SOMATIC SENSATIONS: Tactile (touch, pressure, tickle & itch, vibration, stereognosis) & proprioception (position & movement)

SENSORY UNIT:

A sensory nerve fiber & all its peripheral branches sensory unit. Receptive field of a sensory unit is the area of skin from which impulses are carried by a single sensory unit. Extent of receptive fields of sensory units is variable. Receptive fields of adjacent sensory units overlap. In cornea & sclera, receptive field of a sensory unit is 50 200 mm2.

SENSATIONS:
2 TYPES: SOMATIC SPECIAL SOMATIC SENSATIONS: Mechanoreceptive: Tactile: (touch, pressure, tickle & itch, vibration) & position & movement / proprioception. Thermal Pain

TACTILE SENSATION:
Include: Touch Pressure Tickle & itch vibration

Receptors involved in tactile sensation:

Free nerve endings Merkels discs Hair follicle receptors Meissners corpuscles Krauses corpuscles Pacinian corpuscles Ruffinis end organs

3 types of nerve fibers carry impulses of tactile sensation:

A beta: 30-70 m/sec (myelinated) A delta: 5-30 m/sec (myelinated) C fibers: 0.5-2 m/sec (unmyelinated & slowest)

TOUCH & PRESSURE SENSATION:

A touch stimulus slight indentation of receptor membrane. (fine touch test by cotton wool / pencil tip) Pressure stimulus deformation of deeper tissues. Sensitivity to touch varies in different parts of body & depends upon number of tactile receptors present. Most sensitive parts: tip of tongue, lips, finger tips, then hands, forearm, arm. Least sensitive to touch is back.

In touch sensation, one component is 2 point tactile discrimination. Ability to discriminate 2 very near pointed ends. Minimum seperable distance for it is 1-3 mm (on tip of tongue & finger tips). On the back, the distance is 20-50 mm. Tested by divider or esthesiometer (it consists of metallic handle to which metallic hair of variable thickness can be attached, we start from thickest hair for crude touch & go to finest hair for fine touch). Touch localization (Topognosis) is highly developed (even at the back of body).

OSPE: 2 point Tactile discrimination: Q.a. Test the sense of Two-point tactile discrimination on the big toe of the given subject. 04 b. Minimal separable distance decreases in presence of which 2 factors? 01

Key:
a.

The student introduces himself, briefs the subject & seeks consent.

0.5

Asks the subject to lie down comfortably on a couch & remove the socks from both feet. 0.5 Demonstrates the subject by separating apart (more than 3 mm) 2 blunt ends of Webers compass or a blunt divider and touching to the skin of subjects finger tips simultaneously, with his eyes open, & asking the subject to tell whether he was touched at two points simultaneously or just at one point. 01 Then asks the subject to close his eyes & places the 2 blunt ends of the compass approximated ( less than 1 mm) on the tip of the plantar aspect of his right big toe & asks the subject to tell that he has felt the touch at one point or at 2 points. 01

If the subject does not identify 2 separate points being touched simultaneously, then gradually increases the distance until 2 separate points are identified & measures that distance (normally 1-3 mm) & compares on the other side. 01 b. i) Increased number of receptors present in some area of skin and ii) Bigger representation of that area in sensory cortex of brain. 01

Qa. Test the sense of Topognosis (Tactile Localization) & Extinction in the forearm of the given subject. 04 b. i) Which term is given to the absence of this ability and ii) The lesion of which tract may result in it? 01

The student introduces himself, briefs about the procedure & seeks consent. 01 Asks the subject to sit down comfortably on a chair with eyes closed & exposes both forearms. 01 To test Topognosis (Tactile localization) touches one point at a time on the patients skin of a forearm with the finger tip and asks the subject to open his eyes & point the place where he perceived the touch. 01 To test Extinction, touches simultaneously with the tips of both the index fingers with subjects eyes closed at 2 identical points on the skin of both the forearms gently with a finger tip & asks him to open his eyes & tell where he was touched. 0.5 Tells the subject to tell here or here & here. 0.5 b. i) Topagnosia ii) Lesion of Dorsal Column Medial Lemniscal System. 01

Key a.

In touch sensation, a special sensation is STEREOGNOSIS (ability to identify the object with eyes closed through judgment based on: its shape, size, weight & texture by touch sensation, holding a small object in the palm of one hand). It is highly developed in blind (brail system). This is an adaptation.

OSPE: Sense of stereognosis:

Q.a. Test the sense of Stereognosis in the given subject. 04 b. Which term is given to the absence of this ability and the lesion of which tract may result in it? 01

Key.a.
The student introduces himself, briefs about the procedure & seeks consent. 01 Asks the subject to sit down comfortably on a chair with his eyes closed. 01 Asks the subject to identify a small object placed in his right palm. 01 Compares it in the left palm by placing another small but different object 01 b. Astereognosis Lesion of Dorsal Column Medial Lemniscal System. 01

TICKLE & ITCH SENSATION:

TICKLE Pleasure ITCH Annoying Tickle & itch: A light, local, mechanical stimulation (insect crawling on skin). These may be due to chemicals like histamine. Itching occurs on skin & certain mucus membranes (like that of eye). In conjunctiva, there is irritation. Receptors involved are free nerve endings called C-Mechanoreceptors. Impulses from these receptors are carried by C type of nerve fibers & are slowest conducting & unmyelinated.

Itching scratch reflex relieve itching in 2 ways: By scratching irritant is removed (like insect). Severe scratching pain is produced Pain impulses inhibit itch impulses (distraction). Impulses for tickle & itch are carried by Ventral Spinothalamic Tract (crude tract for crude sensations).

VIBRATION SENSE:

Rhythmic repetitive pressure stimuli are perceived as vibration. When vibrating tuning fork is placed on skin, specially over bones thrill / buzzing sensation perceived. Receptors involved: Meissners (low frequency: 60-80 cycles / sec ) & Pacinian corpuscles (high frequency: 80 600 cycles / sec ). May be Merkels discs. Carried by Dorsal Column Tract.

Qa. Test the sense of vibration in the ankle of the given subject. 04 b. In which physiological condition there may be loss of vibration sense in feet? 01

Key: a.

The student introduces himself & seeks consent. 0.5 Asks the subject to lie down supine on the couch & remove the socks from both feet. 0.5 Demonstrates the test by vibrating a lower frequency (100 Hz) tuning fork and pressing its base over the patient's forehead, then repeating without the vibration, with his eyes open. 0.5 Teaches the subject to say yes, when he receives vibration and say yes, once again when he ceases to feel them. 0.5 Strikes the tuning fork (100 Hz) on a rubber pad / firm object & places the base of the vibrating tuning fork on the medial melleolus, with the subjects eyes closed & compares it with the medial melleolus of the other side. 01 Also places the base of the vibrating tuning fork on the lateral melleolus & compares it with the lateral melleolus of the other side. 01 01

b. In old age there may be loss of vibration sense in feet.

OSPE: Sense of Graphesthesia:

Qa. Test the sense of Graphesthesia in the given subject. 04 b. Which term is given to the absence of this ability and the lesion of which tract may result in it? 01

Key.a.
The student introduces himself, briefs about the procedure & seeks consent. 01 Asks the subject to sit down comfortably on a chair with his eyes closed. 01 Asks the subject to identify with eyes closed, the number (0-9) drawn on his right palm, by dragging gently the rubber-tail of a pencil. 01 Compares it in the left palm by similarly drawing a different number (0-9). 01 b. Graphanesthesia, Lesion of Dorsal Column Medial Lemniscal System. 01

PROPRIOCEPTION: Sense of position & movement.

2 types: STATIC KINESTHETIC STATIC: Conscious perception of orientation of different parts of body with respect to each other. KINESTHETIC: Conscious perception of rate of movement of different parts of body.

Receptors involved are proprioceptors (Muscle spindles, Golgi tendon organs, Ruffinis end organs & Pacinian corpuscles). These receptors are present around the joints (in the muscle, tendon, joint capsule & ligaments). Dorsal Column tract carries impulses of proprioception.

OSPE: Sense of proprioception

Qa. Test the sense of proprioception in the foot of the given subject. 04 b. What are the common locations of the receptors that carry this sensation. 01

Key: a.

The student introduces himself & seeks consent. 0.5 Asks the subject to lie down supine on the couch & remove the socks from both feet. 0.5 Demonstrates the subject, with his eyes open, the upward & downward position of the big toe first, by holding the big toe at interphalangeal joint with the help of index finger & thumb, while keeping the rest of the toes apart with the other hand. 01 Then asks the subject to close his eyes & places the great toe pointing upwards or downwards & asks the subject to tell up or down. 01 Repeats the same in the other foot. 01 01

b. In tendons, joints & ligaments.