A new tactile gnosis instrument in sensibility testing

doi:10.1016/S0894-1130(98)80020-3

Journal of Hand Therapy

Volume 11, Issue 4, October–December 1998, Pages 251-257

https://doi.org/10.1016/S0894-1130(98)80020-3 Get rights and content

Abstract

A new quantitative test instrument for the assessment of tactile gnosis—the ability to identify shapes and textures without vision—is introduced. Introductory investigations of validity and reliability are presented. Fifty-four patients (60 hands) with carpal tunnel syndrome, vibration-induced neuropathy, or nerve repair at distal forearm level, and a matched asymptomatic control group were initially examined. After establishing the cut-off limit for normal tactile gnosis, sensitivity and specificity were calculated to determine the discriminative power of the new instrument. A high sensitivity (1.0) of the new shape/texture identification test was found in the group of patients with nerve repair. Given a cut-off limit, the sensitivity was lower in the groups with vibration-induced neuropathy and carpal tunnel syndrome (0.65 and 0.40, respectively), and the specificity of the test was 0.90 to 0.95.

In a second step, a group of 52 patients who had had nerve repair at the distal forearm level were examined. Test-retest reliability was good, with a weighted kappa value of 0.79 to 0.81. Good reliability was also shown in the internal consistency of test items, with a Cronbach alpha value of 0.78. These introductory results indicate that the new shape/texture identification test can be useful in the assessment of tactile gnosis.

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Relationship Between Sensibility Tests and Functional Outcomes in Patients With Traumatic Upper Limb Nerve Injuries: A Systematic Review
2021, Archives of Rehabilitation Research and Clinical Translation
To investigate which tests of hand sensibility correlate with functional outcomes in patients with upper limb traumatic nerve injuries and to assess if composite scales of sensibility correlate with functions.
MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched in May 2020, with a supplementary search in July 2020. Reference lists of the included publications were hand searched.
Database search found 2437 records. Eligible studies reported on inferential association between sensibility tests and functions pertaining to adults after upper limb nerve repair. Two reviewers independently assessed eligibility. Fifteen publications were included.
Extracted data contain patient characteristics, surgical procedure, follow-up duration, sensibility tests, and functional assessments. Two reviewers independently assessed data quality.
Fifteen publications involving 849 patients were reviewed. All publications reported on median and/or ulnar nerve injuries. Monofilament tests correlated with Short-Form Health Survey (r=0.548, P<.05), pick-up test (r=0.45, P<.05), and function domain of Patient-Rated Wrist and Hand Evaluation Questionnaire (PRWHE) (r=0.58, P<.05). The 8 studies of static and moving 2-point discrimination provided conflicting correlations with activities of daily living (ADL) and/or the pick-up test. Data for area localization and object/shape identification were equivocal as well. No data were found for Ten test and vibration tests. Rosén score sensory domain correlated with ADL (r=0.59; 95% confidence interval [CI], 0.41-0.72) and PRWHE function domain (r=−0.56, P<.05). Medical Research Council sensory scale was related to pick-up test; return to work status; and Disabilities of the Arm, Shoulder, and Hand questionnaire.
Monofilament tests allow practitioners to gather sensibility data meaningful to patients’ overall recovery of functions after upper limb nerve trauma. For 2-point discrimination and other sensibility tests, practitioners should be aware that improvement in test performance does not necessarily translate to improved hand function. Findings from the composite scales indicate that hand sensibility, in general, is related to functions. Future research on other common sensibility tests is recommended to explore how the test relates to patients’ functions.
The sensory function of the uninjured nerve in patients after median and ulnar nerve injury
2017, Journal of Hand Therapy
A retrospective cohort study.
Some patients after median or ulnar nerve injury report a diminished sensibility in the fingers that are supplied by the uninjured nerve.
The purpose of this study was to evaluate the function of the uninjured nerve in patients after peripheral nerve injury to assess the presence and degree of its functional impairment.
There were 28 patients with median and 29 patients with ulnar nerve injury examined for sensory disturbances in the injured and uninjured nerves, using several tests assessing touch, temperature, and vibration sensibility.
In 16 patients after ulnar and 13 patients after median nerve injury, some disturbances in the uninjured nerve were found, mostly in individual tests. Only 8 patients had 3 or more different tests abnormal.
The injured nerve function in patients with functional disturbances in the uninjured nerve was worse than in patients with normal test results.
Posttraumatic changes in central nervous system are the possible reasons.
Level III study.
Clinical relevance commentary in response to: The sensory function of the uninjured nerve in patients after median and ulnar nerve injury
2017, Journal of Hand Therapy
Neurosensory findings among electricians with self-reported remaining symptoms after an electrical injury: A case series
2016, Burns
Symptoms described in previous studies indicate that electrical injury can cause longstanding injuries to the neurosensory nerves. The aim of the present case series was to objectively assess the profile of neurosensory dysfunction in electricians in relation to high voltage or low voltage electrical injury and the “no-let-go phenomenon”.
Twenty-three Swedish male electricians exposed to electrical injury were studied by using a battery of clinical instruments, including quantitative sensory testing (QST). The clinical test followed a predetermined order of assessments: thermal perceptions thresholds, vibration perception thresholds, tactile gnosis (the Shape and Texture Identification test), manual dexterity (Purdue Pegboard Test), and grip strength. In addition, pain was studied by means of a questionnaire, and a colour chart was used for estimation of white fingers.
The main findings in the present case series were reduced thermal perceptions thresholds, where half of the group showed abnormal values for warm thermal perception and/or cold thermal perception. Also, the tactile gnosis and manual dexterity were reduced. High voltage injury was associated with more reduced sensibility compared to those with low voltage.
Neurosensory injury can be objectively assessed after an electrical injury by using QST with thermal perception thresholds. The findings are consistent with injuries to small nerve fibres. In the clinical setting thermal perception threshold is therefore recommended, in addition to tests of tactile gnosis and manual dexterity (Purdue Pegboard).
Hypothenar fat pad flap surgery for end stage and recurrent carpal tunnel syndrome
2016, Hand Surgery and Rehabilitation
One year follow-up results after hypothenar fat pad flap surgery for recurrent and end stage carpal tunnel syndrome (CTS) are reported. Before surgery, the patients’ complaints with a recurrent CTS were mainly pain and return of pathological symptoms (tingling, nocturnal pain, etc.) whereas the patients with end stage CTS reported problems of loss of sensation. Both groups (8 patients in each group) reported a limited functional status for activity of daily living (ADL) prior to surgery. Evaluations of sensibility, strength, pain and Boston Carpal Tunnel Questionnaire were made preoperatively and postoperatively at 3, 6 and 12 months. The major clinical issues for both groups were statistically significantly improved after one year, but already significant results were noted after 3 months. We confirm that the hypothenar fat pad flap is a good solution for recurrent CTS. Moreover, end stage CTS could be a new and promising indication for the use of this vascularized flap.
Nous rapportons les résultats du suivi d’un an chez des patients ayant bénéficié d’un lambeau adipeux hypothénarien après récidive ou à un stade terminal d’un syndrome du canal carpien (SCC). Avant la chirurgie, les patients qui présentaient une récidive se plaignaient principalement de douleurs et de réapparition des symptômes tels que des picotements, réveils nocturnes, etc. Par contre, les patients souffrant d’un stade terminal du SCC mentionnaient surtout une perte de sensibilité. Avant l’intervention chirurgicale, les patients des deux groupes (8 patients dans chaque groupe) étaient limités dans leurs activités de la vie quotidienne à cause du syndrome canalaire. Une évaluation de la sensibilité, de la force, de la douleur ainsi que le questionnaire Boston Carpal Tunnel était effectuée en préopératoire et en postopératoire à 3, 6 et 12 mois. Après 1 an, la majorité des problèmes cliniques était résolue d’une manière statistiquement significative mais on observait déjà une amélioration significative après 3 mois. Nous confirmons que le lambeau adipeux hypothénarien est une bonne solution pour les récidives du SCC. Par ailleurs, le traitement par lambeau adipeux hypothénarien pour les stades terminaux du SCC pourrait être une indication nouvelle et prometteuse.
Test−Retest Reliability and Convergent Validity of Three Manual Dexterity Measures in Persons With Chronic Stroke
2016, PM and R
Decreased manual dexterity is common in persons after stroke. Different measures are used to assess manual dexterity, but a lack of knowledge exists about their reliability and how they are related.
To evaluate the test−retest reliability and convergent validity of 3 manual dexterity measures after stroke.
A test−retest design.
University Hospital.
Forty-five persons (mean age 65 years) with mild-to-moderate impairments in the upper extremity at least 6 months after stroke.
Manual dexterity was assessed on 2 occasions, 1 week apart using the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the modified Sollerman Hand Function Test (mSHFT). The reliability of the BBT and NHPT was evaluated with the intraclass correlation coefficient together with systematic and random measurement errors. Reliability of the mSHFT was evaluated with the Kappa coefficient and the Svensson rank-invariant method (percent agreement and systematic and random disagreements). Convergent validity of the total scores was evaluated with the Spearman rank correlation coefficients (rho).
The intraclass correlation coefficient for the BBT and the NHPT ranged from 0.83 to 0.99. Significant systematic measurement errors were found for both tests and hands. The Kappa coefficient for the total sum score of the mSHFT was 0.95 for the more affected hand and 0.59 for the less affected hand. One of the 3 items showed systematic disagreements for both hands. The convergent validity (rho) for the more affected hand ranged from 0.41 (BBT versus mSHFT) to −0.68 (NHPT versus mSHFT).
The test−retest reliability of the BBT, NHPT and mSHFT was high but all measures showed learning effects. The relationships between the 3 measures indicate that they partly complement one another. The BBT may be preferred for persons with moderate impairments of the upper extremity and the NHPT and the mSHFT for persons with milder impairments. As the mSHFT has the advantage of reflecting activities in daily life it may be a suitable alternative to the NHPT.
III

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¹: This study was supported by grants from the National Swedish Board of Health and Welfare, the Swedish Medical Council (no. 05188), and the Swedish Council for Work Life Research.

²: No benefits in any form, related directly or indirectly to the subject of this article, have been received or will be received by the authors from a commercial party.

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A new tactile gnosis instrument in sensibility testing1,2

Abstract

J Hand Surg.

J Hand Ther.

J Hand Surg.

Neuropsychologia.

J Hand Ther.

J Hand Ther.

J Hand Surg.

J Hand Ther.

J Hand Ther.

J Hand Ther.

Hand.

J Hand Surg.

J Hand Surg.

J Hand Surg.

J Hand Surg.

J Hand Surg.

J Hand Surg.

J Hand Surg.

Rationale for quantitative sensory tests in hand surgery

The need for reliability and validity in hand assessment instruments

J Hand Surg.

Sensibility and re-education of sensation in the hand

Objective methods for determining the functional value of sensibility in the hand

J Bone Joint Surg.

Criticism and study of methods for examining sensibility in the hand

Neurology.