Sensory System ExaminationThe detailed sensory system examination is a time-consuming and difficult assessment and is rarely tested on the exam. In case you need to perform the sensory exam (for example in a 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). Nerve fibers carrying pain and temperature impulses enter the spinal cord and pass through the opposite spinothalamic tract after a few upper segments and up to the brainstem. Children must be sufficiently undressed but draped to preserve their modesty. The initial assessment of the sensory system is done with the child lying on their back and eyes closed. • General principles therefore Always test sensation in a dermatomal distribution, proximal to distal, comparing the right area with the corresponding area on the left. Move from an area of ​​reduced sensation to an area of ​​normal or increased sensation. Map the distribution of sensory loss and decide the type of loss, which may conform to a region (due to damage to the spinal cord or upper brainstem), a dermatome (due to damage to the spinal cord or nerve root), a peripheral nerve or a model of peripheral neuropathy. with involvement of multiple nerves (distribution of gloves and stockings).o Often with spinal injuries, an increased level of sensitivity may occur above the sensory level, which usually indicates the highest spinal segment affected.o Because the spine is longer than the spinal cord in older children, the spinal cord...... middle of paper...... the meninges results in increased resistance to passive flexion neck and extended leg. This can be identified clinically by detecting neck stiffness and Kernig's sign. • Neck stiffness: With the child lying on his or her back in bed, slide one hand under the occiput and gently flex the neck passively. In the presence of meningeal irritation, there is resistance to neck flexion due to spasm of the neck extensor muscles. Normally, the chin can be pulled up to the chest wall.• Kernig's sign: Ask the child to lie flat on the sofa with both legs straight. Bend the hip and knee 90º to one side, then try to straighten the knee while keeping the hip flexed. The Kernig test is positive when a painful spasm of the hamstrings limits knee extension and sometimes the child flexes the head to avoid stretching of the meninges..