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http://projects.csail.mit.edu/courseware/?term=national-junior-honor-society-essay-samples national junior honor society essay samples For a diagnosis of motor only disease (eg, motor neuron disease) when one expects no sensory loss, a thorough sensory examination in the distribution o nerves already showing motor de cits to document the normality o sensation in that distribution is indicated. T us, i a patient has very atrophic hand muscles, a normal sensory examination in the median and ulnar distribution raises the suspicion o such a disease. How would you examine light touch?. Here are 2 kinds o touch subserved by 2 separate sensory systems. Discriminating touch sensation is transmitted by large myelinated ibers in the nerves and travels primarily through the posterior columns. Crude touch is transmitted by small myelinated and unmyelinated ibers that travel through the anterolateral system.1 t e authors use a wisp o cotton or a ne napkin/ tissue or this. We touch a normal part o the ace or body over a very small area and or a brie time with the patient’s eyes open to teach the patient the kind o stimulus we are applying. Then we tell the patient to close eyes and to say “yes” every time he/she eels us touch any part o the body in a similar ashion. T e time between stimuli should be varied. T e objective is to determine i the patient misses the stimulus over a particular area o the body either all the time or more consistently than other regions. Esting sensation using a cotton wisp tests or discriminating touch. O test or the integrity o the anterolateral system or small nerve bers it is more e cacious to test or pain and temperature sensation. How does one test or pain and temperature?. Pain. We use a sharp (previously unused) pin. He patient is instructed on the eel o both the sharp and blunt ends o the pin applied brie ly a single time with a modest pressure and asked to discriminate between the 2. Now with eyes closed, the patient’s ability to discriminate between the 2 ends in selected regions o the body is determined. He same principles used or touch can be used in selecting the regions o interest. He idea would be to detect regions in which the patient either completely or most o the time misses the stimuli in a consistent ashion. Emperature. We use a tuning ork. We warm one o the prongs under warm water and leave the other cool. It is best to achieve a minimal di erence in temperature between the 2 prongs. With eyes closed, the patient is asked to tell i stimulus one or two is “warmer” a er application o the sides o both prongs to the selected area o the skin. One can continue to be certain that the two sides can be discriminated by sel -application o the prongs to the examiner skin (assuming the examiner is normal). Over a short period o time, in act, the temperature di erence becomes smaller and smaller, making the stimulation even more “sensitive,” but at some point in time even the normal subject is not able to tell the di erence. Since pain and thermal sense use almost the same pathways, some authors recommend not doing both. Individual judgment has to be used in this regard. What are some other sensory modalities mediated by large myelinated ibers, and how does one test or them?.

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