct response. If the patient has an ulcer, scar, callus, or necrotic tissue at the test site, apply the tuning fork along the perimeter of the abnormality, not directly on it. 4. Note the number of positive or negative responses to determine whether sensation is present or absent in the area to vibration. Pressure sensation: (protective sensation--.5.07/10 gram monofilament indicative of protective sensation) Using a monofilament: 1. Place the patient in a supine or sitting position. His or her legs should be supported and the area to be tested should be exposed. Touch the monofilament to the patient's arm or hand to demonstrate what it feels like. During the test, the patient should respond "yes" each time the pressure of the monofilament is felt on the area. 2. If testing the foot: Make sure the patient's feet are in a neutral position, with toes pointing straight up. The patient should then close his or her eyes so that the test can begin. Hold the monofilament perpendicular to the foot, press it against the first site, increasing the pressure until the monofilament wire bends into a C-shape. Make sure it does not slide over the skin. The device should be held in place for about 1 second. After the patient responds, record the response on your form. Use a " +" for a positive response and a "-" for a negative response. Then move to the next site. This procedure is conducted in the same way, even if not performed on the foot. 3. Remember to test sites in random order and to vary the time between applications. That way, the patient will not be able to guess the correct response. If the patient has an ulcer, scar, callus, or necrotic tissue at the test site, apply the monofilament along the perimeter of the abnormality, not directly on it. 4. Note the number of positive or negative responses to determine whether sensation is present or absent in the area to pressure/protective sensation. Retrieved From: "Assessing Protective Sensation with a Monofilament". Advances in Skin & Wound Care. FindArticles.com. 22 Aug, 2010. http://findarticles.com/p/articles/mi_qa3977/is_200409/ai_n9449891/ Pain sensation: Utilize a safety pin/end of a paperclip/end of a cotton swab for this. 1. Place the patient in a supine or sitting position. The area to be tested should be exposed. Touch the head of the pin to the patient to demonstrate what a ‘dull’ sensation feels like, then gently touch the sharp point of the safety pin to the patient's arm or hand to demonstrate what ‘sharp’ feels like. During the test, the patient should respond ‘sharp’ or ‘dull’ each time the pin touches the area. 2. The patient should then close his or her eyes so that the test can begin. Hold the safety pin perpendicular to the skin and press either the sharp point, or the pin head against the first site, being careful not to pierce the skin. Make sure it does not slide over the skin. The device should be held in place for about 3 seconds. Ask the patient if the sensation is felt, and which one it is. After the patient responds, record the response on your form. Use a "+" for a positive response and a "-" for a negative response. Then move to the next site. 3. Remember to test sites in random order, test the sensations in random order, and vary the time between applications. That way, the patient will not be able to guess the correct response. If the patient has an ulcer, scar, callus, or necrotic tissue at the test site, apply the tuning fork along the perimeter of the abnormality, not directly on it. 4. Note the number of positive or negative responses to determine whether sensation is present or absent in the area to pain. Normal response: Sensation present, patient able to detect all sensory tests. Abnormal: Absent (patient cannot detect any sensation) or diminished (positive and negative responses to sensation). References: Advances in Skin & Wound Care. FindArticles.com. 22 Aug, 2010. http://findarticles.com/p/articles/mi_qa3977/is_200409/ai_n9449891/ |
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