Neurological Assessment: Assessing Sensory Function

Basic assessment of sensory function involves bilateral evaluation of the

three primary sensation pathways:
1. Pain and Temperature
2. Proprioception
3. Light Touch

Cortical sensory function assessment

-Higher-order aspect of sensation assessment if bilateral primary sensation
pathways are intact
1. Graphesthesia - the ability to recognize writing on the skin purely by
the sensation of touch.

2. Stereognosis- (also known as haptic perception or tactile gnosis) is the

ability to perceive and recognize the form of an object in the absence
of visual and auditory information, by using tactile information to
provide cues from texture, size, spatial properties, and temperature,
etc.

3. Extinction test- the ability to perceive multiple stimuli of the same

type simultaneously.

Desired Outcome of Sensory Function Assessment

› Assessment of sensory function is ordered to detect the presence of
sensory abnormalities and/or to screen for changes in a patient’s
neurological function
Implication
› Abnormal findings during sensory assessment can help identify abnormal
disease states and locate lesions within the nervous system

Sensory Deficits Causative Factors

1. Increasing age
 absence of ankle reflexes
 insensitivity to touch
 vibration
 position
2. Increased body mass index
3. Diabetes mellitus
4. Vitamin B12 deficiency
5. Rheumatoid arthritis
6. Hypertension

Preparation before the assessment

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*The examiner should be familiar with the sensory dermatomes (i.e., area of
skin supplied by a sensory neuron) that arise from spinal nerve ganglion

Sensory Function will be tested for the following senses:

1. Tactile and tactile identification (sharp/dull)
2. Vibration
3. Proprioception/ Position sense
4. Temperature
5. Graphesthesia
6. Two-point discimination
7. Extinction /Point location

Preliminary steps before assessment

1. Review facility/unit-specific protocols for assessing sensory function,
if one is available
2. Review treating clinician’s written orders for assessment of sensory
function
3. Verify completion of facility informed consent documents, if
appropriate. The typical consent executed at admission to a health
care facility encompasses neurological assessment
4. Review the patient’s medical history/medical record for
–allergies (e.g., latex); use alternate materials, if appropriate
–history of neurological deficit or disorder
5. Assemble the appropriate supplies, which include the following:
 Personal protective equipment (PPE; e.g., sterile/nonsterile gloves; use
additional PPE [e.g., gown, mask, eye protection]
 Cotton wisp
 Tongue blade
 128 hz tuning fork
 Coin or key
 2 containers, one holding warm water and the other containing cold
water
 Written information, if available, to reinforce verbal education

How to Assess a Patient’s Sensory Function

1. Perform hand hygiene and don PPE, as appropriate
2. Identify patient using two unique identifiers or according to facility
protocol
3. Establish privacy by closing the door to the patient’s room and/or
drawing the curtain around the bed
4. Introduce yourself to the patient and family members, and explain
your clinical role in the assessment of sensory function
5. Assess patient/family for knowledge deficits regarding the assessment
6. Determine if the patient/family requires special considerations
regarding communication

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 7. Explain the purpose and details of the assessment of sensory function
and provide emotional support as needed
8. Instruct the patient to close his/her eyes and to keep them closed
until instructed to open them

Tactile sensation
1. Tell the patient you are going to touch him/her with an object and ask
him/her to say the word “yes” when the touch is felt
2. Lightly touch a cotton wisp to the face, torso, and all four limbs
3. Note response to each touch
4. Assess tactile identification sensation (tests stereognosis) as follows:
5. Tell the patient you are going to place a common object into his/her
hand and ask that he/she identify the object by touch alone
6. Place a common object such as a coin or key in the patient’s hand;
repeat the process for the opposite hand
7. Note the patient’s response

Sharp/dull sensation test

1. Tell the patient you are going to touch him/her with a sharp or dull
object and ask him/her to identify the touch when felt
2. Break a tongue blade/ cotton applicator in half
3. Lightly touch the sharp end of the blade/ applicator on all four limbs;
repeat with the dull end of the blade
4. Note patient response to all touches

Vibration sensation test

1. Tell the patient that you are going to touch him/her with a vibrating
metal object
2. Ask the patient to identify when the vibration sensation ceases
3. Strike the tuning fork
4. Place the handle of the tuning fork over a bony prominence on the distal
joint of the great toe or the proximal thumb joint
5. Repeat the process for the same joint on the opposite side of the body

Proprioception sensation test (Position sense, joint mobility)

1. Tell the patient that you are going to move his/her great toe or index
finger and to indicate the direction the toe or finger is being moved
2. Move the great toe or index finger up and down; repeat the process for
the same joint on the opposite side of the body. The patient should be
able to correctly identify the movement and direction.
3. Note the patient’s responses to all touch
4. If the patient is unable to correctly identify the movement/direction,
move more proximally (e.g. to the ankle joint) and repeat (e.g. test
whether they can determine whether the foot is moved up or down at
the ankle).
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 Temperature sensation test
1. Tell the patient you will place his/her hand in warm and cold water
2. Instruct the patient to identify if the water is warm or cold
3. Repeat the process for the opposite hand
4. Note the patient’s responses to all attempts

Graphesthesia
1. Have the patient close his/her eyes, or vision is otherwise occluded.
2. Slowly draw a number, letter, or shape using your finger or blunt
instrument.
3. Have the patient identify the stimulus.
4. The procedure is repeated 3-5 times or until you are able to determine
whether the patient has intact or impaired sensation.

Two-Point Discrimination Test

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A test of the ability of a person to differentiate touch stimuli at two nearby p
oints on the body at the same time.

1. The patient closes his/her eyes, or vision is otherwise occluded.

2. Begin the test with the points of the anesthesiometer opened greater
than the mean value for the body part being tested.
3. Provide the stimulus by applying light and equal pressure across the two
points.
4. Have the patient identify if they feel one or two points.
5. Move the two points closer together across consecutive trials until the
patient cannot distinguish the two points as separate.
6. Measure the distance between the two points using the aesthesiometer
ruler.

*Static and moving two point discrimination can be tested.

*Normal values for the fingers include < 6mm for static two point and 2-3 mm
for moving two point.

Extinction test/ Point Location Test

1. Have the patient sit on the edge of the examining table and close his
eyes.
2. Touch the patient on the trunk or legs in one place and then tell the
patient to open eyes and point to the location where he noted sensation.
3. Repeat this a second time, touching the patient in two places on opposite
sides of their body, simultaneously. Then ask the patient to point to
where he felt sensation.
4. Normally patient will point to both areas. If not, extinction is present.

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After the test
› Instruct the patient to open his/her eyes
› Discard used procedure materials according to facility protocol
› Perform hand hygiene
› Update the patient’s plan of care, if appropriate, and document the
following information in the patient’s medical record:
o Date and time of patient assessment
o Results of sensory assessment
o Any unexpected events that occurred, interventions performed,
and if the treating clinician was notified
o All patient/family education, including topics presented,
response to education provided/discussed, plan for follow-up
education, and details regarding any barriers to communication
and/or techniques that promoted successful communication
o Other tests, treatments, or procedures that can be necessary
before or after assessment of sensory function
› Report abnormal test results to the treating clinician

Additional tests that may be ordered during evaluation

o Testing of neuromotor function
o Imaging studies (e.g., CT scan, MRI)
o Electromyography (EMG; i.e., test that evaluates the electrical
activity in a muscle)
o Blood tests (e.g., for vitamin deficiencies, blood glucose levels)
o Nerve biopsy

What to Expect After Assessment of Sensory Function

1. In combination with the results of additional testing, the extent and
type of the patient’s sensory loss is identified, if present
2. If the patient’s sensations of touch, vibration, or temperature are
impaired, identify the pattern of the loss on areas of the body. This
information will help the treating clinician locate the potential lesion
within the nervous system
3. A dermatomal distribution (i.e., area of skin in which sensory nerves
derive from a single spinal nerve root) suggests damage to isolated
nerves (i.e., mononeuritis multiplex) or nerve roots (i.e.,
radiculopathy)
4. Reduced or absent sensation below a certain level suggests damage of
the spinal cord. One-sided loss of sensation is seen when a lesion
causes damage within the brain as is often seen with a
cerebrovascular accident (CVA; i.e., stroke).
5. The location of the lesion is confirmed when motor weakness and
reflex changes follow a similar pattern. Patchy sensory, motor, and
reflex deficits in a limb suggest lesions of the brachial or pelvic nerve
plexus