Light touch: with the patient’s eyes closed, touch lightly with a cotton wisp or fingertip distal to proximal, comparing sides and mapping any level of change.
Monofilament: with the patient’s eyes closed, apply the 10-gram monofilament perpendicular to the skin until it buckles, holding about one to two seconds, at standard plantar sites; record the sites felt and not felt.
Proprioception: hold the sides of the great toe or finger and move it up or down a few degrees with the patient’s eyes closed; ask the direction.
Temperature and pain: where indicated, use warm and cool objects or a sharp and dull stimulus with the patient’s eyes closed, comparing areas; never use a stimulus that breaks the skin.
Map deficits to a distribution — stocking-glove, dermatomal, focal nerve, or below a spinal level — and compare to the prior visit.
Inspect the skin carefully in every area of reduced sensation for unnoticed injury.
Correlate sensory findings with gait, balance, and the patient’s ability to detect hazards.
For any sudden sensory loss, especially with weakness or other deficits, stop and apply the neurologic emergency pathway.
