Sensory assessment is one of the most important component in patient examination.

1. SENSORY ASSESSMENT
Suvarna Ganvir
DVVPF’s College of
Physiotherapy,
Ahmednagar
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2. Objectives
 At the end of lecture the learner shall be
able to
1. Classify sensations
2. Describe preparation of patient
3. Describe assessment of sensations
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3. Classification of sensations
Sensations
Superficial Deep
Combined
cortical
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4. Superficial
Touch
Pain
Temperature
Pressure
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5. Deep
Kinesthesia Proprioception Vibration
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6. Combined
cortical
Stereognosis
Tactile localisation
Two point discrimination
Double simultaneous stimulation
Graphesthesia
Recognition of texture
Barognosis
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7. Patient Preparation
Comfortable relaxed position
Full explanation or purpose of
the test
Informed about the
cooperation required
Requested ‘not to guess’
Occlusion of vision
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8. A trial run or demonstration of each test
should be performed
This will orient the patient to the sensation
being tested
Trial run is a must for patient understanding
without which the result of test may get
affected.
In case of verbal affection, ask patient to
raise his hand or fingers when he feels the
sensation
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9. ❑ SUPERFICIAL-
 TOUCH
 PAIN
 TEMPERATURE
 PRESSURE
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10. Touch Sensation
Perception of a tactile touch input
Equipment : A camel hair brush, Cotton or
tissue is used
Stimulus: area to be tested is lightly
touched or stroked,
Response: patient should indicate when
he recognizes a stimulus by responding
‘Yes or no’
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12. Temperature Awareness
 Ability to distinguish between warm and
cool stimuli.
 Two test tubes with stoppers
 One filled with warm water – 40-45
degrees (104-113 farenheit)
 Other filled with cold water – 5-10 degrees
(41-50 degree farenheit)
 More temp- pain sensation
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13.  Side of the test tube – contact with skin
 Provides sufficient surface area contact
 Test tubes are randomly placed in contact
with skin
 All skin surfaces should be checked.
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15. Pain perception
 Sharp/Dull discrimination
 Indicates function of protective sensation
 Sharp and dull end of a large headed or
safety pin
 Randomly applied perpendicular to the skin
 Stimuli should not be applied too close or in
too rapid succession
 Response- Verbally indicate – Sharp or dull
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16. Pressure
 Therapist’s finger tip or a double tipped
cotton swab
 Firm pressure on the skin
 Firm enough to indent the skin
 Achilis tendon squeezing
 Response- indicate yes or no
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17. ❑ DEEP-
 JOINT POSITION
 KINESTHESIA AWARENESS
 VIBRATION
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18. Kinesthetic awareness
 Awareness of movement
 Extremity or joint is moved through a small
ROM- Initial , mid range or end range
 Therapist grip should not give tactile
stimulation
 Trial session
 Response- describe verbally the direction and
range of movement while the extremity is in
motion
 May respond by duplicating the movement
on other side
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20. Proprioceptive awareness
 Joint position sense or awareness of joints
at rest
 Extremity or joints is moved through a
ROM and held in a static position
 Small increments of ROM are used
 Hand placement should be such that it
causes minimum tactile stimulation
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21.  Response- while the extremity or joint is
held in a static position , patient is asked
to describe the position verbally or to
duplicate the position of the extremity
with contralateral extremity
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23. Vibration perception
 This test requires a tuning fork of 128 Hz
 Ability to perceive a vibratory stimulus
 Tines are briskly hit against the open palm
of the examiner
 Base of a vibrating fork is placed on a
bony prominence before and after hitting
the tines
 Random application of vibratinng and
non vibrating stimuli
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24.  Response– Patient is asked to respond
verbally identifying or otherwise indicating
, if the stimulus is vibrating or non vibrating
each time fork makes contact.
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25. ❑ CORTICAL-
 TACTILE LOCALISATION
 TWO POINT DISCRIMINATION
 STEREOGNOSIS
 BAROGNOSIS
 GRAPHESTHESIA
 RECOGNITION OF TEXTURE
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26.  If superficial touch sensations is absent
over a specific area, it is not possible to
check some cortical sensations in that
area.
 Due care should be taken while
interpreting the results.
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27. Tactile Localisation
 Ability to localise touch sensation on the skin
 Ability to identify the specific point of application
of touch stimulus.
 Using a cotton swap or fingertip, the therapist
touches different skin surfaces. After each
application of a stimulus the patient is given
time to respond.
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28.  Response:
 The patient is asked to identify the location of
the stimuli by pointing to the area or by verbal
description
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30. Two point discrimination
 Ability to perceive two points applied to the skin
simultaneously.
 It is a measure of the smallest distance between two
stimuli (applied simultaneously and with equal pressure)
that can still be perceived as two distinct stimuli.
 Aesthesiometer and two point discriminator is used
 Two reshaped paper clips can also be used, but needs
another examiner to assist
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31.  With each successive application, the two tips are gradually
brought together until the stimuli are perceived as one. The
smallest distance between the stimuli that is still perceived
as two distinct points is measured.
 Response :
 The patient is asked to identify the perception of 'one' or
'two' stimuli.
.
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33. Stereognosis
 Tactile object recognition
 Small easily obtainable, and culturally familiar objects of
differing sizes and shapes(e.g. Key , combs, safety
pins, pencils),
 Patient is blind folded and therapist give a object to the
patient's hand.
 Patient should be allowed to handle several sample test
items during the explanation and demonstration
 Patient has to identify the object with the eyes closed.
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34. Response :
 Patient is asked to name the object
verbally.
 In case of speech impairments , patient
can point at the picture of an object
(sensory testing shields)
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36. Graphesthesia (traced figure identification)
 Ability to recognise letters numbers or designs
 A series of letters, numbers, or designs is traced on the
palm of the patient's hand.
 Between each separate drawing the palm should be
gently wiped with a soft cloth to clearly indicate a change
in figures to the patient.
 The test is also useful substitute for stereognosis when
paralysis prevents grasping an object.
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37.  Response :
 The patient is asked to identify verbally the
figures drawn on the skin.
 Patients with speech impairments may point
at the drawing of the stimulus.
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39. Recognition of texture
Suitable textures may include
cotton,wool,or silk.
The items are placed individually in the
patient's hand.
The patient is allowed to manipulate the
sample texture.
Patient is asked to identify the
individual textures as they are placed in
the hand.may be by name or by texture.
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40. Barognosis
 A set of discrimination weights consisting of small
objects of the same size and shape but of graduated
weight is used.
 The therapist may choose to place a series of different
weights in the same hand one at a time, place a
different weight in each hand simultaneously, or ask the
patient to use a fingertip grip to pick up each weight.
 The patient is asked to compare the weight.
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45. Commonly asked questions
 Assessment of cortical or superficial and
deep sensations 7M
 Give classification of sensations 3M
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