Which part of the hand is best used to feel for superficial body temperature of a client?

Make certain to instruct the patient to tell the physician if they notice a difference in the strength of sensation on each side of their body.

The corresponding nerve root for each area tested is indicated in parenthesis.

1. posterior aspect of the shoulders (C4)
2. lateral aspect of the upper arms (C5)
3. medial aspect of the lower arms (T1)
4. tip of the thumb (C6)
5. tip of the middle finger (C7)
6. tip of the pinky finger (C8)
7. thorax, nipple level (T5)
8. thorax, umbilical level (T10)
9. upper part of the upper leg (L2)
10. lower-medial part of the upper leg (L3)
11. medial lower leg (L4)
12. lateral lower leg (L5)
13. sole of foot (S1)

If there is a sensory loss present, test vibration sensation and temperature sensation with the tuning fork. Also concentrate the sensory exam in the area of deficiency.

Test position sense by having the patient, eyes closed, report if their large toe is "up" or "down" when the examiner manually moves the patient's toe in the respective direction. Repeat on the opposite foot and compare. Make certain to hold the toe on its sides, because holding the top or bottom provides the patient with pressure cues which make this test invalid.

Fine touch, position sense (proprioception) and vibration sense are conducted together in the dorsal column system. Rough touch, temperature and pain sensation are conducted via the spinothalamic tract. Loss of one modality in a conduction system is often associated with the loss of the other modalities conducted by the same tract in the affected area.

Test stereognosis by asking the patient to close their eyes and identify the object you place in their hand. Place a coin or pen in their hand. Repeat this with the other hand using a different object.

Astereognosis refers to the inability to recognize objects placed in the hand. Without a corresponding dorsal column system lesion, these abnormalities suggest a lesion in the sensory cortex of the parietal lobe.

Test graphesthesia by asking the patient to close their eyes and identify the number or letter you will write with the back of a pen on their palm. Repeat on the other hand with a different letter or number.

Apraxias are problems with executing movements despite intact strength, coordination, position sense and comprehension. This finding is a defect in higher intellectual functioning and is associated with cortical damage.

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

With lesions of the sensory cortex in the parietal lobe, the patient may only report feeling one finger touch their body, when in fact they were touched twice on opposite sides of their body, simultaneously. With extinction, the stimulus not felt is on the side opposite of the damaged cortex. The sensation not felt is considered "extinguished".