Mất cảm giác proprioceptive ở chân và bàn chân có thể xảy ra như là kết quả của một trong hai bệnh tủy sống (ở trên) hoặc bệnh thần kinh ngoại vi (dưới đây). Sự mất cảm giác vị trí vụng về của phong trào chân khi đi bộ | 18 CHAPTER 1 Loss of proprioceptive sense in the legs and feet may occur as a result of either spinal cord disease above or peripheral neuropathy below . The loss of sense of position gives rise to clumsiness of leg movement when walking unsteadiness and the need to watch the feet and floor carefully. There is marked unsteadiness and falling when vision cannot compensate . in the dark in the shower when washing the face when putting clothes over the head. Romberg s sign stance steady with eyes open but unsteady with eyes closed is positive in such patients. CLINICAL SKILLS 19 The patient s response to his symptoms Hopefully the nature of the patient s physical illness causing the left leg malfunction will emerge from the history and examination carried out against this background knowledge of common patterns of neurological failure. Just as important and to be conducted during the same history and examination is an evaluation of the patient s response to the illness. How much is the imperfect function in the left leg bothering him What are the practical consequences of having the problem in his everyday life What does he think is the matter Has he worried about a really serious cause Is he anticipating recovery or further disability In this section we recognize that the total illness in any patient is the sum of the physical illness plus the patient s psychological reaction to the physical illness. The latter may be appropriate and entirely understandable. Sometimes however the reaction is exaggerated for some reason making the whole illness a bigger one for the patient his family and the medical staff looking after him. Recognition of the two elements of illness and the management of both are particularly appropriate in patients with neurological disorders. A physical illness with an appropriate reaction The same physical illness with an exaggerated reaction producing a bigger total illness Patient s reaction Both elements need to be Diagnosed Recognized .
