NMS
5/10/99

Sensory exam
•	Subjective findings—rely on the pt to give accurate information
•	Make sure that you do not lead the pt in answers
•	Get a lot of the information from the Hx
•	True neurologic pain the pt is unwilling to reproduce the pain
•	Pain from somatic tissue is not uncommon for the pt to reproduce the pain
•	Paresthesia—only known cause is neurologic lesion
•	Be sensitive to what the pt has already told you—if they tell you that moving my head to the right causes extreme pain shooting down my right arm, don't passively turn their head to the right as part of the exam—you will lose a pt
•	If pt can reproduce the pain it has to be the peripheral nervous system
•	Insidious—pain comes and goes and pt can't reproduce—CNS problem
•	If have decreased pain, decreased proprioception, same side (anesthesia)—peripheral nerve (ulnar palsy)
•	If have decreased pain, decreased proprioception, opposite sides—cord lesion—Brown Sequard (hemi-section of the cord)
•	Pain crosses in the spinal cord right a way
•	Proprioception does not cross in the cord, it crosses in the medulla
•	CNS—can't discriminate the pain or sensation
•	Anesthesia—peripheral neuropathy
•	Decreased sensory discrimination—cortical—agnosia (not to know)
•	Aphasia—cortical lesions—difficulty communicating
•	Problem in the brain will affect the cranial nerves
•	4 A's to a cortical lesions
•	light touch (wisping a cotton ball), temp and pain (pin prick) travel over the same pathways

Proprioception
•	mechanoreception
•	deals w/muscles, tendon, ligament, and joints
•	3 pathways
1.	dorsal columns—highest function—carries info to thalamus to cortex (dorsal column to nucleus cuneatus/gracillus to medial leminscus to thalamus—kinesthesia (test move finger up and down), 2 pt discrimination, stereognosis, vibration on bony prominence
•	thalamus can detect vibration
2.	spinocerebellar—doesn't go to the cortex—positive pronator sign—cerebellum deals w/coordination—walk a straight line, stand straight and touch the tip of your nose—people act as they are intoxicated—unconscious pathway—(+) Romberg
3.	deep tendon reflex—most primitive—stretch of the muscle spindle—hyper-reflexive if brain control is lost