The ten test for sensation.
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ABSTRACT: Study Design Cross-sectional discriminative analysis. Objective To determine whether current perception threshold (CPT) can differentiate between categories of patients with mechanical neck disorders (MNDs). Background Neck pain is the third most common musculoskeletal disorder, affecting a third of all adults each year. It can present as neck pain without musculoskeletal signs; neck pain with musculoskeletal signs but no neurological signs; neck pain with neurological signs. CPT testing can assess altered sensory perception that may reflect neurological changes. Methods Patients with MNDs (n=106) were classified into 3 groups based on a standardized musculoskeletal examination process performed by an experienced physiotherapist blinded to CPT scores. The 3 groups were defined as: MND-I, neck pain without musculoskeletal signs (n=60); MND-II, neck pain with musculoskeletal signs (n=29); MND-III, neck pain with neurological signs (n=17). A rapid protocol of CPT testing was performed at 3 frequencies (5, 250, 2000 Hz), using 3 dermatomal locations on the hand. A 1-way ANOVA with post hoc comparison and effect sizes were calculated to compare the mean CPT score between the groups. A binary logistic regression model was used to predict probability of higher CPT in MND-III and used to create a receiver operating characteristic (ROC) curve. Results Mean CPT differed significantly across the 3 MND groups (MND-I, 9.7; MND-II, 10.6; and MND-III, 11.8; P < .001, η(2) = .6). Post hoc comparisons indicated differences between MND-I and MND-II (P = .05) and between MND-II and MND-III (P = .01), that were large effect sizes (MND I versus II, d = 1 and MND II versus III, d = 2.2). CPT testing was able to distinguish between MND II and III when a threshold value of greater than 11 was used to indicate MND-III. The predicted probability of abnormal CPT in MND-III had an estimated 73% sensitivity and 81% specificity; the odds ratio was 11.5 (P =.001) for the differentiation capacity of CPT between MND-II and III with a cut-off of 11. The area under the ROC curve (AUC) was .84 (95% CI =.72 to .96, P < .001). Conclusions CPT testing has moderate discriminatory accuracy, specificity, and sensitivity for classification of MND categories into neck pain with or without neurological signs. J Orthop Sports Phys Ther, Epub 10 May 2014. doi:10.2519/jospt.2014.5691.The Journal of orthopaedic and sports physical therapy. 05/2014;
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ABSTRACT: Accurate assessment of pain or sensory function in clinical practice is challenging. Quantitative Sensory Testing (QST) is a standardized approach to measuring pain and sensory thresholds or tolerances as a means of assessing the functionality of neural pathways from the receptors along the afferent fibers to the brains. This paper reviews two simple QST techniques potentially useful to clinical practice: the Cold Stress Test and Ten Test. The background, evidence for clinical measurement properties and feasibility issues are considered. Keywords Quantitative evaluation, sensory test, pain, sensation, thresholdPhysiotherapy Practice and Research. 03/2014; 35(1):33-40.
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ABSTRACT: The study was conducted to estimate the extent to which pressure pain sensitivity (PPS) and patient factors predict pain-related disability in patients with neck pain (NP), and to determine if PPS differs by gender. Forty-four participants with a moderate level of chronic NP were recruited for this cross sectional study. All participants were asked to complete self-reported assessments of pain, disability and comorbidity and then underwent PPS testing at 4-selected body locations.Pearsos r w was computed to explore relationships between the PPS measures and the self-reported assessments. Regression models were built to identify predictors of pain and disability. An independent sample t-test was done to identify gender-related differences in PPS, pain-disability and comorbidity. In this study, greater PPS (threshold and tolerance) was significantly correlated to lower pain-disability (r = -.30 to -.53, p≤0.05). Age was not correlated with pain or disability but comorbidity was (r= 0.42-.43, p≤0.01). PPS at the 4-selected body locations was able to explain neck disability (R 2 =25-28%). Comorbidity was the strongest predictor of neck disability (R 2 =30%) and pain (R 2 =25%). Significant mean differences for gender were found in PPS, disability and comorbidity, but not in pain intensity or rating. This study suggests that PPS may play a role in outcome measures of pain and disability but between-subject comparisons should consider gender and comorbidity issues.The Open Orthopaedics Journal 06/2014; 8.
Journal of Physiotherapy 2013 Vol. 59 – © Australian Physiotherapy Association 2013132
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,
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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.