The baresthesia is a medical term used to describe the ability of the human being to distinguish between different degrees of pressure exerted on various points of the body. Sensitivity can be divided into superficial, deep and mixed or discriminative. Baresthesia or sensation of the perception of pressure falls within the classification of deep sensitivity.
During a neurological exploration examination, in which the deep sensitivity is evaluated, specifically the baresthesia, the patient will be able to say which point of those that was pressed had greater or less intensity.
If the patient's ability to determine where he had the greatest pressure intensity is impaired, or the patient simply does not perceive the pressure stimulus, the individual is said to have abaresthesia.
This type of injury is common when there is any injury at the level of the parietal cortex. Although it is also possible if there is alteration of the receptors that send the nerve impulse of pressure in a certain place, or of a specific nerve, among other factors that prevent this information from reaching the brain.
The receptors in charge of perceiving the stimulus of the pressure of minimum intensity are the Pacini corpuscles and to a lesser extent the Golgi corpuscles..
Whereas, the Golgi corpuscles are more specialized to perceive strong pressures and to a lesser extent the Pacini corpuscles.
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If we break down the term baresthesia, we have to "báros" from the Greek (βάρος) means pressure and (aisthesis) means sensitivity and the ending (ia) means quality. Therefore, it can be said then that baresthesia is the quality of feeling pressure.
For the baresthesia assessment test, as well as for all tests that comprise the neurological examination, a calm and quiet environment is required. This ensures proper concentration of the patient and examiner.
It is also necessary that the patient is relaxed and collaborative. On the other hand, the examiner or specialist must inspire a lot of confidence, since the test requires that the patient has the eyes covered.
The specialist will explain in detail to the patient the dynamics of the test. Likewise, it is important to indicate the objective of the test and the appropriate way in which you must answer the questions. Clear and precise answers will be requested.
At no time will the specialist suggest any kind of response to the patient. This should be spontaneous at all times. If this is not met the test is not reliable.
The patient must be comfortably seated to perform the test. The examiner will exert pressure with varying intensity on different places on the patient's body, such as the arms, legs or the trunk. Specifically, emphasis is placed on the upper trapezius, biceps brachii, or calf muscles..
An attempt will be made to choose sites on the right and left sides and it will be observed if there is a difference in responses, when applying the same intensity of pressure to both sides of the body. If this property is not affected, the patient will have no difficulty feeling where pressure is being applied..
The test is performed with great care, avoiding causing pain or harm to the patient.
It should be noted that there are patients who may have polyneuropathies and a simple pressure on a muscle can be a very painful experience. To exert pressure, the fingertip of the examiner can be used, specifically the use of the index finger is recommended..
The patient is questioned to find out at what point he felt the most pressure. The results are recorded.
Another way of performing this test is using the cuff of the blood pressure measuring instrument, called a tensiometer, sphygmomanometer or baumanometer..
The cuff is placed and raised to a certain degree, then the pressure is increased or decreased and the patient is asked if he is now more or less pressed than before.
On the other hand, when the specialist needs it, he will perform a more delicate exploration of the baresthesia, for this he will use a kind of metal discs of different weights or the Eulenburg bartesiometer..
These metal discs of known weights serve to generate pressure on the patient's skin. If you do not have the metal discs, you can use coins of different sizes.
The specialist will place a stack of these discs or coins on the patient in different places.
A special instrument, called a Eulenburg baresthesiometer, can also be used..
This instrument is much more precise, as it allows its use in small areas of skin, applying pressure with a fairly fine blunt tip. This device allows evaluating areas of skin where it would be impossible to place a pile of coins in perfect balance.
The instrument consists of a column that ends in a blunt point and pressing the point against the skin flattens a spring that it carries. It has a graduated scale with a needle that indicates the degree of pressure exerted.
It is based on the following: the patient with a certain sensory alteration will not feel the tip when it is simply placed on the skin, therefore, the specialist begins to generate pressure slowly but progressively, while the instrument indicates how much pressure has gone exercising.
The measurement is obtained when the patient indicates to feel the contact stimulus. It should be noted that this experience is compared with that obtained with a normal subject, this is how the decrease in the sensitivity to contact of the patient can be testified.
The patient should be able to recognize the pressure change if their baresthesia is intact.
In pathologies that present with injury to the parietal cortex, it is common to observe that there is deterioration of tactile sensations, which includes baresthesia along with other alterations, such as: tactile agnosia, pain asymmetry, tingling sensation or hypoesthesia, among others.
The medical conditions that can produce this type of injury and, therefore, present somatosensory alterations are: cerebrovascular accident, Guillain Barré syndrome or hemiplegia, among others.
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