Table 2 Quantitative Sensory Testing Table Left Right Dermatome Heat Heat Heat Average Heat Pain Heat Pain Heat Pain Average Comments: e.g., modality Perceptual Perceptual Perceptual Threshold Threshold Threshold mismatch/paradox Threshold Threshold Threshold (Trial 1) (Trial 2) (Trial 3) (Trial 1) (Trial 2) (Trial 3) TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD Add additional rows as needed MECHANICAL VIBRATION PERCEPTUAL THRESHOLD Frequency of vibration used (include units): N/A Table 3 Frequency of vibration used Left Right Dermatome Vibration Vibration Vibration Average Dermatome (Vibration Vibration Vibration Average Comments: e.g., Perceptual Perceptual Perceptual Perceptual Perceptual Perceptual perception of Threshold Threshold Threshold Threshold Threshold Threshold vibration in remote (Trial 3) dermatomes? (Trial 1) (Trial 2) (Trial 1) (Trial 2) (Trial 3) TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD Add additional rows as needed
Table 2 Quantitative Sensory Testing Table Left Right Dermatome Heat Perceptual Threshold (Trial 1) Heat Perceptual Threshold (Trial 2) Heat Perceptual Threshold (Trial 3) Average Heat Pain Threshold (Trial 1) Heat Pain Threshold (Trial 2) Heat Pain Threshold (Trial 3) Average Comments: e.g., modality mismatch/paradox TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD Add additional rows as needed MECHANICAL VIBRATION PERCEPTUAL THRESHOLD Frequency of vibration used (include units): N/A Table 3 Frequency of vibration used Left Right Dermatome Vibration Perceptual Threshold (Trial 1) Vibration Perceptual Threshold (Trial 2) Vibration Perceptual Threshold (Trial 3) Average Dermatome (Vibration Perceptual Threshold (Trial 1) Vibration Perceptual Threshold (Trial 2) Vibration Perceptual Threshold (Trial 3) Average Comments: e.g., perception of vibration in remote dermatomes? TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD Add additional rows as needed
F1732_Quantitative_Sensory_Testing.docx