Clinical Examination of Proprioception

Question 1

Specific modalities of sensation are carried in the ______________ of the cord.

Answer 1

Posterior columns

Question 2

Specific modalities carried in the posterior columns of the cord

Answer 2

• Position sense
• Vibration
• Pressure
• Texture movement
• Localization of touch
• 2 point discrimination
• Weight
• Ability to decipher letters or numbers written on the skin

Question 3

Best tool used to evaluate vibration sense

Answer 3

128 or 256 Hz tuning fork

Question 4

How to test vibration sense in a patient.

Answer 4

• Have patient close their eyes and instruct them that you are going to place the tuning fork on their angle and to describe what they feel
• Patient should report a “buzzing” or “vibration feel”
• Should they report nothing, move to the knees.
• Should they still feel nothing, move to the hip

Question 5

Loss of vibratory sensation

Answer 5

Pallanesthesia

Question 6

Romberg Test

Answer 6

• Patient stands erect , looking straight ahead, first with eyes open
• Patients feet are approximated
• Doctor stands near the patient
• Patient then closes his or her eyes and stands erect

Question 7

Normal and abnormal findings for Romberg Test

Answer 7

Normal = patient maintains posture and has little or no swaying
Abnormal = patient takes a step to maintain posture or the patient falls.

Question 8

If a patient falls during the Romberg test with their eyes open, what does that indicate?

Answer 8

Cerebellar defect and/or Vestibular Mechanism Defect

Question 9

If a patient falls during the Romberg test with their eyes closed, what does that indicate?

Answer 9

Dorsal column pathology

Question 10

Test requires intact function of the nervous system. The long motor and sensory tracts, cerebellum, basal ganglia, and peripheral nerves.

Answer 10

Hopping on one foot

Squatting on one foot

Question 11

Hopping on one foot test

Answer 11

Patient hops on one leg with eyes open and closed and then hops on the other leg with eyes open and closed

Question 12

Normal and abnormal findings for Hopping on one foot test

Answer 12

Normal = patient maintains posture with eyes open and closed
Abnormal = patient takes a step to maintain posture of the patient falls

Question 13

If a patient has an abnormal findings with the Hopping on one foot test with their eyes open and closed, what does this indicate?

Answer 13

Cerebellar defect and/or Vestibular Mechanism Deficit

Question 14

If a patient has an abnormal finding with the Hopping on one foot test with their eyes closed only, what does this indicate?

Answer 14

Dorsal column pathology

Question 15

Good test to find minor weakness in the lower extremities

Answer 15

Squatting on one foot

Question 16

Squatting on one foot

Answer 16

Patient squats on one leg with eyes open and closed and then squats on the other leg with eyes open and closed

Question 17

Normal and abnormal findings for squatting on one foot

Answer 17

Normal = Patient maintains posture with eyes open and closed
Abnormal = Patient takes a step to maintain posture or the patient falls

Question 18

If a patient fails Squatting on one foot with their eyes open and closed, it indicates a :

Answer 18

Cerebellar deficit or Vestibular mechanism deficit

Question 19

If a patient fails Squatting on one foot with eyes closed only, this indicates a:

Answer 19

Dorsal column pathology

Question 20

Finger to Nose test

Answer 20

Patient has his or her arms straight out to the side and attempts to touch the tip of his or her finger bilaterally with eyes open and closed.

Question 21

Normal and abnormal findings for Finger to Nose test

Answer 21

Normal = Should see smooth and accurate movement
Abnormal = Uncoordinated movement and/or inaccuracy in measuring distance

Question 22

Uncoordinated movement

Answer 22

Dyssynergia

Question 23

Inaccuracy in measuring distance

Answer 23

Dysmetria

Question 24

Finger to Finger Test

Answer 24

Patient has his or her arms straight out to his or her side and attempts to touch the tips of their index fingers together, straight out in front of them, with eyes open and closed

Question 25

Normal and abnormal findings for Finger-to Finger test

Answer 25

``` Normal = Should see smooth and accurate movement Abnormal = Dyssynergia and/or Dysmetria ```

Question 26

Only proprioceptive test done with only the eyes open

Answer 26

Finger to Nose to Finger Test

Question 27

Finger to Nose to Finger Test

Answer 27

The Dr. stands with his finger about 2 feet from the patient and has the patient alternate touching his or her finger from his or her nose to the doctor's finger with the doctor changing finger positions constantly

Question 28

Normal and abnormal findings for Finger to Nose to Finger test

Answer 28

``` Normal = should see smooth and accurate movement Abnormal = Dyssynergia only ```

Question 29

Heel to Shin test

Answer 29

Patient attempts to run his heel from one side down the anterior shin from the knee to the ankle of the opposite leg. This is performed bilaterally with eyes open and closed.

Question 30

Normal and abnormal findings of Heel to Shin test

Answer 30

``` Normal = Should see smooth and accurate movement Abnormal = Dyssynergia and Dysmetria ```

Question 31

Testing for the ability to perform rapid alternating movements

Answer 31

Patting knees rapidly, tapping forefinger to thumb, pronation/supination of the hands performed with eyes open and closed

Question 32

Normal and abnormal findings for Testing the ability to perform rapid alternating movements

Answer 32

``` Normal = performing actions properly Abnormal = Inability to perform actions properly ```

Question 33

Performing actions properly

Answer 33

Diadochokinesia

Question 34

Performing actions improperly

Answer 34

Dysdiadochokinesia

Question 35

What does Dysdiadochokinesia indicate?

Answer 35

Possible cerebellar dysfunction

Question 36

Holmes Rebound Phenomenon

Answer 36

Patient contracts the flexors of the forearm against resistance by the doctor. The doctor releases the arm quickly. This is performed with eyes open and closed

Question 37

Normal and Abnormal findings of the Holmes Rebound Phenomenon

Answer 37

``` Normal = should see a "check reflex" Abnormal = Dyssnergia and/or Dysmetria ```

Question 38

Tandem Gait

Answer 38

Person walk along a straight line on the floor by placing one heel directly in front of the opposite toe with the eyes open and closed

Question 39

Normal and abnormal findings for Tandem Gait

Answer 39

``` Normal = Patient is able to perform both tasks with eyes open and closed Abnormal = dyssynergia and/pr dysmetria ```

Question 40

Joint Position Test

Answer 40

Dr. examines one digit of the patients hand or foot by stabilizing the hand and/or foot and grabbing a single digit from the sides and flex or extend that digit without placing any pressure on the top or bottom of the digit. Ask the patient to inform you whether you are moving the toe or finger up or down. This is performed with eyes closed

Question 41

Abnormal findings of the Joint Position Test

Answer 41

Patient cannot determine accurately whether his finger or toe is being moved up or down

Question 42

What would an abnormal finding on the Joint Position Test indicate?

Answer 42

Possible posterior column disease

Question 43

Abadie's sign

Answer 43

Pinching the Achilles tendon

Question 44

Pitres' sign

Answer 44

Pinching the testicles

Question 45

Biernacki sign

Answer 45

Pinching or striking the ulnar nerve

Question 46

Besides the Achilles tendon, testicles, and ulnar nerve, where can deep pain also be tested by placing pressure on?

Answer 46

Eyeballs

Question 47

When any of the signs (Abadie's, Pitres', Bernacki, or eyeball pressure) are diminished, this indicates what pathology?

Answer 47

Posterior column disease (Tabes dorsalis is the classic example)

Question 48

Combination of both superficial and deep sensations which are then subject to integration with higher cortical functions and memory.

Answer 48

Multimodal sensations

Question 49

Examples of multimodal sensations

Answer 49

``` Stereognosis Barognosis Topognosis Graphognosis 2-point discrimination ```

Question 50

May be assessed by placing a common object (pin, cap, key, button, etc.) in the patients hands with their eyes closed. Patient should be able to identify the object within a few seconds without switching hands

Answer 50

Stereognosis

Question 51

Patient assesses the relative weight of similarly sized and shaped objects that have different weights

Answer 51

Barognosis

Question 52

Touch the patient somewhere on the skin and have him or her point to the area just touched

Answer 52

Topognosis

Question 53

Test the patient by writing a letter or number on their chest, back or palm of the hand and have them identify it

Answer 53

Graphognosis

Question 54

Is determining at which point a patient can determine 2 objects separate from one another

Answer 54

2 point discrimination

Question 55

2 point discrimination varies depending on the location on the body. For example, normal ranges for the finger tips are _____mm while the dorsum of the fingers are ____mm, the palm of the hands ____ mm, and the dorsum of the hand up to ____mm

Answer 55

Tips = 2-4 mm Dorsum fingers = 4-6 mm Palm = 8-12 mm Dorsum hand = 20-30 mm

Question 56

This is the ability for the patient to know a body part is his own body part.

Answer 56

Somatognosis

Question 57

Test for Somatognosis

Answer 57

Placing your arm next to the patient's arm and askin him to "touch your arm with your finger"

Question 58

The ability for the patient to know that he is ill

Answer 58

Nosognosis

Question 59

Test for Nosognosis

Answer 59

In light of overwhelming and obvious evidence of neurological disease such a hemiplegia, the patient will deny that there is a problem