Combined Cortical Sensations

COMBINED CORTICAL
SENSATIONS
STEREOGNOSIS PERCEPTION
 This test determines the ability to recognize the form ofobjects by touch (stereognosis). A
variety of small, easily obtainable, and culturally familiar objects of differing size and
shape are required (e.g., keys, coins, combs, safety pins, pencils, and so forth).
 A single object is placed in the hand, the patient manipulates the object, and then
identifies the item verbally. The patient should be allowed to handle several sample test
items during the explanation and demonstration of the procedure.
 Response: The patient is asked to name the object verbally. For patients with speech
impairments, sensory testing shields can be used (Fig. 3.12). Alternatively, the item
manipulated can be identified from a group of images presented after each test.
STEREOGNOSIS PERCEPTION
 Figure 3.12 A sensory testing shield

can be used for examining
stereognosis in the presence of speech
or language impairments. In this
simulation, the subject manipulates
the object without the use of visual
input. Following manipulation, the
subject points to the matching object
pictured on the ledge of the testing
shield.
TACTILE LOCALIZATION
 This test determines the ability to localize touch sensation on the skin (topognosis). The
patient is asked to identify the specific point of application of a touch stimulus (e.g., tip of
ring finger, lateral malleus, and so forth) and not simply the perception of being touched.
 Tactile localization is typically not tested in isolation and frequently examined in
combination with similar tests such as pressure perception or touch awareness. Using a
cotton swap or fingertip, the therapist touches different skin surfaces. After each
application of a stimulus the patient is given time to respond.
 Response The patient is asked to identify the location of the stimuli by pointing to the
area or by verbal description. The patient’s eyes may be open during the response
component of this test. The distance between the application of the stimulus and the site
indicated by the patient can be measured and recorded. Accuracy of localization over
various parts of the body may be compared to determine the relative sensitivity of
different areas.
TACTILE LOCALIZATION
TWO-POINT DISCRIMINATION
 This test determines the ability to perceive two points applied to the skin simultaneously.
It is a measure of the smallest distance between two stimuli (applied simultaneously and
with equal pressure) that can still be perceived as two distinct stimuli. Two-point
discrimination values vary for different individuals and body parts. As this sensory function
is most refined in the distal upper extremities, this is the typical site for testing. It is
believed to contribute to precision grip movements and instrumental activities of daily
living (IADL).
 Response
 The patient is asked to identify the perception of “one”or “two” stimuli.
TWO-POINT DISCRIMINATION
DOUBLE SIMULTANEOUS STIMULATION
 This test determines the ability to perceive simultaneous touch stimuli (double
simultaneous stimulation [DSS]). The therapist simultaneously (and with equal pressure)
touches: (1) identical locations on opposite sides of the body, (2) proximally and distally on
opposite sides of the body, and/or (3) proximal and distal locations on the same side of the
body. The term extinction phenomenon is used to describe a situation in which only the
proximal stimulus is perceived, with “extinction” of the distal.
 Response
 The patient verbally states when he or she perceives a touch stimulus and the number of
stimuli felt. Several additional tests for the combined (cortical) sensations include
graphesthesia (traced finger identification), recognition of texture, and barognosis
(recognition of weight). However, these tests are usually not performed if stereognosis
and two-point discrimination are found to be intact.
DOUBLE SIMULTANEOUS STIMULATION
GRAPHESTHESIA (TRACED FIGURE
IDENTIFICATION)
 This test determines the ability to recognize letters, numbers, or designs “written” on the
skin. Using a fingertip or the eraser end of a pencil, a series of letters, numbers, or shapes
is traced on the palm of the patient’s hand. During the practice trial, agreement should be
reached about the orientation of the tracings. (For example, the bottom of the traced
figures will always be oriented toward the base of the patient’s hand [wrist].) Between
each separate drawing the palm should be gently wiped with a soft cloth to clearly
indicate a change in figures to the patient. This test is also a useful substitute for
stereognosis when paralysis prevents grasping an object.
 Response
 The patient is asked to identify verbally the figures drawn on the skin. For patients with
speech or language impairments, the figures can be selected (pointed to) from a series of
line drawings.
GRAPHESTHESIA (TRACED FIGURE
IDENTIFICATION)
RECOGNITION OF TEXTURE
 This test determines the ability to differentiate among various textures. Suitable
textures may include cotton, wool, burlap, or silk. The items are placed
individually in the patient’s hand. The patient is allowed to manipulate the sample
texture.
 Response
 The patient is asked to identify the individual textures as they are placed in the
hand. They may be identified by name (e.g., silk, cotton) or by texture (e.g., rough,
smooth).
BAROGNOSIS (RECOGNITION OF WEIGHT)
 This test determines the ability to recognize different weights. A set of discrimination
weights consisting of small objects of the same size and shape but of graduated weight is
used (Fig. 3.13). The therapist may choose to place a series of different weights in the
same hand one at a time, place a different weight in each hand simultaneously, or ask the
patient to use a fingertip grip to pick up each weight.
 Response
 The patient is asked to identify the comparative weight of objects in a series (i.e., to
compare the relative weight of the object with the previous one); or when the objects are
placed (or picked up) in both hands simultaneously the patient is asked to compare the
weight of the two objects. The patient responds by indicating that the object is “heavier”
or “lighter.”
BAROGNOSIS (RECOGNITION OF WEIGHT)
 Figure 3.13
Discrimination
weights are
identical in size,
shape, and texture.
The only
distinguishing
feature is their
variation in weight.

Combined Cortical Sensations

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COMBINED CORTICAL

 Figure 3.12 A sensory testing shield

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