A PILOT STUDY A B S TR A C T OF A STU D Y TO M EASURE THE POSSIBLE DIFFERENCES IN THE PERCEPTIO N OF PAIN A N D TE M P E R A TU R E IN HEM IPLEG IC PATIENTS ■ H ale LA, M Sc (Physio), Physiotherapy D epartm ent, U niversity o f W itw atersrand INTRODUCTION The peripheral sen sation s of p ain and tem perature are so closely linked anatom ically that often only one is assessed during the physiotherapy exam ination o f a neurologically im paired pa­ tient. The assum ption is m ade that they w ould either both be affected or both be norm al. U sually pain perception is evaluated as it is the quicker and easier o f the two tests. H ow ever, could it b e possible that pain sen sibility b e norm al, yet tem perature ab­ norm al? This scenario could have dire consequences for the p a­ tient, as the therapist w ould neglect to w arn the patient or his/her care giver o f the possibility o f b u rn in g them selves, for instance, w hen clim bing into too hot a bath, or sitting too close to a heater. A pilot stud y investigated the validity o f this assum ption in subjects having sustained a cerebral vascu lar accident (CVA). PROCEDURE The pain and tem perature perceptions o f tw enty-tw o acute (less than three m onths prior) CV A patients w ere assessed. Pain w as assessed using the pin prick m ethod, and tem perature, using hot and cold test-tubes on b o th sides o f the bod y in thirteen delphia: W B Saunders 1987:168-181. 2. Shinar G, Gross C R, M ohn J P et al. Inter-observer variability in the assessment of neurological history and exam ination in the Stroke Data Bank. A rch N eurol 1085:42;557-565. 3. Tomasello F, M ariani F , Fieschi C et al. A ssessm ent of inter-observer differences in the Italian m ulticentre study of reversible cerebral ischae- mia. Stroke 1982:12;32-33. 4. Samuelsson M , Samuelsson L, Lindell D. Sensory sym p tom s and signs and results of quantitative sensory therm al testing in patients with lacunar infarct syndrom es. S troke 1994:25(11);2165-2170. ■ (This research has gained the approval o f the Committee for Research on Human Subjects, University o f the Witwatersrand. Ref. No. = M 940610). PHYSICAL THERAPY 1996 APTA ANNUAL CONFERENCE A scientific m eeting and exposition to b e held at the M innea­ polis C onvention C entre, M innesota on Ju n e 14-18, 1996. APTA is honouring its 75 year history and the new look congress will reflect physical therapy's role in health care into the n ext m illen­ nium. Short courses, Instru ctional cou rses and Sym p o siu m w ill be offered w hich w ill cover topics relevant to p hysical therapists including negotiation and conflict resolution fo r health care, in­ corporating w ellness into physiotherapy, chronic pain, cancer assessm ent and cu m ulative traum a. Sym posia include geriatrics, clinical reasoning, soft tissue injury and card iop u lm o nary ther­ apy. There w ill also be interdiscip linary research sym posia, ab­ stract presentations and case conferences. T h e prestigious M ary M cM illan lecture featu res Bella J M ay, a clinical practitioner, educator, author and research er w ho will explore decision m aking in p h y s io th e ra p y fro m th e p ro fe s s io n 's b e g in ­ nings in 1921. T o r e g is te r b y te le ­ phone, call A P T A 's Serv­ ice C entre at 1-800/999- A P T A , e x t 3 3 9 5 . H av e y o u r M a s t e r C a r d o f V ISA cred it card num ber h a n d y . T D D u s e r s : 703/683-6748. To register __ _ _ b y m ail, send your com - o f w hen it did o c c u i. P erhaps it is incum bent on physiotherapists Jpleted registration form w ith cred it card nu m ber and cheque to w arn all their clients o f the possibility and consequences o f a m ade payable to A PTA to: APTA , Physical T h erap y '9 6 R egistra- loss o f tem peratu re sen s a tio n ,e v e n -if-p a in perception appears /tion, 1111 N orth Fairfax Street, A lexand ria, V irginia 22314-1488. norm al. / To register by fax, send your registration form w ith cred it card num ber to 703/706-3396, Attn: Physical T herapy '9 6 Registration. To register via the Internet, send registration and cred it card 1. Guyton A C. B asic N eitrosciences: A n atom y an d P hysiology. 1st Ed. Phila- inform ation to: SV C C T R @ A P T A .O R G . 2 3different areas ' . RESULTS There w ere fifteen fem ale and seven m ale subjects tested, nine o f w h om had rig h t C V A 's, w hile thirteen had sustained left C V A 's. E ight o f the subjects had norm al sensation, and ten had b oth pain and tem perature decreased. Four o f the subjects (all left C V A 's) reported a norm al perception to pain, b u t this w as de­ creased as com pared to tem perature, especially to heat. DISCUSSION The results w ere in keeping w ith those o f Sam uelsson et aft. H ow ever, the stud y requires m ore strin g en t inclusion criteria, for exam ple a sm aller age range as the appreciation o f sensation may decrease w ith age, and a larger sam ple in order to determ ine the difference b etw een left and right C V A 's. O nly m iddle cerebral artery territory strokes should be included. U nfortunately the nature o f the assessm ent o f sen sation requires that the subject be able to understand the test and be able to com m unicate their reply, thus aphasic subjects, b o th receptive and expressive w ould have to be excluded. Follow -up studies m ay have to be included, as sensation perception m ay im prove w ith time follow ing a CVA . CONCLUSION A lthough there w as not conclusive evidence these tw o sensa­ tions m ay b e affected d ifferently b y a C V A . there w ere exam ples Physical Tlierapy '9G A P T A S c i e n t i f i c M e e tin g & E x p o s itio n REFERENCES B la d s y 3 2 M e i 1996 SA T y d s k rif F is io te ra p ie , D e e l 5 2 N o 2 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) mailto:SVCCTR@APTA.ORG