Journal of Physiotherapy 2013 Vol. 59 – © Australian Physiotherapy Association 2013 132
The Ten Test for Sensation
The Ten Test (TT) is a quantitative sensory test requiring
no test equipment (Strauch 2003). The subject reports his/
her light touch perception of the skin area being tested
compared to the reference normal area when the examiner
gives a simultaneous stimulus by stroking a normal area
and the area under examination. When examining subjects
with bilateral hand involvement it has been suggested that a
normally innervated facial comparator could be used. The
response from the patient rating the sensibility of the test area
is recorded as a fraction out of 10 between 1/10 and 10/10 (10
= normal sensory perception). The test may be repeated to
produce an average score. Detailed test procedure available
Reliability and validity: The TT has been found to be
reliable and repeatable. Inter-observer reliability was
excellent (ICC = 0.91) and very strong agreement (Ð =1.00,
p < 0.003) was found between examiners (Strauch 1997; Sun
2010). Good to excellent intra-observer reliability (ICC =
0.62 to 0.90, p < 0.05) was found (Strauch 1997) when equal
delivery of the stimulus pressure to the test and normal
areas was evaluated. Multiple studies demonstrated the TT
may be used for outcome measurement (Novak 2003, 2005;
Humphreys 2007). The TT is recommended for: clinical use
in patients age > 5 years (Sun 2010); different conditions of
upper extremities (Patel 1999; Faught 2002; Novak 2005),
and lower extremities (Humphreys 2007); and pre/post
operative sensory evaluation (Strauch 1997, MacDermid
2004, Novak 2003).
This test provides a quantitative score to the ratings
obtained while the examiner administers light moving
touch stimuli to a test area and simultaneously comparing
that to a reference area of ‘normal’ sensation. Advantages:
The TT is quick to administer, requires no equipment and
can be used where self-report measures are not feasible or
possible. It provides a reliable option for clinicians in busy
clinical settings, and/or where quantitative sensory testing
equipment is unavailable. Limitations: The test requires
patient co-operation and the concept of rating sensibility
may be cognitively challenging for some patients. Testing
is best compared to contra-lateral body part with same
dermatome innervation which can be problematic in
bilateral conditions. Maintaining equal pressure and a
precise test area for simultaneous stimulation of both the
normal and abnormal part may be challenging. If the patient
presents with hyperaesthesia (sensory sensitisation, or an
abnormal pain response), or allodynia over a hypoaesthetic
territory (Spicher 2008), then the scoring (and clinical
interpretation) differs: normal sensation = 1 and the test
area is scored between 1/10 and 10/10 (10 = hyperaesthesia).
Testing contraindications include open wounds or absence
of an available normal reference territory.
Zakir Uddin, Joy MacDermid and Tara Packham
School of Rehabilitation Science, McMaster University,
Patel MR, Bassini L (1999) J Reconstr Microsurg 15: 523.
Strauch B, Lang A (2003) Plast Reconstr Surg 112 : 593.
Strauch B et al (1997) Plast Reconstr Surg. 99: 1074.
Sun HH et al (2010) J Plast, Reconstr Aesthet Surg 63: 1849–
Faught BE, McKee NH (2002) J Reconstr. Microsurg 18: 634.
MacDermid JC, Doherty T (2004) J Orthop Sports Phys Ther
Novak CB (2003) Clin Plast Surg Apr 30: 127–138.
Novak CB, Mackinnon SE (2005) J Hand Ther 18: 230–240.
Humphreys DB et al (2007) J Neurosurg 107: 314–318.
Spicher C et al (2008). Somatosens Mot Res 25: 77–92.