NBCOT Occupational Therapy Certification Practice Exam

The best administration method when testing two-point discrimination in a patient with a median nerve injury is to apply the stimuli beginning at the little finger and progress toward the thumb. This approach is effective because, following a median nerve injury, there may be more significant sensory deficits in the areas innervated by that nerve, particularly in the thumb and the radial side of the hand. By starting at the little finger, which is usually less affected, the clinician can establish a baseline of tactile sensation and gradually work towards the more critical area of the thumb, where the impact of the injury is typically greater.

Testing in this manner also helps to identify the point at which the patient begins to feel the two-point stimuli, which is essential for assessing sensory recovery and function. Establishing the threshold starting from the less affected area allows for a clearer understanding of the patient's sensory capabilities, making it easier to chart progress in their rehabilitation.

The other methods such as starting with the thumb, presenting stimuli in an organized pattern, or allowing unlimited time to respond do not align with the most effective and clinical practice for assessing two-point discrimination in this specific context, since they may not accurately capture the patient's sensory deficits or can introduce biases or variability in the testing process.