Neurotips and orange sticks
While there are lots of different acceptable ways to examine for pinprick sensation, the use of a neurotip is the gold standard. They are cheap and easily available, and disposable. Students should not leave Imperial saying "we have never seen or used a neurotip". A broken wooden orange stick or even a toothpick will do fine as an alternative for 'pinprick' sensation. The use of anything non-disposable is NOT ACCEPTABLE.
Similarly there are lots of items one can use to scratch the foot and observe the movement of the toe in response. An orange stick (made of the wood from an orange tree, hence the name), which is NOT sharp (so not a toothpick)) is the gold standard. The stimulus is not unpleasant if done properly, and one can easily observe the Babinski response using this. Many teachers use the 'wrong' (pointed) end of a patella hammer to scratch the foot with. Some neurologists say this is unacceptable. I have also seen other neurologists using a key. Either is certainly not very hygienic, although the skin is not breached (unless one has a very aggressive student).
Imperial students should not leave Imperial saying "we have never used or seen an orange stick".
Neurotips are meant to be disposable. The neurotips have a plastic cover which you can remove, as shown below. They are not sharp enough to draw blood. You should NEVER use a needle, which will cause bleeding and discomfort. Once used, a neurotip should be discarded, and never used on a different patient.
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