Assessment of Superficial,

Deep and Cortical sensations

Presented by:
Hisham. P
2ND semester
MPT in neuro sciences.
 INTRODUCTION:
The sensory system provides information that places the individual in relation
to the environment.

• Superficial sensation is concerned with touch, pain, temperature.

• Deep sensation includes muscle and joint position sense (proprioception),
kinesthesia, and vibration sense.
• Cortical sensations are two-point discrimination, stereognosis, and
graphesthesia.
1. SUPERFICIAL SENSATION:
• Superficial sensation refers to sensory experiences arising from the
skin and mucous membranes.
• Superficial sensation is concerned with touch, pain, temperature.
1. SUPERFICIAL SENSATION: DERMATOME
• Dermatomes are areas of the skin whose sensory distribution is innervated by
the afferent nerve of a peripheral nerve that “connects” the nerve to the spinal
cord.
• In total there are 30 dermatomes that relay sensation from a particular region of
the skin to the brain - 8 cervical nerves (note C1 has no corresponding
dermatomal area), 12 thoracic nerves, 5 lumbar nerves and 5 sacral nerves.
1. SUPERFICIAL SENSATION: DERMATOME
1. SUPERFICIAL SENSATION: DERMATOME
Technique
• Dermatome Testing is done ideally with a pin and cotton wool. Ask the patient
to close their eyes and give the therapist feedback regarding the various stimuli.
Testing should be done on specific dermatomes and should be compared to
bilaterally.
• Light Touch Test - Light Touch Sensation - Dab a piece of cotton wool on an
area of skin.
• Pinprick Test - Pain Sensation - Gently touches the skin with the pin ask the
patient whether it feels sharp or blunt.
1. DERMATOME KEY SENSORY POINTS
• Key sensory points are readily located in relation to bony anatomical landmarks
in the dermatomes C2 - S5.
• Each dermatome has a specific area mentioned, but for testing each
dermatomes, there is a specific point in each dermatomes known as KEY
SENSORY POINTS.
1. DERMATOME KEY SENSORY POINTS
Dermatome Point Image

C2 At least one cm lateral to the occipital

protuberance at the base of the skull.
Alternately, it can be located at least 3
cm behind the ear.

C3 In the supraclavicular fossa, at the

midclavicular line.

C4 Over the acromioclavicular joint.

1. DERMATOME KEY SENSORY POINTS
Dermatome Point Image

C6 On the dorsal surface of the proximal

phalanx of the thumb.

C7 On the dorsal surface of the proximal

phalanx of the middle finger.

C8 On the dorsal surface of the proximal

phalanx of the little finger.
1. DERMATOME KEY SENSORY POINTS
Dermatome Point Image

C5 C5 On the lateral (radial) side of the

antecubital fossa just proximal to the
elbow.

T1 On the medial (ulnar) side of the

antecubital fossa, just proximal to the
medial epicondyle of the humerus.

T2 At the apex of the axilla.

1. DERMATOME KEY SENSORY POINTS
Point (every points on At the midclavicular line) Image

T3 the third intercostal space

T4 the fourth intercostal space, located at the level of the nipples.
T5 the fifth intercostal space,
Т6 located at the level of the xiphisternum.
T7 one quarter the distance between the level of the xiphisternum and the
level of the umbilicus.
T8 one half the distance between the level of the xiphisternum and the
level of the umbilicus.
Т9 three quarters of the distance between the level of the xiphisternum and
the level of the umbilicus.
T10 located at the level of the umbilicus.
T11, midway between the level of the umbilicus and the inguinal ligament.
T12 over the midpoint of the inguinal ligament.
1. DERMATOME KEY SENSORY POINTS
Dermatome Point Image

L1 Midway between the key sensory

points for T12 and L2.

L2 On the anterior-medial thigh, at the

midpoint drawn on an imaginary line
connecting the midpoint of the inguinal
ligament and the medial femoral
condyle.
L3 At the medial femoral condyle above
the knee.
1. DERMATOME KEY SENSORY POINTS
Dermatome Point Image

L4 Over the medial malleolus.

L5 On the dorsum of the foot at the third

metatarsal phalangeal joint.

S1 On the lateral aspect of the calcaneus

(posterior).

S2 At the midpoint of the popliteal fossa.

(posterior).
1. DERMATOME KEY SENSORY POINTS
Dermatome Point Image

S3 Over the ischial tuberosity or infra-

gluteal fold.

S4/5 In the perianal area, less than one cm.

lateral to the mucocutaneous junction.
1. SUPERFICIAL SENSATION: TOUCH AWARENESS
Preparation:
• Explain the procedure to the patient to ensure they understand what will
happen.
• Ensure the patient is in a comfortable and relaxed position.
• Have the patient close their eyes or look away to prevent visual input from
aiding their perception.
1. SUPERFICIAL SENSATION: TOUCH AWARENESS
1. Light touch
2. Crude touch

Tools Needed :
• Cotton ball or cotton wool
• Brush or tissue paper
• Camel hair brush.
1. SUPERFICIAL SENSATION: TOUCH AWARENESS
1. Light touch
2. Crude touch

• A piece of cotton, camel-hair brush, or tissue is used

to perceive the tactile touch input. Light touch or
stroke is applied in the area to be tested. The patient is
asked to indicate where he/she recognizes that a
stimulus has been applied.

• In crude touch, a hard object is used to give the hard

touch input.
1. SUPERFICIAL SENSATION: TOUCH AWARENESS
Documentation:
• Body Diagram: Use a body diagram to mark areas with impaired or absent
sensation.
• Descriptive Notes: Include any patient reports of unusual sensations (e.g.,
tingling, numbness).
• Comparative Results: Note differences between sides of the body to detect
asymmetry.

Interpretation:
• Intact: The patient correctly identifies all touches and pressures.
• Impaired: The patient misses some touches or requires increased pressure to
perceive them.
• Absent: The patient does not perceive touches or pressures at all.
1. SUPERFICIAL SENSATION: TOUCH AWARENESS
Defects:
NAME DEFECT

Hypoesthesia: Reduced sensitivity to touch.

Hyperesthesia: Increased sensitivity to touch.

Paresthesia: Abnormal sensations like tingling or

pricking.

Anesthesia: Complete loss of touch sensation.

Dysthesia: Distorted or uncomfortable sensation from

normal touch.
1. SUPERFICIAL SENSATION: TOUCH AWARENESS
Condition: Defect
Peripheral Neuropathy Partial or complete loss of touch sensation due to Damage to peripheral nerves. Eg:
diabetes. (C6: loss of sensation on over back of thumb).
Spinal Cord Injury: Loss of touch sensation below the level of injury. Can be partial or complete depending on
the extent of damage.
Stroke: Hemispheric loss of touch sensation if the stroke affects one side of the brain.
Affects the opposite side of the body.
Multiple Sclerosis: Partial or complete loss of touch sensation due to demyelination. Can affect various parts
of the body depending on lesion locations.
Hansen’s disease or Partial to complete loss of touch sensation in affected areas.
Leprosy Progressive nerve damage caused by bacterial infection.
Alcoholic Neuropathy: Partial loss of touch sensation due to chronic alcohol abuse.
Damage to peripheral nerves from toxic effects of alcohol.
Chemotherapy-Induced Partial loss of touch sensation as a side effect of certain chemotherapy drugs.
Neuropathy: Damage to peripheral nerves
Carpal Tunnel Partial loss of touch sensation in the fingers and hand. Compression of the median nerve in
Syndrome: the wrist.
1. SUPERFICIAL SENSATION: TOUCH AWARENESS
Complications:
Complications of Defects in Touch Sensation:
• Injury Risk: Increased risk of cuts, bruises due to lack of proper touch feedback.
• Chronic Pain: Persistent abnormal sensations can lead to chronic pain and discomfort.
• Impaired Motor Skills: Difficulty with tasks requiring fine motor skills, such as writing
or buttoning clothes.
• Infections: Injuries may go unnoticed, leading to infections.
• Reduced Quality of Life: Difficulties in daily activities and emotional distress due to
abnormal sensations.
ASIA scale:
The American Spinal Injury Association (ASIA) Impairment Scale (AIS) is a
standardized tool used to assess and classify the severity of spinal cord injuries
(SCI).
The ASIA sensory examination involves testing two types of sensation:
• Light Touch (LT)
• Pin Prick (PP)
Steps in Sensory Examination:
Identify Key Sensory Points: Test light touch and pin prick sensations at key
points within each dermatome (areas of skin supplied by sensory fibers from a
single spinal nerve). There are 28 dermatomes on each side of the body.
ASIA scale:
Scoring:
0: Absent sensation
1: Altered, including hyperesthesia or partial sensation
2: Normal sensation
Recording Scores: Record the scores for each dermatome on both sides of the
body.
ASIA Sensory Levels:
Sensory Level: The most caudal (lowest) dermatome with a normal score (2) for
both light touch and pin prick sensation.
Sensory Grading: Sensory scores help determine the ASIA impairment grade,
which ranges from A to E.
ASIA scale:
Interpretation of ASIA Impairment Scale Grades:
A: Complete. No sensory or motor function is preserved in the sacral segments
S4-S5.
B: Sensory Incomplete. Sensory but not motor function is preserved below the
neurological level and includes the sacral segments S4-S5.
C: Motor Incomplete. Motor function is preserved below the neurological
level, and more than half of key muscles below the neurological level have a
muscle grade less than 3.
D: Motor Incomplete. Motor function is preserved below the neurological
level, and at least half of key muscles below the neurological level have a
muscle grade of 3 or more.
E: Normal. Sensory and motor functions are normal.
ASIA scale:
1.SUPERFICIAL SENSATION: TEMPERATURE AWARENESS:
Temperature sensation, or thermoreception, involves the
detection of heat and cold through thermoreceptors in
the skin.

Uses of thermoception in body:

• Homeostasis: Helps in maintaining body temperature

by triggering responses such as sweating, shivering,
and adjusting behavior (e.g., seeking shade or warmth,
adjusting clothing, seeking appropriate environments).
• Protection: Alerts us to extreme temperatures that can
cause damage, prompting actions to avoid burns or
frostbite.
1.SUPERFICIAL SENSATION: TEMPERATURE AWARENESS:
Preparation:

• Explain the procedure to the patient, including that they will be tested with
both sharp and dull stimuli.
• Ensure the patient is in a comfortable position and relaxed.
• Have the patient close their eyes or look away to prevent visual cues from
aiding their perception.
1.SUPERFICIAL SENSATION: TEMPERATURE AWARENESS:
Temperature Awareness test:
Tools Needed:
• Test tubes or small vials
• One filled with warm water (around 40°C or 104°F)
• One filled with cold water (around 10°C or 50°F)
• Thermal probes (optional)
• Towel or cloth for drying skin
1.SUPERFICIAL SENSATION: TEMPERATURE AWARENESS:
Procedure:
•Randomly apply the warm and cold test tubes to
the patient's skin in various locations. Make sure
the test tubes have distinct temperatures and the
patient can distinguish between them.
•Ask the patient to indicate whether they feel
"warm" or "cold" each time a test tube is applied.
•Allow sufficient time between stimuli to prevent
thermal adaptation.
•Testing Sites: Commonly tested areas include
the hands, arms, legs, feet, and face. Ensure to
test both sides of the body and different
dermatomes.
1.SUPERFICIAL SENSATION: TEMPERATURE AWARENESS:
Defects in Thermoception:
NAME DEFECT

Hypothermia: Reduced sensitivity to cold.

Hyperthermia: Reduced sensitivity to heat.

Thermal Allodynia: Painful response to normally non-painful

temperature stimuli.

Thermal Hypoesthesia: Decreased sensitivity to temperature changes.

Thermal Hyperesthesia: Increased sensitivity to temperature changes.

1.SUPERFICIAL SENSATION: TEMPERATURE AWARENESS:
Conditions:
Condition: Defect
Peripheral Neuropathy Partial loss of thermoception due to damage to peripheral nerves.
Eg: diabetes
Spinal Cord Injury: Loss of thermoception below the level of injury.
Can be partial or complete depending on the extent of damage.
Stroke: Can lead to deficits in temperature perception on the opposite side of the body.

Multiple Sclerosis: Demyelination of neurons leading to partial or complete loss of thermoception.

Can be hemispheric or more widespread.
Leprosy and Burns: Partial to complete loss of thermoception in affected areas.

Guillain-Barré Partial loss of thermoception due to acute nerve inflammation.

Syndrome Typically affects peripheral nerves.
Chemotherapy-Induced Partial loss of thermoception as side effect of certain chemotherapy drugs causing
Neuropathy: damage to peripheral nerves.
1.SUPERFICIAL SENSATION: TEMPERATURE AWARENESS:
Complications:
• Increased risk of burns or frostbite due to lack of proper response to extreme
temperatures.
• Skin damage from burns or frostbite can lead to infections.
• Regulation Issues: Problems in body temperature regulation can lead to systemic
issues like heat stroke or hypothermia.
• Daily Functioning: Difficulty in performing daily tasks that require temperature
perception, such as cooking or bathing.
1.SUPERFICIAL SENSATION: PAIN SENSATION:
Definition: Pain sensation, or nociception, involves the detection of potentially
harmful stimuli through nociceptors, signaling tissue damage or potential injury.

Uses:
• Protection: Acts as an immediate warning system, prompting reflexive actions to
avoid or minimize injury.
• Healing and Recovery: Encourages behaviors that protect injured areas,
facilitating healing and preventing further damage (e.g., resting a sprained
ankle).
• Medical Diagnosis: Serves as a critical indicator in diagnosing medical
conditions, guiding healthcare providers to the source of an issue (e.g.,
identifying appendicitis through abdominal pain).
1.SUPERFICIAL SENSATION: PAIN SENSATION:
Preparation:

• Explain the procedure to the patient, including

that they will be tested with both sharp and dull
stimuli.
• Ensure the patient is in a comfortable position
and relaxed.
• Have the patient close their eyes or look away to
prevent visual cues from aiding their perception.
1.SUPERFICIAL SENSATION: PAIN SENSATION:
Tools Needed
• Pin or safety pin (ensure it's sterile and safe to use)
• Blunt object (e.g., the back of a pen)

Assessment Method
• Use a sterile pin or safety pin for the sharp stimulus and a
blunt object for the dull stimulus.
• Randomly alternate between sharp and dull stimuli, lightly
touching the patient's skin at various locations.
• Instruct the patient to respond with "sharp" when they feel
the sharp stimulus and "dull" when they feel the dull stimulus.
• Testing Sites: Commonly tested areas include the hands,
arms, legs, feet, and face. Ensure to test both sides of the body
and different dermatomes
1.SUPERFICIAL SENSATION: PAIN SENSATION:
Defects in pain sensations:
NAME DEFECT

Hypoalgesia: Reduced sensitivity to pain

Hyperalgesia: Increased sensitivity to pain

Analgesia: Complete loss of pain sensation.

Allodynia Pain due to stimuli that do not normally

provoke pain.
Neuropathic Pain: Pain caused by damage to the nervous system
1.SUPERFICIAL SENSATION: PAIN SENSATION:
conditions:
Condition: Defect
Diabetes (Diabetic Partial or complete loss of pain sensation, or development of chronic pain.
Neuropathy): Damage to peripheral nerves due to high blood sugar levels.
Spinal Cord Injury: Loss of pain sensation below the level of injury.
Can be partial or complete depending on the extent of damage..
Stroke: Hemispheric loss of pain sensation if the stroke affects one side of the brain.

Multiple Sclerosis: Partial or complete loss of pain sensation, or development of neuropathic pain.
Demyelination affects pain pathways.
Leprosy or Hansen’s Partial or complete loss of pain sensation in affected areas.
disease. Nerve damage caused by bacterial infection.
Guillain-Barré Partial or complete loss of pain sensation, or development of neuropathic pain.
Syndrome
Chemotherapy-Induced Partial loss of thermoception as side effect of certain chemotherapy drugs causing
Neuropathy: damage to peripheral nerves.
1.SUPERFICIAL SENSATION: PAIN SENSATION:
conditions:
Condition: Defect
Congenital Complete loss of pain sensation from birth. Genetic disorder affecting nerve function.
Insensitivity to Pain

Fibromyalgia: Increased pain sensitivity (hyperalgesia) and widespread pain.

Central nervous system processing disorder.

Complex Regional Severe pain following injury or surgery, with increased pain sensitivity.
Pain Syndrome Affects one limb, often following trauma
(CRPS)
Trigeminal Neuralgia: Severe facial pain triggered by normal activities.
Affects the trigeminal nerve

Syringomyelia: Loss of pain sensation due to formation of a cyst in the spinal cord across the shoulders
and back.

Alcoholic Neuropathy Partial loss of pain sensation, or development of chronic pain.

Peripheral nerve damage due to chronic alcohol abuse.
1.SUPERFICIAL SENSATION: PAIN SENSATION:
Complications of Defects in Pain Sensation:
• Injury Risk: Increased risk of severe injuries due to lack of pain awareness (e.g.,
cuts, burns, fractures).
• Chronic Pain: Persistent pain that can affect daily functioning and quality of life.
• Infections: Unnoticed injuries can lead to infections.
• Impaired Healing: Poor response to injuries due to lack of pain signaling.
• Psychological Impact: Chronic pain can lead to anxiety, depression, and reduced
overall well-being.
2. DEEP SENSATION:
• Deep sensation includes muscle and joint position sense
(proprioception), kinesthesia, and vibration sense.
2.DEEP SENSATION: PROPRIOCEPTION:
Preparation:
Explain the procedure to the patient, ensuring they understand what to expect.
Ensure the patient is in a comfortable and relaxed position.
Have the patient close their eyes or look away to prevent visual input from
aiding perception.

Tools Needed
None specifically required, but a comfortable space for the patient to be
positioned and moved is necessary.
.
2.DEEP SENSATION: PROPRIOCEPTION:
Proprioception Awareness test:
Procedure:
• Stabilize the joint being tested (e.g., finger, toe, wrist, elbow, ankle).
• Move the joint into various positions (e.g., up, down, left, right).
• Ask the patient to describe the position of the joint (e.g., "up" or "down")
without looking.
• Alternatively, the patient can mimic the position with the opposite limb if
assessing larger joints.
• Testing Sites: Commonly tested areas include the fingers, toes, wrists,
elbows, ankles, and knees. Ensure to test both sides of the body.
2.DEEP SENSATION: PROPRIOCEPTION:
Uses:
Motor Control: Essential for coordinating movements and performing tasks like
walking, running, and lifting objects.
Balance and Stability: Helps maintain balance and posture by providing
continuous feedback about body position.
Spatial Awareness: Contributes to awareness of the body’s location in space,
aiding in navigation and interaction with the environment.
Reflexes and Reactions: Enables quick reflexive responses to maintain balance
and avoid obstacles.
2.DEEP SENSATION: PROPRIOCEPTION:
Abnormalities:
NAME DEFECT
Proprioceptive Deficit Reduced or absent awareness of body position and movement.
Leads to difficulty in coordinating movements.
Proprioceptive Ataxia Lack of awareness of movement deficits.
Often occurs in conjunction with other neurological conditions
Sensory Ataxia Gait abnormalities, frequent stumbling, and difficulty with fine motor
tasks due to damage to peripheral nerves or dorsal columns of the
spinal cord.
Upper Limb Reduced ability to sense the position and movement of the arms and
Proprioception Deficit hands.
- Impact: Challenges in performing tasks requiring hand-eye
coordination, such as writing, typing, or gripping objects.
Lower Limb Reduced ability to sense the position and movement of the ankle and
Proprioception Deficit knee.
2.DEEP SENSATION: KINESTHESIA:
Kinesthesia Awareness test:
Awareness of movement is known as kinesthesia. The Therapist passively moves
a joint through a relatively small range of motion and the patient is asked to
describe the direction of movement. The patient can also respond by
simultaneously duplicating the movement with the opposite extremity.
2.DEEP SENSATION: KINESTHESIA:
Preparation:
• Explain the procedure to the patient, ensuring they understand what to expect.
• Ensure the patient is in a comfortable and relaxed position.
• Have the patient close their eyes or look away to prevent visual input from
aiding perception.
2.DEEP SENSATION: KINESTHESIA:
Procedure:
• Stabilize the joint being tested.
• Move the joint slowly through small ranges of motion.
• Ask the patient to describe the direction of movement (e.g., "moving up" or
"moving down") without looking.
• Testing Sites: Similar to joint position sense, commonly tested areas include the
fingers, toes, wrists, elbows, ankles, and knees.
2.DEEP SENSATION: KINESTHESIA:
Physiological Uses of Kinaesthesia Sensation:
• Movement Coordination: Enables smooth and coordinated movements.
Essential for tasks like walking, running, and fine motor activities.
• Body Position Awareness: Provides information about the position and
movement of body parts. Crucial for maintaining balance and posture.
• Motor Learning: Involves learning new movements and skills through practice.
Important for activities such as sports, playing musical instruments, and
dancing.
• Feedback for Movement Adjustments: Provides real-time feedback to adjust
movements. Important for tasks requiring precision, such as reaching and
grasping.
2.DEEP SENSATION: KINESTHESIA:
Defects in Kinaesthesia Sensation:
NAME DEFECT

Proprioceptive Deficit: Reduced or absent awareness of body position and movement.

Leads to difficulty in coordinating movements.
Anosognosia Lack of awareness of movement deficits.
Often occurs in conjunction with other neurological conditions
Hypoesthesia: Decreased sensitivity to kinesthetic feedback.
Reduced ability to perceive limb movements.

Ataxia: Lack of voluntary coordination of muscle movements.

Can affect gait, speech, and eye movements.
2.DEEP SENSATION: KINESTHESIA:
Conditions Affecting Kinaesthesia Sensation:
Condition: Defect
Peripheral Neuropathy: Partial or complete loss of kinesthetic sensation.
Nerve damage due to diabetes, infections, or toxins.
Parkinson’s Disease: Loss of pain sensation below the level of injury.
Can be partial or complete depending on the extent of damage..
Stroke: Hemispheric loss of kinesthetic sensation if the stroke affects one side of the brain.
Impaired movement and coordination on the opposite side of the body.
Multiple Sclerosis: Partial or complete loss of kinesthetic sensation due to demyelination.
Affects coordination and balance.
Cerebellar Disorders: Ataxia and impaired kinesthetic sensation due to cerebellar damage.
Affects coordination, balance, and fine motor control.
Guillain-Barré Partial or complete loss of kinesthetic sensation due to acute nerve inflammation.
Syndrome Affects peripheral nerves.
Alcoholic Neuropathy: Partial loss of kinesthetic sensation due to chronic alcohol abuse.
Damage to peripheral nerves affects coordination and balance.
2.DEEP SENSATION: KINESTHESIA:
Conditions Affecting Kinaesthesia Sensation: cntd:
Condition: Defect

Vitamin B12 Impaired kinesthetic sensation due to nerve damage.

Deficiency Leads to coordination and balance issues.

Ehlers-Danlos Joint hypermobility and proprioceptive deficits.

Syndrome Affects movement coordination and stability.

Charcot-Marie-Tooth Hereditary condition causing progressive loss of kinesthetic sensation.

Disease: Affects peripheral nerves leading to coordination issues.
2.DEEP SENSATION: KINESTHESIA:
Complications of Defects in Kinaesthesia Sensation:
• Movement Disorders: Difficulty in performing coordinated and smooth
movements. Problems with walking, reaching, and other motor tasks.
• Increased Fall Risk: Impaired balance and spatial orientation increase the
likelihood of falls. Greater risk of injury from falls.
• Loss of Fine Motor Skills: Challenges in tasks requiring precise hand
movements. Difficulty with activities such as writing, typing, and using tools.
• Impaired Daily Functioning: Difficulty in performing daily activities and self-
care tasks. Increased dependence on others.
• Chronic Pain and Fatigue: Abnormal movements and posture can lead to
muscle strain and pain. Increased effort required for movements can cause
fatigue.
2.DEEP SENSATION: VIBRATION:
Preparation:
• Explain the procedure to the patient, ensuring they understand what to expect.
• Ensure the patient is in a comfortable and relaxed position.
• Have the patient close their eyes or look away to prevent visual input from
aiding perception.
2.DEEP SENSATION: VIBRATION:
Tools Needed:
Tuning fork (preferably 128 Hz)

Procedure:
• Strike the tuning fork to make it vibrate.
• Place the base of the vibrating tuning fork on a bony prominence (e.g., the ankle,
wrist, elbow, or knee).
• Ask the patient to indicate when they feel the vibration start and stop.
• To ensure accuracy, intermittently dampen the tuning fork to stop the vibration
without moving it and ask the patient to indicate if they still feel it.
• Test multiple bony prominences, starting from distal (e.g., toes, fingers) and
moving proximal if necessary (e.g., ankles, wrists, knees, elbows).
• Testing Sites: Commonly tested areas include the toes, fingers, ankles, wrists,
2.DEEP SENSATION: VIBRATION:

NAME DEFECT

Reduced Vibration Sense: Decreased ability to perceive vibrations.

Impact: Difficulty detecting subtle vibrations, leading to
reduced awareness of environmental changes and diminished
sensory feedback.
Complete Loss of Vibration Inability to perceive any vibrations.
Sense Impact: Significant impairment in detecting environmental
stimuli, affecting balance and spatial awareness.
2.DEEP SENSATION: VIBRATION:
Conditions Affecting VIBRATION:
Condition: Defect
Peripheral Neuropathy: Nerve damage leading to diminished or lost vibration sense..

Parkinson’s Disease: Neurodegenerative changes affecting sensory processing.

Spinal cord injury Disruption of sensory pathways transmitting vibration sense.

Multiple Sclerosis: Partial or complete loss of kinesthetic sensation due to demyelination.

Affects coordination and balance.

Vitamin B12 Nerve damage impairing vibration perception.

Deficiency

Guillain-Barré Acute peripheral nerve inflammation impairing vibration sense..

Syndrome
2.DEEP SENSATION: VIBRATION:
Complications:
1. Balance Problems:
- Difficulty maintaining stability, particularly on uneven surfaces due to lack
of sensory feedback.
2. Coordination Issues:
- Challenges in performing tasks requiring precise movements.
3. Increased Risk of Injury:
- Higher likelihood of falls and accidents due to lack of sensory feedback.
3. CORTICAL SENSATION:
• Cortical sensations are two-point discrimination, stereognosis, and
graphesthesia.
3.CORTICAL SENSATION: STERIOGNOSIS :
Stereognosis is the ability to recognize and identify objects by touch alone,
without visual or auditory input. This involves integrating tactile information with
memory and perception.

Uses:
Object Recognition: Identifying objects in the dark or without looking.
Daily Activities: Performing tasks like finding keys in a bag or recognizing coins
in a pocket.
Occupational Tasks: Essential for professions requiring tactile identification, such
as surgeons and craftsmen.
3.CORTICAL SENSATION: STERIOGNOSIS:
Preparation:
• Explain the procedure to the patient, ensuring they understand what to expect.
• Ensure the patient is in a comfortable and relaxed position.
• Have the patient close their eyes or look away to prevent visual input from
aiding perception.
3.CORTICAL SENSATION: STERIOGNOSIS:
Tools Needed
A variety of small, familiar objects (e.g., coin, key, paperclip, pen cap, marble).

Procedure:
• Place one of the small objects in the patient’s hand.
• Ask the patient to manipulate the object with their fingers and identify it.
• Repeat the procedure with different objects, using one hand at a time.
• Ensure a variety of objects are used to test different textures, shapes, and sizes.
• Testing Sites: Test both hands to assess potential differences between sides.
3.CORTICAL SENSATION: STERIOGNOSIS:
Uses:

• Sensory Mapping: Evaluating the density and function of sensory receptors in

different skin areas.
• Neurological Diagnosis: Identifying sensory deficits and monitoring conditions
like peripheral neuropathy.
• Rehabilitative Planning: Tailoring interventions for sensory re-education.
3.CORTICAL SENSATION: STERIOGNOSIS:
Defects of stereognosis:
NAME DEFECT

Reduced Stereognosis Decreased ability to recognize objects by touch.

- Impact: Difficulty identifying objects without visual input,
affecting manual dexterity.

Complete Loss of Stereognosis Inability to recognize any objects by touch.

- Impact: Significant impairment in tactile recognition, leading
to reliance on visual information.

Astereognosis Inability to recognize objects by touch. It is often associated

with lesions in the parietal lobe and can be a sign of sensory
cortex dysfunction.
3.CORTICAL SENSATION: STERIOGNOSIS:
Conditions Affecting Stereognosis:
Condition: Defect
Peripheral Neuropathy: Nerve damage impairing the ability to recognize objects by touch.

Parkinson’s Disease: Neurodegenerative changes affecting sensory integration.

Spinal cord injury Demyelination affecting sensory pathways involved in tactile recognition.

Multiple Sclerosis: Demyelination affecting sensory pathways involved in tactile recognition.

Stroke Parietal lobe damage impairing stereognosis on the opposite side of the body.

Cerebral Palsy Brain damage leading to impaired stereognosis.

Alzheimer’s Disease Cognitive decline affecting tactile recognition and object identification.
3.CORTICAL SENSATION: STERIOGNOSIS:
Complications:
1. Impaired Object Recognition:
- Difficulty identifying objects without looking at them.
2. Reduced Manual Dexterity:
- Challenges in performing tasks requiring fine motor skills.
3. Increased Dependence on Vision:
- Reliance on visual cues for object identification and manipulation.
3.CORTICAL SENSATION: GRAPHESTHESIA:
Preparation:
• Explain the procedure to the patient, ensuring they understand what to expect.
• Ensure the patient is in a comfortable and relaxed position.
• Have the patient close their eyes or look away to prevent visual input from
aiding perception.
3.CORTICAL SENSATION: GRAPHESTHESIA:
Tools Needed:
Blunt instrument (e.g., pen cap, tongue depressor, or the end of a cotton swab).

Procedure:
• Use a blunt instrument to trace a number, letter, or simple shape on the patient’s
palm.
• Ask the patient to identify the traced figure.
• Repeat the procedure with different figures, using one hand at a time.
• Ensure a variety of figures are used to test different patterns.
• Testing Sites: Commonly tested areas include the palms and fingertips. Ensure to
test both sides of the body.
3.CORTICAL SENSATION: GRAPHESTHESIA:

NAME DEFECT

Agraphesthesia Inability to recognize writing on the skin, often due to lesions

in the parietal lobe, particularly in the postcentral gyrus.

Reduced Stereognosis Decreased ability to recognize objects by touch.

- Impact: Difficulty identifying objects without visual input,
affecting manual dexterity.

Complete Loss of Stereognosis Inability to recognize any objects by touch.

- Impact: Significant impairment in tactile recognition, leading
to reliance on visual information.
3.CORTICAL SENSATION: GRAPHESTHESIA:
Complications:
1. Impaired Object Recognition:
- Difficulty identifying objects without looking at them.
2. Reduced Manual Dexterity:
- Challenges in performing tasks requiring fine motor skills.
3. Increased Dependence on Vision:
- Reliance on visual cues for object identification and manipulation.
3.CORTICAL SENSATION: GRAPHESTHESIA:
Condition: Defect
Peripheral Neuropathy: Nerve damage reducing graphesthesia sensation.

Parkinson’s Disease: Neurodegenerative changes affecting sensory integration.

Spinal cord injury Demyelination affecting sensory pathways involved in tactile recognition.

Multiple Sclerosis: Demyelination affecting sensory pathways.

Stroke Damage to parietal lobe impairing graphesthesia on the opposite side of the body.

Traumatic Brain Injury Damage to sensory processing areas impairing graphesthesia.

3.CORTICAL SENSATION: 2 POINT DISCRIMINATION:
Preparation:
• Explain the procedure to the patient, ensuring they understand what to expect.
• Ensure the patient is in a comfortable and relaxed position.
• Have the patient close their eyes or look away to prevent visual input from
aiding perception.
3.CORTICAL SENSATION: 2 POINT DISCRIMINATION:
Tools Needed:
• Two-point discriminator or calipers (adjustable)
• Aesthesiometer
Testing:
• Adjust the two-point discriminator or calipers to a specific distance.
• Lightly touch the patient’s skin with either one or two points of the discriminator.
• Ask the patient to identify whether they feel one or two points of contact.
• Vary the distance between the two points and repeat the procedure, testing at various
distances.
• Record the smallest distance at which the patient can correctly identify two points as
separate.
Testing Sites: Commonly tested areas include the fingertips, hands, arms, legs, and back.
Ensure to test both sides of the body and different dermatomes.
3.CORTICAL SENSATION: 2 POINT DISCRIMINATION:
It determines the ability to perceive two points applied to the skin simultaneously.
Aesthesiometer or the circular two-point discriminator are the devices to test.
The two tips of the instrument are applied to the skin simultaneously with the tip
spread apart. With each successive application, the two tips are gradually brought
closer together until the stimuli are perceived as one. The smallest distance
between the stimuli that is still perceived as two distinct points is measured.
1.SUPERFICIAL SENSATION: 2 POINT DISCRIMINATION:
Physiological uses of 2 point discrimination:
• Tactile Acuity: Determines the ability to perceive fine details and textures.
• Essential for tasks requiring fine motor skills, such as writing and typing.
• Sensory Feedback: Provides feedback for grip force and manipulation of objects.
• Crucial for handling delicate items and adjusting movements accordingly.
• Differentiation of Stimuli: Enables the brain to distinguish between two close
stimuli.
1.SUPERFICIAL SENSATION: 2 POINT DISCRIMINATION:
Defects in Two-Point Discrimination:
1. Reduced Two-Point Discrimination: Decreased ability to distinguish between two
closely spaced points.Indicates a loss of tactile acuity and spatial awareness.
2. Increased Two-Point Discrimination Threshold: Need for greater distance between
points to perceive them as separate.Sign of sensory nerve impairment or damage.
Complications of Defects in Two-Point Discrimination:
• Impaired Fine Motor Skills: Difficulty in performing tasks requiring precise finger
movements.
• Challenges in activities like buttoning clothes, writing, or typing.
• Decreased Sensory Feedback: Risk of dropping or damaging items due to poor
tactile feedback.
• Reduced Quality of Life: Challenges in daily activities leading to frustration and
dependence on others. Potential impact on professional tasks and hobbies.
CONCLUSION:
• Each of these assessments, when performed systematically and accurately,
contributes to the early detection and diagnosis of neurological disorders.
They aid in the localization of lesions, the identification of disease
progression, and the formulation of effective management plans.
Understanding and mastering these sensory tests are essential for any
clinician involved in the care of patients with neurological conditions.

• Thus, ongoing education and practice in these areas are imperative for
advancing neurological care and ensuring comprehensive patient
evaluation.
 REFERENCE:
• Marino, R. J., et al. (2003). "ASIA (American Spinal Injury Association) standards for
neurological classification of spinal cord injury." The Journal of Spinal Cord Medicine,
26(Suppl 1), S50-S56.
• Maynard, F. M., et al. (1997). "International standards for neurological and functional
classification of spinal cord injury." Spinal Cord, 35(5), 266-274.
• Ditunno, J. F., et al. (1994). "ASIA 1992–Standard Neurological Classification of Spinal
Cord Injury." Spinal Cord, 32(2), 70-80.
• DeLisa's Physical Medicine & Rehabilitation: Principles and Practice"
• Neurologic Examination" by Robert J. Schwartzman
• "Bates' Guide to Physical Examination and History Taking" by Lynn S. Bickley
• "Clinical Methods: The History, Physical, and Laboratory Examinations" (3rd edition),
Chapter 61: The Neurologic Examination" by Swash and Schwartz
• "Sensory examination: A comprehensive review of techniques and methods" published in
Clinical Medicine & Research.
• Guidelines for the Management of Peripheral Neuropathy in Diabetes" by the American
Diabetes Association.
THANKYOU..