Testing Sensibility, Including Touch-Pressure, Two-point Discrimination, Point Localization, and Vibration

Bell-Krotoski, Judith; Weinstein, Sidney; Weinstein, Curt

doi:10.1016/s0894-1130(12)80292-4

Cited by 251 publications

(173 citation statements)

References 27 publications

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“…A response is given only when the presence and location of a von Frey stimulus is perceived. False positives do occur, but because thresholds are doublechecked their influence is minimized (Bell-Krotoski et al 1993). Two-point discrimination employs a forcedchoice paradigm in which subjects must nominate whether one or two points are perceived.…”

Section: Methodological Considerationsmentioning

confidence: 99%

“…The skin of the hands is highly specialized to detect the spatial and temporal cues that subserve texture and form, particularly the glabrous or hairless skin on the palmar surface. However, cutaneous sensitivity declines with age, a change associated with reduced hand function and an increased risk of injury (Bell-Krotoski 1995). The feedback from sensory receptors in both the glabrous and hairy skin have been shown to play a role in the modulation of fine movement (Caccia et al 1973;Johansson and Westling 1984;Deuschl et al 1995;Macefield and Johansson 1996;McNulty et al 1999), and sensory impairments may exacerbate the decline in fine motor skills with ageing (Potvin et al 1980;Jette et al 1990).…”

Section: Introductionmentioning

confidence: 99%

“…The gold standard for testing cutaneous sensation is calibrated von Frey filaments (Bell-Krotoski 1995;Dannenbaum et al 2002) with which the smallest consciously perceived mechanical skin deformation can be quantified. Age-related changes in sensation are usually investigated at a single site, typically the index fingertip (e.g., Thornbury and Mistretta 1981;Desrosiers et al 1996;Tremblay et al 2005;Murata et al 2010), although the tip of the little finger (Bruce 1980), two to three fingertips (Cole et al 1998;BearLehman et al 2003), or all five fingertips (Kalisch et al 2008;Aoki and Fukuoka 2010), have been compared.…”

Section: Introductionmentioning

confidence: 99%

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Age-related changes in cutaneous sensation in the healthy human hand

Bowden

McNulty

2012

AGE

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Cutaneous sensation deteriorates with age. It is not known if this change is consistent over the entire hand or if sensation is affected by changes in skin mechanics. Cutaneous perceptual thresholds were tested at eight sites in the glabrous skin and two in the hairy skin of both hands in 70 subjects (20-88 years), five male and five female per decade, using calibrated von Frey filaments, two-point discrimination, and texture discrimination. Venous occlusion at the wrist (40±10 mmHg) and moisturizer were used to alter skin mechanics. Cutaneous thresholds increased significantly with age (p<0.001); von Frey thresholds were 0.04 g [0.02-0.07] (median and interquartile range) in the 20s and 0.16 g [0.04-0.4] in the 80s, with differences between hands for older females (p00.044) but not males. The pattern of changes in cutaneous sensation varied according to the site tested with smaller changes on the fingers compared to the palm. Two-point discrimination deteriorated with age (p00.046), but with no interaction between sex, handedness, or changes in skin mechanics. There were no significant differences for texture discrimination. Changes in skin mechanics improved cutaneous thresholds in the oldest males after moisturizing (p00.001) but not otherwise. These results emphasize the complex pattern of age-related deterioration in cutaneous sensation with differences between sexes, the hands, sites on the hand, and the mode of testing. As the index fingertip is not a sensitive indicator of sensory decline, the minimum assessment of age-related changes in cutaneous sensation should include both hands, and sites on the palm.

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Section: Methodological Considerationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Age-related changes in cutaneous sensation in the healthy human hand

Bowden

McNulty

2012

AGE

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“…82 Most studies agree that sensitivity is greater than specificity for the SWMF 82,87,134 -that is, false positives are more common than false negatives. This can be affected by the threshold at which abnormality is defined, 5,7,134 contact time, 141 or other aspects of technique. Clear descriptions of application techniques and decision rules should assist with defining reliability and validity and how it varies in different conditions.…”

Section: Sensory Evaluationmentioning

confidence: 99%

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

MacDermid¹,

Doherty²

2004

J Orthop Sports Phys Ther

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Carpal Tunnel Syndrome (CTS) is a pressure-induced neuropathy that causes sensorimotor disturbances of the median nerve, which impair functional ability. A clear history that elicits relevant personal and work exposures and the nature of symptoms can lead to a high probability of a correct diagnosis. Hand diagrams and diagnostic questionnaires are available to provide structure to this process. A variety of provocative tests have been described and have variable accuracy. The Phalen's wrist flexion and the carpal compression tests have the highest overall accuracy, while Tinel's nerve percussion test is more specific to axonal damage that may occur as a result of moderate to severe CTS. Sensory evaluation of light touch, vibration, or current perception thresholds can detect early sensory changes, whereas 2-point discrimination changes and thenar atrophy indicate loss of nerve fibers occurring with more severe disease. Electrodiagnosis can encompass a variety of tests and is commonly used to assess the presence/severity of neuropathic changes and to preclude alternative diagnoses that overlap with CTS in presentation. The pathophysiologic changes occurring with different stages of nerve compression must be considered when interpreting diagnostic test results and predicting response to physical therapy management.

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“…This issue needs further investigation with a more thorough method and a larger sample to determine the effectiveness of the HH hand in bimanual use. (Callahan 1990, Bell-Krotoski 1993; thus it is sensitive to damage to the receptors and the afferent nerve fibres. It has, however, also been used in clients with CNS impairments such as cerebrovascular accidents and CP (Cooper et al 1993, Dannenbaum and Jones 1993, Robertson and Jones 1994, Gordon and Duff 1999, Winward et al 1999, and is thus used for evaluating lesions in ascending sensory pathways and supraspinal centres involved in the perception of tactile stimuli.…”

Section: Do Sensory Deficits Affect Dexterity and Bimanual Performance?mentioning

confidence: 99%

Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia

Krumlinde‐Sundholm

Eliasson

2002

Develop Med Child Neuro

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Children with hemiplegic cerebral palsy (CP) commonly exhibit tactile sensory deficiencies in their hands in addition to their motor problems. The aim of this study was to compare and evaluate the usefulness of some common tests of tactile sensibility for use with children with hemiplegic CP. Twenty‐five children with hemiplegia aged between 5 and 18 years, and 19 control individuals participated. All children were examined with Semmes‐Weinstein monofilaments, two‐point discrimination (2PD), stereognosis of familiar objects, stereognosis of forms, and functional sensibility. Dexterity, spasticity, and bimanual task performance were also assessed. Results from the different sensory tests deviated greatly. We found three tests to be useful: 2PD of 3mm spacing, which was the most sensitive test, stereognosis of familiar objects, and functional sensibility assessed through the Pick‐up test (comparing performance with and without the influence of vision). Stereognosis of forms and threshold values of touch (Semmes‐Weinstein monofilaments) are seemingly less useful tests for children with CNS impairments. Deficient sensibility was strongly related to dexterity. Aspects concerning the testing methodology are discussed.

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Testing Sensibility, Including Touch-Pressure, Two-point Discrimination, Point Localization, and Vibration

Cited by 251 publications

References 27 publications

Age-related changes in cutaneous sensation in the healthy human hand

Age-related changes in cutaneous sensation in the healthy human hand

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia

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