Chromatic and luminance sensitivity for skin and skinlike textures.

Despite the importance of the appearance of human skin for theoretical and practical purposes, little is known about visual sensitivity to subtle skin-tone changes, and whether the human visual system is indeed optimized to discern skin-color changes that confer some evolutionary advantage. Here, we report discrimination thresholds in a three-dimensional chromatic-luminance color space for natural skin and skinlike textures, and compare these to thresholds for uniform stimuli of the same mean color. We find no evidence that discrimination performance is superior along evolutionarily relevant color directions. Instead, discriminability is primarily determined by the prevailing illumination, and discrimination ellipses are aligned with the daylight locus. More specifically, the area and orientation of discrimination ellipses are governed by the chromatic distance between the stimulus and the illumination. Since this is true for both uniform and textured stimuli, it is likely to be driven by adaptation to mean stimulus color. Natural skin texture itself does not confer any advantage for discrimination performance. Furthermore, we find that discrimination boundaries for skin, skinlike, and scrambled skin stimuli are consistently larger than those for uniform stimuli, suggesting a possible adaptation to higher order color statistics of skin. This is in line with findings by Hansen, Giesel, and Gegenfurtner (2008) for other natural stimuli (fruit and vegetables). Human observers are also more sensitive to skin-color changes under simulated daylight as opposed to fluorescent light. The reduced sensitivity is driven by a decline in sensitivity along the luminance axis, which is qualitatively consistent with predictions from a Von Kries adaptation model.

Saphenous nerve transfer: A new approach to restore sensation of the sole.

BACKGROUND: Loss of protective sensation of the sole may lead to repeated trauma, chronic nonhealing ulcers, and even amputation. Saphenous nerve (SN) to posterior tibial nerve (PTN) transfer can restore sensation of the sole. METHOD: This study was conducted in a tertiary referral center in Central India. Twenty-one patients (32 feet) diagnosed with loss of sensation of the sole were included in this study. Causes of loss of sensation were Hansen's disease (n = 18), complex sciatic nerve injury (n = 1), lumbosacral spinal tumor (n = 1), and lumbosacral meningomyelocele (n = 1). Seventeen feet (14 patients) had ulcers on the sole. Preoperative and postoperative sensory tests performed on the sole included tests for touch, pain, temperature, pressure, vibration, and two-point discrimination. Results were classified as per the British Medical Research Council (MRC) scoring system. RESULTS: Seventeen patients (26 feet) were available for follow-up at 6 months after surgery. All patients had improvement in sensory parameters. Ulcers completely healed in 13 feet and reduced in size in four feet. MRC score improved from S0 in 22 feet and S1 in 10 feet to S3 + in 20 feet, S3 in four feet, and S2 in two feet. CONCLUSIONS: Sensory neurotization with SN transfer to PTN can restore protective sensation to the sole and help in the healing of ulcers.

Thermal record of the test tubes method used for small fibers assessment / Registro térmico do método dos tubos de ensaio aplicado na avaliação de fibras finas

In Brazil, the test that uses test tubes filled with cold water (25ºC) and tubes filled with water heated to a temperature of 45ºC is recommended by the Ministry of Health as a way of evaluate thermal sensitivity on the injured skin of leprosy patients. The purpose of this work was to quantify the thermal stimulation applied to the skin, as well as the temperature variation of the heated water and of the tube's outer surface during stimulation sessions. The experiment had the participation of 14 healthy volunteers (31.2±11.4 years-old), ten of which were male (33.1±13.5 years-old) and four were female (26.5±4.7 years-old). Three consecutive stimulation sessions were carried out, each of them with four stimuli. The maximum skin temperature at the end of the stimuli was measured at 35.8±0.6ºC. Such temperature values may be useful in the assessment of the loss of small fibers, which are responsible for the sensation of warmth.

No Brasil, o teste que utiliza tubos de ensaio preenchidos com água aquecida (45ºC) e resfriada (25ºC) é preconizado pelo Ministério da Saúde como forma de avaliar a sensibilidade térmica nas lesões de pele de pacientes com hanseníase. O objetivo deste trabalho foi quantificar o estímulo térmico na pele e a variação das temperaturas da água aquecida e da superfície externa do tubo, durante as sessões de estimulação. O experimento contou com 14 voluntários saudáveis (31,2±11,4 anos), sendo dez do gênero masculino (33,1±13,5 anos) e quatro do gênero feminino (26,5±4,7 anos). Realizaram-se três sessões seguidas de estimulação com quatro estímulos em cada sessão. A temperatura registrada na pele, ao final dos estímulos, apresentou diferenças entre as sessões, atingindo o máximo de 35,8±0,6ºC. Estes valores de temperatura podem ser úteis na avaliação da perda de fibras finas responsáveis pela sensação de aquecimento.

Thermal record of the test tubes method used for small fibers assessment.

In Brazil, the test that uses test tubes filled with cold water (25ºC) and tubes filled with water heated to a temperature of 45ºC is recommended by the Ministry of Health as a way of evaluate thermal sensitivity on the injured skin of leprosy patients. The purpose of this work was to quantify the thermal stimulation applied to the skin, as well as the temperature variation of the heated water and of the tube's outer surface during stimulation sessions. The experiment had the participation of 14 healthy volunteers (31.2 ± 11.4 years-old), ten of which were male (33.1 ± 13.5 years-old) and four were female (26.5 ± 4.7 years-old). Three consecutive stimulation sessions were carried out, each of them with four stimuli. The maximum skin temperature at the end of the stimuli was measured at 35.8 ± 0.6ºC. Such temperature values may be useful in the assessment of the loss of small fibers, which are responsible for the sensation of warmth.

The discrimination of chromatic textures.

Color discrimination is influenced by chromatic distributions such as they appear on differently illuminated 3D surfaces (T. Hansen, M. Giesel, & K. R. Gegenfurtner, 2008). Here, we measured discrimination thresholds for chromatically variegated stimuli and modeled the data employing a model with multiple chromatic mechanisms. Each mechanism has a differently tuned half-wave-rectified cosine-shaped sensitivity profile centered at a different chromatic direction. To estimate thresholds, the model's responses to a test and a comparison stimulus are determined. A detection variable is calculated by taking the difference of the responses to the two stimuli and by a subsequent nonlinear combination of the responses. The model was fitted to the data presented in T. Hansen et al. (2008) and to data from two new experiments. In the first experiment, we measured discrimination thresholds for stimuli chromatically variegated along a direction orthogonal to the one used in the previous experiments. In the second experiment, we investigated the interplay between chromatic distributions and different mean contrast levels. We found that a model with eight mechanisms accounted for the effect of chromatic variation within the stimuli and provided a better fit to the discrimination thresholds than a four mechanisms model.

Tactile threshold detection in leprosy patients with an electronic algometer.

OBJECTIVE: To propose an electronic method for sensitivity evaluation in leprosy and to compare it to the Semmes-Weinstein monofilaments. METHODS: Thirty patients attending the Dermatology outpatient clinic of HCFMRP-USP were consecutively evaluated by both the electronic aesthesiometer and Semmes-Weinstein monofilaments on hand and foot test points. The intraclass correlation coefficient (ICC) was calculated to determine the variability of the electronic measures and the Kappa coefficient was calculated to determine the agreement between methods according to their categories (altered and non-altered tactile sensitivity). RESULTS: The ICC was approximately 1, demonstrating repeatability. The Kappa coefficient showed more than 75 and 63% agreement on the hand and foot points, respectively. The mean agreement between the 2 methods for the 7 points of the right and left hand was 77.14 and 75.71%, respectively. The mean agreement for all 10 points was 74.33 and 63.66% on the right and left foot, respectively. In cases of disagreement the detection of altered tactile sensitivity by the electronic esthesiometer on the right and left foot was 90.91 and 84.25%, respectively, with no detection by the monofilaments. CONCLUSION: The results suggest that the electronic esthesiometer is a reliable and easy application, capable of evaluating alterations of tactile sensitivity in leprosy patients.

Is there a relationship between light touch-pressure sensation and functional hand ability?

PURPOSE: To investigate and compare the level of light touch-pressure sensation as tested via the Semmes Weinstein monofilament (SWM) test with the level of functional hand ability. METHODS: Twenty-seven persons with isolated sensory deficit due to leprosy and 31 healthy controls were tested in the Occupational Therapy department of a hospital for patients with Hansen's disease. Palmar light touch thresholds were determined by SMW testing. Functional hand ability was tested via the Jebsen-Taylor Hand Function Test (JTHFT) and the Functional Dexterity Test (FDT). All participants were measured by manual muscle testing (MMT) to exclude any motor impairment. Data analysis compared sensory thresholds and level of functional hand ability between the two groups and examined the relationship between the variables. RESULTS: In the group with sensory deficit, the sensory thresholds were significantly higher than in the control group. Significant correlations were found between the sensory thresholds measured by the SWM test and the FDT and JTHFT scores, with higher correlations found for tasks entailing manipulation of small objects. CONCLUSIONS: The findings support the existence of a relationship between sensory light touch thresholds tested by the Semmes Weinstein monofilaments (SWMs) and hand function. However, the SWM test alone is not sufficient as an indicator of hand function and must therefore be supplemented with other hand function tests.

Rehabilitation of insensitive hands.

This article highlights the physical, social and emotional problems faced by persons with insensitive hands and problems of disuse, misuse and overuse. Evaluation of sensation and residual functional capabilities is the first step in planning the process of rehabilitation. Acceptance of disability by the patients and their attitude are important for successful rehabilitation. Possible solutions are suggested.

Sensory testing with monofilaments in Hansen's disease and normal control subjects.

Sensory testing with Semmes-Weinstein filaments was conducted on: 112 normal subjects to determine the effects of age, gender and occupation on threshold perception, 27 Hansen's disease (HD) patients to determine inter-observer and intra-observer reliability of testing, and 101 patients with HD and a history of hand and/or foot ulceration to identify thresholds for injury risk. Filament thresholds were found related to age (p < 0.002) and occupation (p < 0.001) but not gender (p > 0.1). Inter-observer and intra-observer reliability was found to be high (intraclass correlation coefficient = 0.88-0.93). The 4.93 (7.0-7.7 g) filament had 97% sensitivity and 100% specificity for identifying a history of foot injuries, and the 4.17 (1.2-1.6 g) filament had 100% sensitivity and 100% specificity for identifying hand injuries.

Correlation of quantitative tests of nerve and target organ dysfunction with skin immunohistology in leprosy.

Loss of nociception and hypohidrosis in skin are hallmarks of leprosy, attributed to early invasion by Mycobacterium leprae of Schwann cells related to unmyelinated nerve fibres. We have studied skin lesions and contralateral clinically unaffected skin in 28 patients across the leprosy spectrum with a range of selective quantitative sensory and autonomic tests, prior to biopsy of both sites. Unaffected sites showed normal skin innervation, when antibodies to the pan-neuronal marker PGP (protein gene product) 9.5 were used, with the exception of intraepidermal fibres which were not detected in the majority of cases. Elevation of thermal thresholds and reduced sensory axon-reflex flare responses in affected skin correlated with decreased nerve fibres in the subepidermis, e.g. axon-reflex flux units (means+/-SEM) for no detectable innervation; decreased innervation; and clinically unaffected skin, were 23+/-3.1; 41.2+/-7.3; and 84.5+/-4.0, respectively. Reduced nicotine-induced axon-reflex sweating was correlated with decreased innervation of sweat glands. Where methacholine-induced direct activation of sweat glands was affected, there was inflammatory infiltrate and loss of sweat gland structure. This study demonstrates a correlation between selective nerve dysfunction on clinical tests and morphological changes in skin, irrespective of the type of leprosy, and is the first to show that loss of sweating in leprosy may result either from decreased innervation and/or involvement of the sweat glands. The findings have implications for the selection and monitoring of patients with leprosy in clinical trials which aim to restore cutaneous function.

Reference values for touch sensibility thresholds in healthy Nepalese volunteers.

A hundred and thirty-six apparently healthy volunteers between the ages of 16 and 67 were used to determine normative thresholds of tactile sensibility in the Nepali adult population. Tactile sensibility thresholds on standardized sites on hands and feet were assessed for two sensory tests: Semmes-Weinstein monofilaments (SWM) and moving-point discrimination (M2PD). Results are reported as the proportion of subjects able to feel a given threshold. The effect of age, sex, side, occupation, smoking habit and alcohol consumption on the results was examined with quantile regression. On the hand 200 mg seemed an appropriate threshold for 'normal' touch sensibility measured with monofilaments. About 99% (95% confidence interval 97-100) of individuals could detect this filament at all sites. A similar proportion could discriminate two points 4 mm apart which were moved from proximal to distal on the volar pad of the distal phalanx of the index and little finger. For the sole of the foot the thresholds were 2 g and 8 mm. Variability of results was greatest at the heel. Normal thresholds for tactile sensibility were higher than those published for the North American population. Monofilament thresholds suitable for screening were 200 mg (log number 3 center dot 61) and 2 g (log number 4 center dot 31) for hand and foot, respectively. For moving 2-point discrimination on the hand this threshold was 4 mm.

An evaluation of the Semmes-Weinstein 6.10 monofilament as compared with 6 nylon in leprosy patients.

In a previous study Birke and Sims (1986) identified the 5.07 (10 y) Semmes-Weinstein monofilament, as the most useful tool, in measuring protective sensation in the sole of the foot of leprosy patients. This study has demonstrated that the standard 6 Nylon being used in Karigiri, is as good as the monofilament, in assessing protective sensation in leprosy patients. However there is a need for standardising procedures for measuring sensory loss in leprosy patients.