Course 2 - Sensory & Co-ordinating Structures

2. Sensory and Co-ordinating Structures
Course-specific learning outcomes + references

After this course, you should make sure that you can:

• List and describe the major structures involved in sensation and co-ordination
• Outline the principal properties, relations and functional interactions of these structures
• Assess the status of relevant peripheral and central nervous structures involved in
co-ordination and sensation, via case history observation and appropriate testing
• Demonstrate key psychomotor skills relevant to your examination of the above
• Apply the above to a novel theoretical clinical situation, testing hypotheses generated

• Explicitly analyse your diagnostic process, reflecting on its strengths and weaknesses
• Evaluate the bearing of these processes on your subsequent healthcare

NB the above may be the subject of formative or summative assessment, in line with your prevailing professional body's guideliness

References

Visit as many of the references shown below as possible prior to your course. These are drawn from a variety of texts and take a range of forms (pictorial, textual and tabular). Our intention is to provide you with an assortment of information sources that you can choose from - and that you can match to your own learning style.

The structures involved: central and peripheral: Ref 1 pp 360-377

Movement disorders: detection, terminology and underlying causes: Ref 1 pp 356-358;
Ref 8 pp 183-191

Tests of co-ordination: hands-on assessment of a patient’s ability to perform smooth, controlled movement of various bodily regions: Ref 8 pp 177-181

Context for sensory examination: Ref 1 pp 363-371

Sensory testing procedure: e.g. Touch (discriminative and non); vibration; pain (deep structures and skin); joint position sense: Ref 7 pp 1347-1351

Sensation: what you find and what it means: Ref 8 pp 171-176

2. Sensory and Co-ordinating Structures
Indicative content – related theory and skills

You'll need to bring your own:

Cotton wool
Clean, unused pins (e.g. Medipin)

Tuning forks – especially 128 Hz. for vibration tests

Paperclips (the reason will be made clear...)

A. TESTING COORDINATION
Indications: loss of dextrous use of part(s) of the body - clumsiness; ‘shakes’
difficulty with walking; altered handwriting

• The structures involved
Central and peripheral receptors, central pathways and decision-makers

• Gait
Related to structural cause e.g. tripping, stamping, steppage, reeling

• Tremor
Postural, resting, intention types. Differentiation: linkage to structures involved

• Other movement disorders
Terminology and underlying causes; e.g. tic, myokymia, choreo-athetosis

• Tests of co-ordination
Gain familiarity with the hands-on assessment of a patient’s ability to perform smooth, controlled movement of various bodily regions

B. TESTING SENSATION
Indications: Alteration of sensation, potential structural change in the nervous system

• How is sensation carried to our consciousness?
Peripheral nerves’ distributions. Dermatomes - standard current maps (e.g. as used at the institute of Neurology, Queen Square, London)
Central pathways and appreciation; abnormal (e.g. referred) sensation

• Altered sensation- terminology
Record / communicate findings accurately and succinctly using accepted terms

• Practical assessment of sensation
Touch (discriminative / non); vibration; pain (deep and skin); joint position sense

• Interpretation of change in sensation
Problem solving: - making sense of sensory examination findings
For example - common peripheral nerve and nerve root injuries; central nervous system damage in the spinal column and within the skull.