The Sensitive Nervous System Chapter IX: Manual Assessment of Nerve Conduction

This is a summary of Chapter IX of “The Sensitive Nervous System” by David Butler. The Value The neurological exam is an excellent way to sample the patient’s nervous system. When looking at the neurological system, we must realize that testing does not reflect a tissue injury alone. It demonstrates the neurological pathway’s response. There is no such thing as a focal lesion in the nervous system. We must also understand that the exam is a very small component of a further comprehensive assessment, providing moderate diagnostic value at best. Sensitivity for a screen like this is inherently poor, meaning this examination cannot rule out nervous system pathology or involvement. Sensory Examination If we are going to walk the neurological walk, we first need to talk the neurological talk. Here are some important definitions. Allodynia: Pain from a non-painful stimulus. Hyperalgesia: Increased response to a painful stimulus. Analgesia: No pain from a painful stimulus. Hyperpathia: Abnormal pain reaction to a repetitive stimulus. Hypoalgesia: Decreased response to a painful stimulus. Hypoesthesia: Decreased sensitivity to a stimulus. Hyperesthesia: Increased sensitivity to a stimulus. Dysesthesia: Unpleasant, but not painful response to a stimulus. First, we will take a look at dermatomes. Now depending on who you talk to, dermatomal levels will be different. Moreover, many people have anatomically variant dermatomes, and often times these can fluctuate throughout the day. There are however, some signature zones that are fairly consistent throughout the literature. There are several different sensations that need to be tested. Make

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