Normal distributions of thermal and vibration sensory thresholds
Corresponding Author
Gillian Bartlett MSc
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
Division of Clinical Epidemiology, the Montreal General Hospital, 1650 Cedar Avenue Montreal, Quebec, H3G 1A4, Canada
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, CanadaSearch for more papers by this authorJohn D. Stewart MB, BS, FRCP(C)
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
Search for more papers by this authorRobyn Tamblyn PhD
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
Health Services and Outcomes Research Group, the Royal Victoria Hospital, Montreal, Quebec, Canada
Search for more papers by this authorMichal Abrahamowicz PhD
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
Division of Clinical Epidemiology, the Montreal General Hospital, 1650 Cedar Avenue Montreal, Quebec, H3G 1A4, Canada
Search for more papers by this authorCorresponding Author
Gillian Bartlett MSc
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
Division of Clinical Epidemiology, the Montreal General Hospital, 1650 Cedar Avenue Montreal, Quebec, H3G 1A4, Canada
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, CanadaSearch for more papers by this authorJohn D. Stewart MB, BS, FRCP(C)
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
Search for more papers by this authorRobyn Tamblyn PhD
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
Health Services and Outcomes Research Group, the Royal Victoria Hospital, Montreal, Quebec, Canada
Search for more papers by this authorMichal Abrahamowicz PhD
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
Division of Clinical Epidemiology, the Montreal General Hospital, 1650 Cedar Avenue Montreal, Quebec, H3G 1A4, Canada
Search for more papers by this authorAbstract
The distributions of sensory thresholds were estimated in a healthy population while controlling for potential covariates. Using the method of levels and the two-alternative forced choice, thermal and vibration thresholds respectively were measured in the hand and foot of 148 subjects. Age was uniformly distributed between 20 and 86 years. Independent effects of age, gender, height, and skin temperature were estimated using multiple linear regression. Parametric and nonparametric methods were used to estimate the distributions of interest. Significant age-related increases were observed for all vibration thresholds (P < 0.0001), and for thermal thresholds in the foot (P < 0.0002). Percentiles were estimated for thermal thresholds in the hand and age-adjusted continuous distributions were calculated for all other thresholds. Height was positively associated with vibration thresholds in the foot (P < 0.003), and appropriate corrections were made. Our results provide reference values for thermal and vibration sensory thresholds in a healthy population, allowing for the accurate diagnosis of disordered sensory function. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21:367–374, 1998.
References
- 1 Aaserud O, Juntunen J, Matikainen E: Vibration sensitivity thresholds: methodological considerations. Acta Neurol Scand 1990; 82: 277–283.
- 2 Abrahamowicz M, Ciampi A, Ramsay J: Nonparametric density estimation for censored survival data: regression spline approach. Can J Statistics 1992; 20: 171–185.
- 3 Akaike H: A new look at the statistical model identification. IEEEE Trans Automatic Control 1974; AC19: 716–723.
- 4 American Diabetes Association: Report and recommendations of the San Antonio Conference on diabetic neuropathy. Diabetes 1988; 37: 1000–1004.
- 5 Arezzo JC, Schaumburg HH, Laudadio C: Thermal sensitivity tester: device for quantitative assessment of thermal sense in diabetic neuropathy. Diabetes 1986; 35: 590–592.
- 6 Bertelsmann FW, Heimans JJ, Weber EJM, Van der Veen EA, Schouten JA: Thermal discrimination thresholds in normal subjects and in patients with diabetic neuropathy. J Neurol Neurosurg Psychiatry 1985; 48: 686–690.
- 7 Bleecker ML: Quantifying sensory loss in peripheral neuropathies. Neurobehav Toxicol Teratol 1985; 7: 305–308.
- 8 Bravenboer B, van Dam PS, Hop J, v. d. Steenhoven J, Erkelens DW: Thermal threshold testing for the assessment of small fibre dysfunction: normal values and reproducibility. Diabet Med 1992; 9: 546–549.
- 9 Brown MJ, Asbury AK: Diabetic neuropathy. Ann Neurol 1984; 15: 2–12.
- 10 Deng H, He F, Zhang S, Calleman CJ, Costa LG: Quantitative measurements of vibration threshold in healthy adults and acrylamide workers. Int Arch Occup Environ Health 1993; 65: 53–56.
- 11 Doeland HJ, Nauta JJ, van Zandbergen JB, van der Eerden HA, van Diemen NG, Bertelsmann FW, Heimans JJ: The relationship of cold and warmth cutaneous sensation to age and gender. Muscle Nerve 1989; 12: 712–715.
- 12
Dorfman LJ,
Robinson LR:
AAEM minimonograph #47: Normative data in electrodiagnostic medicine.
Muscle Nerve
1997;
20:
4–14.
10.1002/(SICI)1097-4598(199701)20:1<4::AID-MUS1>3.0.CO;2-H CAS PubMed Web of Science® Google Scholar
- 13 Era P, Jokela J, Suominen H, Heikkinen E: Correlates of vibrotactile thresholds in men of different ages. Acta Neurol Scand 1986; 74: 210–217.
- 14 Feinstein AR: Clinical Epidemiology: The Architecture of Clinical Research. Philadelphia, W. B. Saunders, 1958.
- 15 Feldman EL, Stevens MJ: Clinical testing in diabetic peripheral neuropathy. Can J Neurol Sci 1994; 21: S3–S7.
- 16 Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA: A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 1994; 17: 1281–1289.
- 17 Fowler CJ, Carroll MB, Burns D, Howe N, Robinson K: A portable system for measuring cutaneous thresholds for warming and cooling. J Neurol Neurosurg Psychiatry 1987; 50: 1211–1215.
- 18 Gerr F, Hershman D, Letz R: Vibrotactile threshold measurement for detecting neurotoxicity: reliability and determination of age- and height-standardized normative values. Arch Environ Health 1990; 45: 148–154.
- 19 Gerr F, Letz R: Vibrotactile threshold testing in occupational health: a review of current issues and limitations [review]. Environ Res 1993; 60: 145–159.
- 20 Gerr F, Letz R: Covariates of human peripheral nerve function: II. Vibrotactile and thermal thresholds. Neurotoxicol Teratol 1994; 16: 105–112.
- 21 Gerr F, Letz R, Hershman D, Farraye J, Simpson D: Comparison of vibrotactile thresholds with physical examination and electrophysiological assessment. Muscle Nerve 1991; 14: 1059–1066.
- 22 Goldberg JM, Lindblom U: Standardised method of determining vibratory perception thresholds for diagnosis and screening in neurological investigation. J Neurol Neurosurg Psychiatry 1979; 42: 793–803.
- 23 Gruener G, Dyck PJ: Quantitative sensory testing-methodology, applications and future directions [review]. J Clin Neurophysiol 1994; 11: 568–583.
- 24 Guy RJ, Clark CA, Malcolm PN, Watkins PJ: Evaluation of thermal and vibration sensation in diabetic neuropathy. Diabetologia 1985; 28: 131–137.
- 25 Hilz MJ, Claus D, Neundorfer B: Early diagnosis of diabetic small fiber neuropathy by disturbed cold perception. J Diabetes Complications 1988; 2: 38–43.
- 26 Jacobs JM, Love S: Qualitative and quantitative morphology of human sural nerve at different ages. Brain 1985; 108: 897–924.
- 27
Jensen TS,
Bach FW,
Kastrup J,
Dejgaard A,
Brennum J:
Vibratory and thermal thresholds in diabetics with and without clinical neuropathy
Acta Neurol Scand
1991;
84:
326–333.
[published erratum appears in
Acta Neurol Scand
1992;
85:
159–160].
10.1111/j.1600-0404.1992.tb04019.x Google Scholar
- 28 Kojo I, Pertovaara A: The effects of stimulus area and adaptation temperature on warm and heat pain thresholds in man. Int J Neurosci 1987; 32: 875–880.
- 29 Lautenbacher S, Strian F: The role of body size in somatosensory testing. Electromyogr Clin Neurophysiol 1993; 33: 113–118.
- 30 Lindblom U: Quantitative testing of sensibility including pain, in E Stalberg, R Young (eds): Clinical Neurophysiology. London, Butterworths, 1980, pp 169–190.
- 31 Maser RE, Nielsen VK, Bass EB, Manjoo Q, Dorman JS, Kelsey SF, Becker DJ, Orchard TJ: Measuring diabetic neuropathy. Assessment and comparison of clinical examination and quantitative sensory testing. Diabetes Care 1989; 12: 270–275.
- 32 Merchut MP, Toleikis SC: Aging and quantitative sensory thresholds. Electromyogr Clin Neurophysiol 1990; 30: 293–297.
- 33 Nico J, de Neeling JN, Beks PJ, Bertelsmann FW, Heine RJ, Bouter LM: Sensory thresholds in older adults: reproducibility and reference values. Muscle Nerve 1994; 17: 454–461.
- 34 O'Brien PC, Dyck PJ: Procedures for setting normal values. Neurology 1995; 45: 17–23.
- 35 Ochoa JL, Mair WGP: The normal sural nerve in man: I. Ultrastructure and numbers of fibres and cells. Acta Neuropathol 1969; 13: 197–216.
- 36 Peripheral Neuropathy Association: Quantitative sensory testing: a consensus report from the Peripheral Neuropathy Association. Neurology 1993; 43: 1050–1053.
- 37 Pertovaara A, Kojo I: Influence of the rate of temperature change on thermal thresholds in man. Exp Neurol 1985; 87: 439–445.
- 38 Rabinovitch MA, Rose CP, Schwab AJ, Fitchett DH, Honos GN, Stewart JA, Chen LF, Castilla EP, Gomez AA, Abrahamowicz M: A method of dynamic analysis of iodine-123-metaiodobenzylguanidine scintigrams in cardiac mechanical overload hypertrophy and failure. J Nucl Med 1993; 34: 589–600.
- 39 Redmond JM, McKenna MJ, Feingold M, Ahmad BK: Sensory testing versus nerve conduction velocity in diabetic polyneuropathy. Muscle Nerve 1992; 15: 1334–1339.
- 40 Said G, Goulon-Goeau C, Slama G, Tchobroutsky G: Severe early-onset polyneuropathy in insulin-dependent diabetes mellitus: a clinical and pathological study. N Engl J Med 1992; 326: 1257–1263.
- 41 Stewart JD, Nguyen DM, Abrahamowicz M: Quantitative sweat testing using acetylcholine for direct and axon reflex mediated stimulation with silicone mold recording: controls versus neuropathic diabetics. Muscle Nerve 1994; 17: 1370–1377.
- 42 Thomson FJ, Masson EA, Boulton AJ: Quantitative vibration perception testing in elderly people: an assessment of variability. Age Ageing 1992; 21: 171–174.
- 43 Verdugo RJ, Ochoa JL: Quantitative somatosensory thermotest: a key method for functional evaluation of small calibre afferent channels. Brain 1992; 3: 893–913.
- 44 Wiles PG, Pearce SM, Rice PJ, Mitchell JM: Vibration perception threshold: influence of age, height, sex, and smoking and calculation of accurate centile values. Diabet Med 1991; 8: 157–161.
- 45
Yarnitsky D:
Quantitative sensory testing.
Muscle Nerve
1997;
20:
198–204.
10.1002/(SICI)1097-4598(199702)20:2<198::AID-MUS10>3.0.CO;2-# CAS PubMed Web of Science® Google Scholar
- 46 Yarnitsky D, Ochoa JL: Warm and cold specific somatosensory systems. Psychophysical thresholds, reaction times and peripheral conduction velocities. Brain 1991; 114: 1819–1826.
- 47 Yarnitsky D, Sprecher E: Thermal testing: normative data and repeatability for various test algorithms. J Neurol Sci 1994; 125: 39–45.
- 48 Young MJ, Breddy JL, Veves A, Boulton AJ: The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study. Diabetes Care 1994; 17: 557–560.