Sensory System Examination The detailed sensory system examination is a difficult and time-consuming evaluation and is rarely tested during the examination. In the event that you need to perform the sensory exam (e.g., child with sensory symptoms, spinal cord injury, or peripheral nerve disorder) unexpectedly, the following section will help you cover the basics. Sensory examination includes testing of the spinothalamic tract (pain, light touch, and temperature), posterior column (position sense or proprioception, and vibration), and cortical senses (stereognosia, graphesthesia, and extinction). The nerve fibers carrying pain and temperature impulses enter the spinal cord and after a few higher segments cross the opposite spinothalamic tract and ascend to the brainstem. Children should be sufficiently undressed but draped to preserve modesty. The initial evaluation of the sensory system is carried out with the child lying on his back and eyes closed.• General principles Always test the sensation in a dermatomal distribution, from proximal to distal, comparing the right area with the corresponding area on the left. Switch between the reduced sensitivity area and the normal or increased sensitivity area. Map the distribution of sensory loss and decide on the pattern of loss, which may conform to a region (due to spinal cord or upper brain stem injury), a dermatome (due to spinal cord or nerve root injury ), a peripheral nerve, or a model of peripheral neuropathy with involvement of multiple nerves (distribution via gloves and stockings).o Often, in cases of spinal lesions, a level of increased sensitivity above the sensory level may occur, which usually indicates the most affected spinal segment.o Since the spinal column is longer than the spinal cord in older children, the spinal cord if...... middle of paper...... meninges lead to greater resistance to passive flexion of the neck and extended leg. This can be identified clinically by highlighting neck stiffness and Kernig's sign. • Neck stiffness: with the child lying on his back in the cot, slide a hand under the occiput and gently flex the neck passively. In the presence of meningeal irritation, resistance to neck flexion is found due to spasm of the neck extensor muscles. Normally the chin can be brought up to the chest wall. • Kernig's sign: ask the child to lie down on the sofa with both legs extended. Flex your hip and knee to 90 degrees to one side, then attempt to straighten your knee while keeping your hip flexed. The Kernig test is positive when painful spasm of the hamstrings limits knee extension and sometimes the child will flex the head to avoid stretching of the meninges.