Occupational Therapy Department

Course Name: Hand Assessment and Splinting (061013210)

Lecture 4. Sensibility Testing.

Objectives of lecture 4:
By the end of this lecture, students will be able to:
Demonstrate competence in conducting Ten test, Moberg pick-up test, two-point
discrimination, Semmes-Weinstein Monofilament Test and Shape-texture
identification

Ten test
The patient is asked to rate the perception of light stroking touch applied by the examiner by
comparing it with the unaffected area or the contralateral hand and scoring it on a scale of 1 to 10
(10 = normal sensory perception and 1 = absent). An advantage of this method is that it is very
quick and requires no equipment. However, it may be cognitively challenging for the patient to
interpret what “normal” sensation is. Reliability of the Ten Test has been shown to be very good
https://www.youtube.com/watch?v=ktvjsqbIfUM

Two-point discrimination
is the ability to discern that two nearby objects touching the skin are truly two distinct points, not
one. It is often tested with two sharp points during a neurological examination and is assumed to
reflect how finely innervated an area of skin is. In clinical settings, two-point discrimination is a
widely used technique for assessing tactile perception. It relies on the ability and/or willingness
of the patient to subjectively report what they are feeling and should be completed with the
patient’s eyes closed
https://youtu.be/_f488-BNid8
Two Point Discrimination Value:
Normal <6mm
Fair 6-10mm
Poor 11-15mm
Protective where only one point is perceived.
Anesthetic where points are not perceived

Moberg pick-up test

Is a standardized test to assess for hand dexterity and functional sensibility. It is a timed test first
used in neuro-rehabilitation to evaluate hand motor activity. It is simple and quick to administer,
easy to replicate and inexpensive to acquire.
https://www.youtube.com/watch?v=fxr5c_Uh5ss&t=32s

Semmes-Weinstein Monofilament Test

the Semmes-Weinstein Monofilament Test (SWMT) widely used in practice nowadays. It is
made up of 20 calibrated nylon filaments of different thicknesses that are applied perpendicularly
to the skin until they buckle. The thickness of each filament determines the weight or force of the
single point stimulus, which ranges from deep pressure to very light touch and equates to five
levels of functional sensibility (Table 10.1). Using the full kit of 20 filaments is time consuming,
and a 5-filament version is available
https://www.youtube.com/watch?v=F_iqmN7lQL4
Shape-texture identification
the Shape-Texture Identification (STI) test aims to assess active touch, three shapes and three
textures (raised dots) are presented in three different sizes. The patient is instructed to actively
explore each shape using either the index finger (for median nerve injuries) or the fifth finger (in
ulnar nerve injuries) (Figs. 10.10 and 10.11). The STI test has undergone extensive testing for its
psychometric qualities in patients with nerve trauma and carpal tunnel syndrome.
https://www.youtube.com/watch?v=eNBKAUrfFjA&t=182s