A 68-year-old woman presents for outpatient physical therapy with an improperly fitted cane. You escort her to the examination room while observing her gait pattern, which is characterized by a slower self-selected walking speed, wide base of support, and increased time spent in double limb support. She has a long-standing history of hypertension (15 years), hypercholesterolemia (10 years), and diabetes (25 years). In addition to reporting several falls in the past 6 months, none of whichresulted in injury serious enough to be hospitalized, the patient describes increasing pain in her lowerextremities that is deep, sharp, and burning, that is symmetrical, and occasionally wakes her up atnight. The patient lives alone in a one-bedroom apartment in a building with an elevator and levelentrance to the lobby.
1. Of all the senses, which one is most often affected by the patient’s medical conditions and how
would you assess it?
2. Given her history of falls, which sensory systems should you examine? Why? How?
3. How would you examine pain sensation and what findings would you expect given the longstanding history of diabetes? Why is it important to examine pain sensation?
4. How would you quantitatively measure touch awareness (touch-evoked potentials) in this patient?
5. The test findings indicate mild loss of proprioception and vibration in the lower extremities (distal more than proximal). What receptors are responsible for these sensory modalities? Where are thereceptors located? Identify the ascending pathway that mediates proprioception and vibration.