BACKGROUND: The two-point discrimination (2PD) test is widely used in clinical practice to assess tactile acuity and central somatosensory function in stroke patients.
OBJECTIVES: The aim of this study was to evaluate the reliability of 2PD test in fingers on the affected and non-affected sides in acute stroke patients.
METHODS: This was a single group repeated-measures inter-rater reliability study. Thirty adults with completed ischemic stroke and left paresis participated in the study. Static 2PD sensation was assessed using a standardized Dellon discriminator. Two examiners performed measurements of 2PD sensation on both hands. Each examiner made three series of measurements at intervals of 1 minute. After 15 minutes, the study was conducted in the same order by a second examiner.
RESULTS: The ability for 2PD sensation was significantly reduced in all examined fingers on the affected side in comparison to the non-affected side. The difference was statistically significant (in each case, p < 0.0001). Inter-rater reliability (ICC2,1) for the first measurement at the affected site ranged from 0.95 to 0.98; at the non-affected site ranged from 0.30 to 0.82. Analysis of the average value of three measurements (ICC2,3) yielded values for the affected site ranging from 0.98 to 0.99; at the non-affected site ranged from 0.81 to 0.95.
CONCLUSIONS: The 2PD sensation values for all fingers were higher for the affected site in comparison to the non-affected site. Conducting three repeatable measurements ensures measurement reliability and repeatability when evaluating 2PD sensation in fingers on both sides in acute stroke patients.
Au-YeungS. S., & Hui-ChanC. W. (2009). Predicting recovery of dextrous hand function in acute stroke. Disability and Rehabilitation, 31, 394–401.
2.
BanisterL. C., CrewtherS. G., GavrilescuM., & CareyL. M. (2015). Improvement in touch sensation after stroke is associated with resting functional connectivity changes. Frontiers in Neurology, 165, 1–15.
3.
BolesD. B., & GivensS. M. (2011). Laterality and sex differences in tactile detection and two-point thresholds modified by body surface area and body fat ratio. Somatosensory & Motor Research, 28, 102–109.
4.
BulutT., AkgunU., OzcanC., UnverB., & SenerM. (2016). Inter- and intra-tester reliability of sensibility testing in digital nerve repair. Journal of Hand Surgery (European Volume), 41, 621–623.
5.
CareyL. M., & MatyasT. A. (2011). Frequency of discriminative sensory loss in the hand after stroke in a rehabilitation setting. Journal of Rehabilitation Medicine, 43, 257–263.
6.
DellonA. L., MackinnonS. E., & CrosbyP. M. (1987). Reliability of two-point discrimination measurements. Journal of Hand Surgery (American Volume), 12, 693–696.
7.
DinseH. R., KleibelN., KalischT., RagertP., WilimzigC., & TegenthoffM. (2006). Tactile coactivation resets age-related decline of human tactile discrimination. Annals of Neurology, 60, 88–94.
8.
GemperlineJ. J., AllenS., WalkD., & RymerW. Z. (1995). Characteristics of motor unit discharge in subjects with hemiparesis. Muscle Nerve, 18, 1101–1114.
9.
GoddeB., StauffenbergB., SpenglerF., & DinseH. R. (2000). Tactile coactivation-induced changes in spatial discrimination performance. Journal of Neuroscience, 20, 1597–1604.
10.
KalronA., Greenberg-AvrahamiM., & AchironA. (2015). Validity and test-retest reliability of a measure of hand sensibility and manual dexterity in people with multiple sclerosis: The ReSense test. Disability and Rehabilitation, 37, 914–920.
11.
KennettS., Taylor-ClarkeM., & HaggardP. (2001). Noninformative vision improves the spatial resolution of touch in humans. Current Biology, 11, 1188–1191.
KimJ. S., & YiS. J. (2013). Comparison of two-point discrimination perception in stroke patients with and without diabetes mellitus. See comment in PubMed Commons below. Journal of Physical Therapy Science, 25, 1007–1009.
14.
Krumlinde-SundholmL., & EliassonA. C. (2002). Comparing tests of tactile sensibility: Aspects relevant to testing children with spastic hemiplegia. Development Medicine & Child Neurology, 44, 604–612.
15.
LangC. E., BlandM. D., BaileyR. R., SchaeferS. Y., & BirkenmeierR. L. (2013). Assessment of upper extremity impairment, function, and activity after stroke: Foundations for clinical decision making. Journal of Hand Therapy, 26, 104–114.
16.
LiaoC., ZhangW., YangM., MaQ., LiG., & ZhongW. (2014). Surgical decompression of painful diabetic peripheral neuropathy: The role of pain distribution. See comment in PubMed Commons below. PLoS One, 9, 1–10.
17.
LundborgG., & RosénB. (2004). The two-point discrimination test–time for a re-appraisal?Journal of Hand Surgery (European Volume), 29, 418–422.
18.
MarxR. G., HudakP. L., BombardierC., GrahamB., GoldsmithC., & WrightJ. G. (1998). The reliability of physical examination for carpal tunnel syndrome. Journal of Hand Surgery (European Volume), 23, 499–502.
19.
MeyerS., De BruynN., LafosseC., Van DijkM., MichielsenM, et al. (2015). Somatosensory impairments in the upper limb poststroke: Distribution and association with motor function and visuospatial neglect. Neurorehabilitation and Neural Repair. pii: 1545968315624779.
20.
MeyerS., KarttunenA. H., ThijsV., FeysH., & VerheydenG. (2014). How do somatosensory deficits in the arm and hand relate to upper limb impairment, activity, and participation problems after stroke? A systematic review. Physical Therapy, 94, 1220–31.
21.
MobergE. (1990). Two-point discrimination test. A valuable part of hand surgical rehabilitation, e.g. in tetraplegia. Scandinavian Journal of Rehabilitation Medicine, 22, 127–134.
22.
MozaffarianD., BenjaminE. J., GoA. S., et al. (2015). Heart disease and stroke statistics—2015 update: A report from the American Heart Association. Circulation, 133, 38–360.
23.
NovakC. B., MackinnonS. E., & KellyL. (1993). Correlation of two-point discrimination and hand function following median nerve injury. Annals of Plastic Surgery, 31, 495–498.
24.
PatelA. T., DuncanP. W., LaiS. M., & StudenskiS. (2000). The relation between impairments and functional outcomes poststroke. Archives of Physical Medicine and Rehabilitation, 81, 1357–1363.
25.
RogerV. L., GoA. S., Lloyd-JonesD. M., et al. (2012). Heart disease and stroke statistics—2012 update: A report from the American Heart Association. Circulation, 125, 188–197.
26.
RozentalT. D., BeredjiklianP. K., GuyetteT. M., & WeilandA. J. (2000). Intra-and interobserver reliability of sensibility testing in asymptomatic individuals. Annals of Plastic Surgery, 44, 605–609.
27.
SilvaP. G., JonesA., AraujoP. M., & NatourJ. (2014). Assessment of light touch sensation in the hands of systemic sclerosis patients. Clinics, 69, 585–588.
28.
SullivanJ. E., & HedmanL. D. (2008). Sensory dysfunction following stroke: Incidence, significance, examination, and intervention. Topics in Stroke Rehabilitation, 15, 200–217.
29.
Van BrakelW. H., KhawasI. B., GurungK. S., KetsC. M., van LeerdamM. E., & DreverW. (1996). Intra- and inter-tester reliability of sensibility testing in leprosy. International Journal of Leprosy and Other Mycobacterial Diseases, 64, 287–298.
30.
WarlowC., SudlowC., DennisM., et al. (2003). Stroke. Lancet, 362, 1211–1224.
31.
WinwardC. E., HalliganP. W., & WadeD. T. (1999). Current practice and clinical relevance of somatosensory assessment after stroke. Clinical Rehabilitation, 13, 48–55.
32.
WolnyT., SauliczE., LinekP., MyśliwiecA., & SauliczM. (2016). Effect of manual therapy and neurodynamic techniques vs ultrasound and laser on 2PD in patients with CTS: A randomized controlled trial. Journal of Hand Therapy, 29, 235–245.
33.
WolnyT., SauliczE., GnatR., & KokoszM. (2010). Butler’s neuromobilizations combined with proprioceptive neuromuscular facilitation are effective in reducing of upper limb sensory in late-stage stroke subjects: A three-group randomized trial. Clinical Rehabilitation, 24, 810–821.
