What is the recommended method for charting sensation in an arm?

Standardized Method for Charting Sensation in the Arm

The recommended method for charting sensation in an arm is to use the Fugl-Meyer Assessment (FM) sensory component, which evaluates light touch and proprioception in a standardized manner across specific arm locations. 1

Recommended Assessment Protocol

Patient Positioning

• Patient should be seated comfortably with arm supported
• Ensure proper lighting and minimal distractions in the examination room
• Position the arm in a neutral position on a supporting surface 1

Sensory Assessment Components

1. Light Touch Assessment

   • Test at specific standardized locations:
     • Upper arm (biceps and triceps areas)
     • Forearm (volar and dorsal aspects)
     • Hand (palm and dorsum)
     • Fingers (index and fifth finger)
   • Use consistent pressure with standardized stimulus (cotton swab/monofilament)
   • Document responses as:
     • 0 = Anesthesia (absent sensation)
     • 1 = Hypoesthesia or dysesthesia (impaired sensation)
     • 2 = Normal sensation 1, 2

2. Proprioception Assessment

   • Test at major joints:
     • Shoulder
     • Elbow
     • Wrist
     • Thumb
     • Index finger
   • Move joint slightly up and down with patient's eyes closed
   • Document responses as:
     • 0 = No sensation
     • 1 = Impaired sensation (can detect movement but not direction)
     • 2 = Normal sensation (correctly identifies direction) 1, 2

3. Optional Additional Assessments

   • Temperature sensation (warm/cold)
   • Sharp/dull discrimination
   • Two-point discrimination (if available)
   • Stereognosis (object recognition by touch) 2

Documentation Format

Create a standardized chart with the following format:

Arm Sensation Assessment
Date/Time: [Date]
Examiner: [Name]

Light Touch Sensation:
- Upper arm: [0/1/2]
- Forearm: [0/1/2]
- Hand: [0/1/2]
- Fingers: [0/1/2]

Proprioception:
- Shoulder: [0/1/2]
- Elbow: [0/1/2]
- Wrist: [0/1/2]
- Thumb: [0/1/2]
- Index finger: [0/1/2]

Additional Notes: [Document any asymmetry, areas of altered sensation, or patient reports]

Clinical Pearls and Pitfalls

• Consistency is key: Use the same testing protocol and scoring system for all assessments to enable meaningful comparison over time 1
• Avoid leading questions: Ask "Do you feel this?" rather than "Can you feel this?"
• Compare sides: Always compare findings with the unaffected arm to establish baseline sensitivity
• Document timing: For stroke patients, document time since stroke onset as this affects interpretation 1
• Consider positioning: Improper arm positioning can affect sensation assessment results 1
• Avoid observer bias: When possible, have the same examiner perform serial assessments 2

Special Considerations

• For patients with communication difficulties, establish a reliable non-verbal communication method before testing
• For patients with cognitive impairments, simplify instructions and verify understanding
• For patients with severe sensory loss, consider using the Perceptual Threshold Test with electrical stimulation as an alternative assessment method 3
• When monitoring recovery (especially post-stroke), include assessment at standardized time points (acute, 3 months, 6 months) 1

By following this standardized approach to sensory assessment and documentation, you'll ensure consistent, reliable measurements that can be effectively used to track changes in arm sensation over time and guide clinical decision-making.