Sensory System Examination || CNS Examination || Pediatrics — Transcript

Full transcript

1. 0:00hello everyone today i am going to cover
2. 0:03the very important part of the cns
3. 0:05examination as i have already covered
4. 0:08higher mental function science of
5. 0:10meningeal irritation cranial nerve and
6. 0:12motor system examination
7. 0:15today i am going to tell you the details
8. 0:16of
9. 0:17sensory system examination
10. 0:20so the sensations are brutally
11. 0:22categorized into spatial and the somatic
12. 0:25sensation i have already explained this
13. 0:28part in the cranial nerve examination so
14. 0:31not going into the detail today about
15. 0:33the spatial sensation i will cover the
16. 0:36somatic sensation today in which touch
17. 0:39temperature pain pressure position
18. 0:41will be
19. 0:42covered somatic sensations are further
20. 0:46classified into primary and the
21. 0:47secondary sensations in primary
22. 0:49sensation further classified into
23. 0:52superficial and deep sensations
24. 0:54superficial sensation also known as
25. 0:56extraceptive in which pain touch and
26. 0:59temperature in deep also known as
27. 1:02proprioceptive pressure position and
28. 1:04vibration comes and secondary also known
29. 1:07as cortical sensation in which two point
30. 1:09discrimination tactile localization
31. 1:11estrogenosis and graphisthesia
32. 1:14comes
33. 1:18there are mainly two sensory tracts for
34. 1:20the somatic sensations
35. 1:22one is the spinothalamic tract also
36. 1:24known as enterolateral sensory system or
37. 1:27enterolateral spinothalamic tract in
38. 1:30which anterior
39. 1:32spinothalamic tract for the groot touch
40. 1:34and lateral for the pain and temperature
41. 1:37posterior column and medial lemniscus
42. 1:39also known as posterior sensory system
43. 1:42for the deep sensation pressure position
44. 1:44vibration and also for the light touch
45. 1:46and cortical sensations
46. 1:49structures which are involved for the
47. 1:51sensory perception are from the receptor
48. 1:54in the skin mucous membrane as a
49. 1:56thermoreceptors
50. 1:57and in muscle tendon as a
51. 1:59mechanoreceptor then it traveled to the
52. 2:01peripheral nerve dorsal root ganglia
53. 2:03considered as a first order then in
54. 2:06spinal cord as a second order then
55. 2:08travel to the brain stem
56. 2:10then in thalamic nucleus considered as a
57. 2:12third order then in sensory cortex
58. 2:15parietal lobe considered as a fourth
59. 2:17order neuron
60. 2:19now the things which will be required
61. 2:21for the sensory system examination tunic
62. 2:23fork
63. 2:24128 hertz to test tube with the cool and
64. 2:28warm water safety pin coin
65. 2:31any cuboid or cubist structure
66. 2:34and cotton wisp
67. 2:37so before starting the sensory system
68. 2:40examination we should explain to the
69. 2:42child that we are going to touch your
70. 2:45body part with the cotton or other
71. 2:47things
72. 2:48and we should instruct the child child
73. 2:51should respond which part of the body
74. 2:53right left and
75. 2:55exactly which part is touched by the
76. 2:58cotton or other things
77. 3:00and child should keep the eyes closed
78. 3:03all the times
79. 3:04and before touching any body part we
80. 3:07should show the child that we are going
81. 3:09to touch with the cotton or with the pin
82. 3:11and
83. 3:13assessment should be done from distal
84. 3:15body part
85. 3:17toward the proximal
86. 3:18and also we have to compare the right
87. 3:21and left part simultaneously
88. 3:25so how to assess the superficial
89. 3:27sensation in which first is for light
90. 3:30touch we will use the cotton whisk so in
91. 3:32this video you can see
92. 3:34i am touching the distal body part with
93. 3:37the cotton wisp also comparing the right
94. 3:39to the left
95. 3:41and child should respond which part of
96. 3:43the body is touched by the cotton wisp
97. 3:45so this is the method for the light
98. 3:48touch ideally we should expose the all
99. 3:50body parts except genitals so we will be
100. 3:54able to know which dermatome is affected
101. 3:57as seen in the
102. 3:59neuropathy
103. 4:01now for the pain sensation we can use
104. 4:03the safety pin and we should show the
105. 4:05child that we are using the septifin and
106. 4:08we will touch both blunt and the sharp
107. 4:11end of the safety pin and child should
108. 4:14respond
109. 4:15which stimuli either sharp or dull
110. 4:17stimuli is touched to the witch body
111. 4:20part for the pain sensation
112. 4:24last superficial sensation is
113. 4:25temperature sensation in this video you
114. 4:27can see i'm using the test tube which is
115. 4:30filled with the warm water up to 40
116. 4:32degree centigrade and another with the
117. 4:34cool water
118. 4:35up to 30 degree centigrade temperature
119. 4:38and we should tell the child
120. 4:41the sensation either cool or warm
121. 4:43whichever is filled when we are touching
122. 4:46after superficial sensation we should
123. 4:48assess the deep sensation in which for
124. 4:50pressure we can use our thumb to praise
125. 4:52the body part and child should say which
126. 4:55body part is praised by our thumb so in
127. 4:58this video you can see i am comparing
128. 5:00both right and left and moving from
129. 5:02distal to the proximal
130. 5:04for the pressure sensations
131. 5:09now for the position sensation we will
132. 5:11hold the hand and we will move the
133. 5:13finger up and down and child should
134. 5:15respond either
135. 5:17up or down similarly we can perform in
136. 5:20the lower legs also by moving the toes
137. 5:23so in this image you can see how to
138. 5:25perform for the position sensations
139. 5:28for position we can perform the rombuck
140. 5:32test also
141. 5:33i have already explained the details of
142. 5:35romberg test in the eighth cranial nerve
143. 5:38examination
144. 5:39whenever child is having the loss of
145. 5:41position sense in the legs
146. 5:44having the sensory atexia and when we
147. 5:46will tell the child to close the eyes
148. 5:49child will not be able to maintain the
149. 5:51posture
150. 5:52and
151. 5:53it is seen in the peripheral neuropathy
152. 5:55tabi's dorsal is considered as a
153. 5:58rhomboxane positive
154. 6:01now for the vibration sensation we
155. 6:03should use a 128 hertz tunic fork and in
156. 6:07this video you can see
157. 6:08i'm striking the tunic fork with our
158. 6:11elbow or we can charge the tuning fork
159. 6:14striking the thinner aspect of our palm
160. 6:17and we should keep the tunic fork
161. 6:19over the
162. 6:20bony prominence we should start from the
163. 6:23digital part of the body move toward the
164. 6:25proximally and compare the right and
165. 6:27left
166. 6:28we should keep over the
167. 6:30bony prominence and child should
168. 6:33say whenever child is having the feeling
169. 6:35of budge sound
170. 6:38for the vibration sensations
171. 6:40now cortical sensation in which two
172. 6:42point discrimination so in this video
173. 6:45you can see i'm using the compass we can
174. 6:47use a v-shape clip in which the distance
175. 6:49between the two blunt point can be
176. 6:51adjusted so this is the ability to
177. 6:53recognize
178. 6:54simultaneously two blunts point
179. 6:57so at the fingertip
180. 6:59child can
181. 7:00feel up to 1 mm distance and at finger
182. 7:03tip 2 to 4 mm dorsum of palm 4 to 6 and
183. 7:07it palm 8 to 12 mm
184. 7:09and a dorsum of hand 20 to 30 and dorsum
185. 7:12of wood
186. 7:13around up to 40 mm so we can adjust the
187. 7:16distance between two plant point to
188. 7:19assess the two point discrimination
189. 7:22after that for the tactile localization
190. 7:25simultaneously we have to touch the
191. 7:28two body parts so if the child is able
192. 7:31to perceives two stimuli simultaneously
193. 7:35we can either touch by the cotton or
194. 7:38with the our finger example in this
195. 7:40video you can see i'm touching the face
196. 7:42and the upper limb simultaneously we can
197. 7:45touch the both the limbs simultaneously
198. 7:48right and left
199. 7:50or we can touch the face or
200. 7:52any limb so this is tactile localization
201. 7:57now for the sterognosis this is the
202. 7:59ability to recognize or identify the
203. 8:02object by feeling so in this video you
204. 8:04can see i have given the chocolate to
205. 8:06the child
206. 8:07now i am giving the coin
207. 8:09we should give the either pain safety
208. 8:12pin
209. 8:13or
210. 8:14any circular or cube shape structure so
211. 8:18child should be able to
212. 8:20identify the object its shape is texture
213. 8:23everything should be filled by the child
214. 8:25it is labeled as a sterognosis
215. 8:30now for the graphics these are we will
216. 8:32explain to the child to close the eyes
217. 8:34and we will draw
218. 8:37any number or any letter over the palm
219. 8:40and child should recognize the written
220. 8:44later on number over the sk this is
221. 8:47graphisia
222. 8:50so this is all about the sensory system
223. 8:52examination
224. 8:54in next video i will cover the
225. 8:56cerebellar function assessment thank you
226. 8:58so much