Temperature and Sense of position

Temperature:

This is examined using two test tubes containing hot and cold water. The part to be tested is touched with both the tubes in turn and ask him which is hot and which is cold. Too hot or cold water should not be used because they produce only pain sensation. Negative tests should be applied occasionally. This is the first sensation that is lost in leprosy.

Sense of position:

This is the ability to describe or imitate (In the opposite side of the body with the eyes closed, the position in which one limb has been placed. Ask the subject to close his eyes and keep his limbswill relaxed. Hold one of his limbs move it passively in various directions and finally keep it in a particular position. Then ask the subject to keep the opposite limb also in the same position. If he is not able to do the same, then his sense of position is defective.

Joint sense or Appreciation of passive movement:

Gradually move a part or whole of a limb into a new position and ask him to say ‘Yes’ as soon as he recognizes the movement. Movements of less than 100 can be appreciated at all normal joints. If the sense of movement is defective, the angle through which the movement isto be carried out for the subject to recognize is greater. Ask the subject the oirection of movement i.e. whether up or down, after moving a digit into a new position.

5. Stereognosis: This is the ability to recognize with eyes closed, common familiar objects from their size shape and form, when placed in hand.

To test size, two objects of different size, but same shape are placed in his palm and ask him to say which is the larger. Small rods or match sticks of different lengths can be used.

To test recognition of shape, familiar objects like coin, key, pen etc are given and ask to identify them, Loss of this sense is known as astereognosis. This can occur with parietal lobe lesions and posterior column lesions. In parietal lobe lesions, position sense and light touch are normal, whereas in posterior column lesions, position sense, vibration sense and light touch are profoundly disturbed.

6. Vibration sense

If the foot of a vibrating tuning fork is placed on the surface of the body at any bony prominence, the vibrations can be felt, provided they are sufficiently strong. If the subject perceives the vibration, ask him to say when he ceases to feel it. If the examiner can still perceive it; the patient’s perception of vibration is impaired. This is a valuable test, as the ability to appreciate vibration may be lost in various diseases, like tabes dorsalis, peripheral neuritis and posterior column disorders. There is often some loss of vibration sense in the feet and legs, in old age. A tuning fork of 128 Hz should be used. Vibrations of higher frequency are more difficult to be perceived.

7. Test the sensory cranial nerves - I, II, V, VII, IX & X

8. Any abnormal sensations

These are experienced by the patient even without any external stimulus. Eg. pins and needles, numbness, tingling sensation, crawling of insects, itching, tightness or pressure.

Other disturbances of sensation

Sensory inattention

Ask the subject to close his eyes. Corresponding points on both sides of body are simultaneously stimulated by painful, tactile orthermal stimuli. Ask him to saywhich side is stimulated. In sensory inattention he fails to appreciate the stimulus on one side of the body. This is seen in parietal lobe lesion, on the opposite side of body.

Sensory loss: Sensations could be lost in lesions of sensory pathways at any level. Cortical sensations like tactile localisation, tactile discrimination and stereognosis are lost in lesions of parietal cortex, whereas the sensations like crude touch, pain and temperature probably appreciated at the thalamic level are preserved.

 

 

Report Pattern:

1. Biodata

Name: Age: Sex: Occupation: Address:

2. General Examination

Build & nourishment

Pallor

Jaundice

Cyanosis

Clubbing of fingers

Oedema

Enlargement

Pulse

Blood Pressure

Respiratory rate

Temperature

Higher functions:

General appearance and behaviour

Level of consciousness

Mental & emotional state

Rt. I Lt. handed

Delusions and Hallucinations

Orientation in place, time and person

Memory

Intelligence

Sleep

Speech

3. Sensory system examination

Question:

Trace the different Sensory pathways.

 

 

 

 

 

 

 

Reference on Medicinal plants  Part I

Reference on Medicinal plants Part II

 

reference on  Indian medicinal plants and its treatments.