A complete peripheral sensory assessment addresses each of the following each visit, scaled to the patient’s condition and orders, and compares each finding to baseline.
Light touch — distal-to-proximal in the hands and feet, comparing sides and noting the level at which sensation changes.
Protective sensation — the 10-gram Semmes-Weinstein monofilament at standard plantar sites in any patient with diabetes or known neuropathy.
Proprioception — position sense at the great toe and fingers, and its bearing on balance and falls.
Temperature and pain sensation — the ability to discriminate warm from cool and sharp from dull, where indicated, given the burn and injury risk when absent.
Reported sensory symptoms — numbness, tingling, burning, or a band-like or stocking-glove distribution, and any change from baseline.
Skin in areas of reduced sensation — for unnoticed injury, pressure, or early breakdown (cross-reference Wounds).
The distribution and symmetry of any deficit — stocking-glove versus focal versus a sudden hemibody or below-a-level pattern (the last routes to Neurological).
Footwear, assistive devices, and the home environment as they bear on injury and fall risk in an insensate patient (cross-reference Safety).
The glycemic and medication context where neuropathy is diabetic or drug-related (cross-reference Endocrine/Metabolic).
Functional impact — the effect on gait, balance, and safe handling of objects and hot surfaces.
