● Compare symmetric areas on the two sides of the body, including the arms, legs, and trunk.
● For pain, temperature, and touch sensation, compare distal to proximal areas of the extremities. Scatter the stimuli to sample most of the dermatomes and major peripheral nerves. One suggested pattern is to include:
● both shoulders (C4)
● the inner and outer aspects of the forearms (C6 and T1)
● the thumbs and little fingers (C6 and C8)
● the fronts of both thighs (L2)
● the medial and lateral aspects of both legs (L4 and L5)
● the little toes (S1)
● the medial aspect of each buttock (S3)
● For vibration and position sensation, test the fingers and toes first. If these are normal, you may safely assume that more proximal areas are also be normal.
● Vary the pace of your testing so that the patient does not merely respond to your repetitive rhythm.
● When you detect an area of sensory loss or hypersensitivity, map out its boundaries in detail. Stimulate first at a point of reduced sensation, then in progressive steps until the patient reports a change to normal sensation.
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