Effects of traverse length on human perioral directional sensitivity

The relationship between labial vibrotactile detection and pure-tone hearing thresholds in healthy, ageing adults

PURPOSE

Orofacial anatomy is unique from other body systems in that oral musculature inserts directly into the underlying cutaneous skin, allowing for tight temporal synchronicity between somatosensory and auditory performance feedback to maintain correct orofacial behaviours across the lifespan. Unfortunately, little is currently known regarding the changes in orofacial sensory capacities associated with ageing and how these somatosensory and auditory changes may impact feedback during functional behaviours such as speech or swallowing. The purpose of this descriptive study was to begin assessing the relationship between the auditory and labial somatosensory system in healthy ageing adults.

METHOD

Pure-tone hearing thresholds were determined for 500, 1000, 2000 and 4000 Hz. Using a 2-alternative forced choice paradigm, 60 adults (19-84 years) completed vibrotactile detection thresholds (VDT) at the 5 and 10 Hz test frequencies.

RESULT

A significant difference for age by group was identified at the 5 Hz test frequency. Spearman Correlations identified a significant correlation between age and pure tone hearing thresholds and the 5 Hz test frequency threshold.

CONCLUSION

A relationship between pure tone hearing thresholds and labial somatosensory was identified. Future studies will begin the processing of modelling the complex multivariate sensorimotor relationship in healthy individuals before moving to a disordered population.

Labial Vibrotactile Somatosensory Perception: A Pilot Study in Healthy Aging versus Young Adult Participants

The purpose of this pilot study was to begin characterizing changes in labial vibrotactile somatosensation in healthy older adults as a foundational step in determining how changes in orofacial sensation can affect functional behaviors, such as speech and feeding. Labial vibrotactile perception capacity of healthy older adults ( n = 15) was compared to a cohort of healthy young adults ( n = 5). Vibrotactile inputs were delivered to the glabrous surface of the left lower lip at 5, 10, 50, and 150 Hz. A modified von Bekesy (staircase) method was used to identify participants' thresholds and response standard deviations for each test frequency. Consistent with findings in other body regions, a decrease in labial vibrotactile detection sensitivity was expected in healthy older adults. The threshold values for the 5 and 10 Hz test frequencies were higher in the older group and the differences in response standard deviations at these frequencies were statistically significant. This pilot study identified changes in labial perception among healthy older adults.

Tactile direction discrimination and vibration detection in diabetic neuropathy

OBJECTIVE

To evaluate the clinical usefulness of quantitative testing of tactile direction discrimination (TDD) in patients with diabetic neuropathy.

MATERIALS AND METHODS

TDD and vibration detection were examined on the dorsum of the feet in 43 patients with type 1 diabetes mellitus and clinical signs and symptoms indicating mild neuropathy, and abnormal results for neurography, temperature detection, or heart rate variability. Test-retest examination of TDD was performed in nine of the patients.

RESULTS

Twenty-six of the patients had abnormal TDD (sensitivity 0.60) and 20 had abnormal vibration detection (sensitivity 0.46). Ten of the patients had abnormal TDD and normal vibration detection. Four of the patients had abnormal vibration detection and normal TDD. Test-retest examination of TDD showed a high degree of reproducibility (r = 0.87).

CONCLUSION

TDD seems more useful than vibration detection in examination of diabetic neuropathy.

The tactile integration of local motion cues is analogous to its visual counterpart

The visual and somatosensory systems have been shown to process spatial information similarly. Here we investigate tactile motion processing using stimuli whose perceptual properties have been well established in vision research, namely superimposed gratings (plaids), barber poles, and bar fields. In both modalities, information about stimulus motion (speed and direction) conveyed by neurons at low levels of sensory processing is ambiguous, a conundrum known as the aperture problem. Our results suggest that the tactile perception of motion, analogous to its visual counterpart, operates in multiple stages: first, the perceived direction of motion is determined by a majority vote from local motion detectors, which are subject to the aperture problem. As in vision, the conflict between the cues from terminators and other local motion cues is gradually resolved over time so that the perceived direction approaches the veridical direction of motion.

Mechanical frequency and stimulation-site-related differences in vibrotactile detection capacity along the lip vermilion in young adults

Accurate clinical assessment of the infraorbital and mental branch of the trigeminal nerve is aided by an appreciation of the variations in sensitivity that may exist along the surface of the perioral region under examination. The purpose of this investigation was to map the mediolateral spatial and frequency variations in vibrotactile detection capacity to inputs delivered to the upper lip (UL) and lower lip (LL) vermilion. Mechanical vibrotactile inputs at frequencies of 5, 10, 50, and 150 Hz were delivered to three locations on the vermilion of the UL and LL: midsagittally and laterally (left and right) at a point halfway between the midsagittal plane and the oral angle. An adapted staircase tracking method was used to converge upon a threshold value for each test frequency at each stimulation site. The results indicated that midsagittal vermilion sites were significantly more sensitive to our range of vibrotactile inputs compared to lateral vermilion locations. In addition, no significant differences in sensitivity as a function of laterality or between the UL and LL vermilion sites were noted. Greater midline sensitivity to vibrotactile stimulation suggests that receptive fields at this location may be of greater density and/or demonstrate greater overlap compared to lateral vermilion sites.

Morphometric Analysis of Implant-Related Anatomy in Caucasian Skulls

BACKGROUND

Sequelae related to implant placement/advanced bone grafting procedures are a result of injury to surrounding anatomic structures. Damage may not necessarily lead to implant failure; however, it is the most common cause of legal action against the practitioner. This study aimed to describe morphological aspects and variations of the anatomy directly related to implant treatment.

METHODS

Morphometric analyses were performed in 22 Caucasian skulls. Measurements of the mental foramen (MF) included height (MF-H), width (MF-W), and location in relation to other known anatomical landmarks. Presence or absence of anterior loops (AL) of the inferior alveolar nerve (IAN) was determined, and the mesial extent of the loop was measured. Additional measurements included height (G-H), width (G-W), thickness (G-T), and volume (G-V) of monocortical onlay grafts harvested from the mandibular symphysis area, and thickness of the lateral wall (T-LW) of the maxillary sinus. The independent samples t test, and a two-tailed t test with equal variance were utilized to determine statistical significance to a level of P < 0.05. Multiple regression analyses were performed to determine if each one of these measurements was affected by age and gender.

RESULTS

The most common location of the MF in relation to teeth was found to be below the apices of mandibular premolars. The mean MF-H was 3.47 +/- 0.71 mm and the mean MF-W was 3.59 +/- 0.8 mm. The mean distance from the MF to other anatomical landmarks were: MF-CEJ = 15.52 +/- 2.37 mm, MF to the most apical portion of the lower cortex of the mandible = 12.0 +/- 1.67 mm, MF to the midline = 27.61+/- 2.29 mm, and MF-MF = 55.23 +/- 5.34 mm. A high prevalence of AL was found (88%); symmetric occurrence was a common finding (76.2%), with a mean length of 4.13 +/- 2.04 mm. The mean size of symphyseal grafts was: G-H = 9.45 +/- 1.08 mm, G-W = 14.5 +/- 3.0 mm, and G-T = 6.15 +/- 1.04 mm, with an average G-V of 857.55 +/- 283.97 mm3 (range: 352 to 1,200 mm3). The mean T-LW of the maxillary sinus was 0.91 +/- 0.43 mm.

CONCLUSION

Implant-related anatomy must be carefully evaluated before treatment due to considerable variations among individuals, in order to prevent injury to surrounding anatomical structures and possible damage.

Mechanosensory and thermosensory changes across the border of impaired sensitivity to pinprick after mandibular nerve injury

PURPOSE

The study goal was to determine how sensory function varies across the border of impaired sensitivity to pinprick in patients with mandibular nerve injuries.

PATIENTS AND METHODS

Borders of decreased sensitivity to pinprick were mapped in 15 patients who reported altered sensation. Four mechanoreceptive, 2 thermoreceptive, and 2 thermonociceptive functions were studied at 5 sites separated by 0.6 cm across the border. The tests were repeated to evaluate day-to-day consistency in the pattern of variation for each sensory measure.

RESULTS

The estimates of sensory function were not found to vary in a systematic manner from outside to inside the pinprick-impaired area for all patients for any of the 8 tests. However, for every test, some patients exhibited large variations. On average, the magnitudes of loss in contact detection, subjective intensity of light touch, and direction discrimination were greatest; the magnitudes of loss in 2-point perception and in heat and cold pain perception were least. Some patients provided no evidence of impairment on certain tests. For some patients, the estimates suggested increased sensitivity within the pinprick-impaired area (eg, to noxious cold stimuli).

CONCLUSIONS

Although certain patients exhibit impairment, there is no obligatory loss in light touch, 2-point perception, direction discrimination, or temperature perception across the border of decreased sensitivity to pinprick. The differences among patients suggest that the data from individual patients should be evaluated in clinical studies and in clinical practice. Researchers should not rely solely on average values and summary statistics.

Capturing the spatial percepts evoked by moving tactile stimuli: a novel approach

Forced-choice procedures are conventionally used to study the percepts evoked by stimuli that move across the skin and enable an unbiased estimation of subjects' sensory capacities. These procedures, however, require subjects to assign complicated percepts to one of a small number of experimenter-defined response categories, none of which may satisfactorily describe the perceptual experience. To address this limitation, we developed a psychophysical approach, which graphically captures spatial information about a moving stimulus in a holistic manner. Briefly summarized, the stimulus object controlled for location, velocity, direction and distance is moved across the skin of a blind-folded subject, after which the subject draws its path on a life-size, two-dimensional photograph of the body region stimulated. Using this approach, we demonstrated that the drawings contain perceptually relevant information, estimates of direction discrimination and subjective traverse length derived from the drawings closely parallel data obtained with forced-choice and magnitude estimation methods, respectively, and generate comparable psychophysical functions of stimulus velocity. In addition, information is represented in the complex shapes of the curves and in the locations at which they are drawn. Analyses of these latter features support the hypothesis that non-sensory factors (individual subject biases) also affect the drawings.

Evocation and characterization of percepts of apparent motion on the face

The percepts evoked by sequential stimulation of sites in close spatial proximity (< or = 2.5 cm) on the face were studied. Both method-of-limits and magnitude-estimation procedures were used to identify and characterize alterations in the percepts produced by systematic changes in the temporal and spatial parameters of the sequence. Each site was stimulated by a vertically oriented row of miniature vibrating probes. Apparent motion was consistently perceived when the delay between the onsets of sequentially activated rows (interstimulus onset interval, or ISOI) fell within a relatively narrow range of values, the lower limit of which approximated 5 msec. Both the upper limit and the perceived smoothness and continuity of the motion percepts (goodness of motion) increased with the duration for which each row stimulated the skin over the range evaluated, 15-185 msec. For the successive activation of only two rows, goodness of motion was not influenced by changes in their separation from 0.4 to 2.5 cm. The ISOI values at which magnitude estimates of goodness of motion were highest increased with the duration for which each row stimulated the skin. As such, maximum goodness of motion decreased with increases in the apparent velocity of motion. When the number of sequentially activated rows was increased from two to four or more, the quality of the motion percepts improved. For the successive activation of multiple closely spaced rows, values of ISOI at which numerical estimates of goodness of motion were highest approximated integral fractions of the duration for which each row stimulated the skin. In this situation, the probes rose and fell in a regular, step-locked rhythm to simulate an edge-like or rectangular object moving across the skin. The goodness of motion so attained was relatively independent of the apparent velocity of motion.

Directional sensibility for quantification of tactile dysfunction

Examination of tactile directional sensibility, i.e., the ability to tell the direction of an object's motion across the skin, has been recommended by several authors for examination of patients with somatosensory disorders. Recent findings about the physiological mechanisms underlying directional sensibility suggested possibilities to further improve the test. In the present investigation a test was constructed that allowed a semiquantification of the directional sensibility of six body areas within 20 min. Normal values were obtained by testing healthy subjects (n = 40), and the normal values were compared to those obtained in a group of patients with tactile symptoms (n = 20). Ten of the patients had abnormal sensory conduction in one or several nerves, and they also had abnormal directional sensibility. Hence, examination of directional sensibility, according to the present protocol, provides a semiquantitative test that appears to be as sensitive as electrophysiological measurement of conduction in detecting dysfunction in tactile nerves.

Effect of stimulus force on perioral direction discrimination: clinical implications

Clinicians have used the same instrument (viz, Semmes-Weinstein pressure aesthesiometers [Research Design, Inc, Houston, TX] or "von Frey hairs") for tests of both contact detection and direction discrimination. However, patients' ability to discriminate direction may be underestimated by barely detectable moving stimuli. To determine whether the aesthesiometers underestimate direction discrimination, we evaluated the capacity of 13 normal subjects to distinguish opposing directions provided by 10 different hairs. The hairs were selected to deliver forces below and above the contact-detection threshold. Each was stroked over 1.0 cm of perioral skin at the velocity at which the subject was predicted to best discriminate direction of motion. It was found that valid estimates of perioral direction discrimination can be obtained with appropriately selected aesthesiometers. Specifically, the least stiff hair whose handle displays a manufacturer's marking two units greater than that of the contact-detection "threshold hair" should be used to deliver the moving stimuli. The resultant force applied by this hair will exceed 10 times the subject's contact-detection threshold force. If a less-stiff hair is used, the capacity to distinguish direction may be underestimated.

Human, tactile, directional sensibility and its peripheral origins

Tactile directional sensibility is probably functionally important and deserves attention as it is known to be sensitive to many different disturbances of the somatosensory system. Therefore, the ability of healthy adults to determine the direction of motion of a light tactile stimulus travelling proximally or distally along a straight line on depilated, hairy skin of the forearm was examined with two-alternative, forced-choice technique. The aim was to investigate the relative importance of different types of afferent information which may be used for this purpose. A test was started with the moving stimulus covering a distance of no less than 2.5 mm, which was subsequently increased until the subject could report the direction of motion reliably. Afterwards, the distance was decreased until the subject could no longer do so. Three different stimulation conditions were used and for a point stimulator touching the skin it was found that the necessary distance decreased to 2.5 mm after a moderate increase of the vertical contact load. No such decrease was found when a frictionless air-stream point stimulator was used instead. The distances which had to be covered by the point stimulator touching the skin increased to values which were comparable to those obtained with the air-stream stimulator after the lateral extensibility of the skin had been diminished. This was achieved by attaching a surgical sticky plaster around the stimulated skin area. The present findings consequently indicated that optimal, tactile, directional sensitivity depends on peripheral afferent messages which signal the direction of lateral stretching of the skin.

Characterization of the percepts evoked by discontinuous motion over the perioral skin

The capacity of human subjects to process information about discontinuous and continuous movement was evaluated. Constant-velocity brushing stimuli were delivered through aperture plates that rested lightly upon the mandibular skin. Each plate consisted of either two spatially separated, slit-like openings or a single continuous, longer opening. It was discovered that percepts of smooth apparent motion were achieved with the split apertures (i.e., from discontinuous movement) for only limited ranges of stimulus velocity. Moreover, the optimal velocity supporting smooth apparent motion increased with the separation between the slit-like openings. In a second series of experiments, subjects' ability to discriminate opposing directions of discontinuous and continuous movement was evaluated. It was found that subjects could derive directional information from percepts elicited by discontinuous movement. However, the capacity to discriminate opposing directions of continuous movement cannot be explained solely in terms of the ability to process information about the change in position of a stimulus from its onset to its offset.

Directional sensitivity along the upper limb in humans

The capacity of four neurologically healthy young adults to distinguish opposing directions of cutaneous motion was determined at five different sites along the proximal-distal axis of the upper limb. Constant-velocity brushing stimuli (ranging from 0.5 to 32.0 cm/sec) were delivered through an aperture in a Teflon plate that was securely positioned in light contact with the skin. In one series of experiments, directional sensitivity in d' units was assessed at each site, using an aperture length of 0.75 cm. In a second series of experiments, the aperture length required to obtain the same criterion level of directional sensitivity at each site was determined. To attain the sensitivity reached at distal sites, a proximal stimulus had to traverse a longer chord of skin. Specifically, chords 5.9 times longer on average (range = 5.4-6.2) were required on the proximal forearm than on the index finger pad. This finding suggests that relative directional sensitivity increases sixfold from the proximal forearm to the finger pad. Moreover, relative directional sensitivity on the shoulder was comparable to that observed on the proximal forearm for two of the subjects, and approximately one-half that observed on the proximal forearm for the other two subjects. In addition to such a prominent spatial gradient in relative directional sensitivity, the velocity of stimulus motion at which directional sensitivity was highest increased systematically as the test site was shifted from the finger pad to the proximal forearm. Specifically, the optimal velocity on the finger pad varied among subjects from 1.5 to 9.4 cm/sec (mean = 5.4 cm/sec), and on the proximal forearm from 11.5 to 31.2 cm/sec (mean = 18.6 cm/sec). The optimal velocity on the shoulder was not significantly different from that observed on the proximal forearm. The results suggest that effective and informed clinical testing of patients' capacity to distinguish opposing directions of motion on cutaneous regions that differ in peripheral innervation density requires appreciation of the sensitivities of different skin regions, as well as the unique velocity dependency of direction discrimination at each skin site.

Perioral somesthetic sensibility: do the skin of the lower face and the midface exhibit comparable sensitivity?

Studies of the perioral somatosensory capacities of neurologically normal adults were reviewed to determine whether sensitivities within the mental and infraorbital nerve distributions are comparable. It was found that tactile detection sensitivity, spatial acuity, and sensitivity to warmth are greater on skin sites located on the midface than on the lower face. In contrast, sensitivity to direction of motion and to differences in surface texture may be greater on skin sites located on the lower face. The literature further suggests that sensitivity within the distribution of each nerve varies appreciably. For example, the vermilion of the lips exhibits considerably greater vibrotactile detection sensitivity, spatial acuity, and sensitivity to direction of motion than does the perioral hairy skin. In addition, spatial acuity is notably greater on midline structures. These findings suggest that knowledge of the patterns of spatial variations in perioral tactile sensibilities can be effectively used during neurosensory examination to select control skin sites for comparison with areas of suspected neurosensory impairment and to distinguish apparent pathological alterations in tactile sensitivity from normal regional differences that characterize the perioral complex.

Effects of trauma to the mandibular nerve on human perioral directional sensitivity

The capacity of 4 patients who had previously experienced trauma to their mandibular nerves to distinguish opposing directions of tactile motion over the distribution of the mental nerve was compared to that of 8 neurologically normal adults. Brushing stimuli were delivered to the perioral region and were precisely controlled for their velocity, the length of skin traversed, the width of skin contacted, and the orientation and direction of motion. A temporal, 2-alternative, forced choice method was used to obtain estimates of directional sensitivity, d'. It was discovered that impairment in cutaneous directional sensitivity could be readily detected within areas of hypaesthesia. Although directional sensitivity was found to increase linearly with the length of skin traversed for both the patients and the neurologically normal adults, the slope and the x-intercept of the linear relationship differed between the two groups. The difference in the slope suggests that direction discrimination within the hypaesthetic areas is relatively insensitive to changes in the length of skin traversed. The difference in the x-intercept suggests that a greater length of skin must be traversed before any information about direction is made available at the hypaesthetic sites. The dependency of the capacity of neurologically normal and impaired individuals to process information about direction of tactile motion on the length of skin traversed and the velocity of stimulation suggests that a high degree of stimulus control is required for the detection and quantification of subtle neurosensory deficits.