Mislocalization of near-threshold tactile stimuli in humans: a central or peripheral phenomenon?

Modernising tactile acuity assessment; clinimetrics of semi-automated tests and effects of age, sex and anthropometry on performance

Background

Reduced tactile acuity has been observed in several chronic pain conditions and has been proposed as a clinical indicator of somatosensory impairments related to the condition. As some interventions targeting these impairments have resulted in pain reduction, assessing tactile acuity may have significant clinical potential. While two-point discrimination threshold (TPDT) is a popular method of assessing tactile acuity, large measurement error has been observed (impeding responsiveness) and its validity has been questioned. The recently developed semi-automated ‘imprint Tactile Acuity Device’ (iTAD) may improve tactile acuity assessment, but clinimetric properties of its scores (accuracy score, response time and rate correct score) need further examination.

Aims

Experiment 1: To determine inter-rater reliability and measurement error of TPDT and iTAD assessments. Experiment 2: To determine internal consistencies and floor or ceiling effects of iTAD scores, and investigate effects of age, sex, and anthropometry on performance.

Methods

Experiment 1: To assess inter-rater reliability (ICC_(2,1)) and measurement error (coefficient of variation (CoV)), three assessors each performed TPDT and iTAD assessments at the neck in forty healthy participants. Experiment 2: To assess internal consistency (ICC_(2,k)) and floor or ceiling effects (skewness z-scores), one hundred healthy participants performed the iTAD’s localisation and orientation tests. Balanced for sex, participants were equally divided over five age brackets (18–30, 31–40, 41–50, 51–60 and 61–70). Age, sex, body mass index (BMI) and neck surface area were assessed to examine their direct (using multiple linear regression analysis) and indirect (using sequential mediation analysis) relationship with iTAD scores.

Results

Mean ICC_(2,1) was moderate for TPDT (0.70) and moderate-to-good for the various iTAD scores (0.65–0.86). The CoV was 25.3% for TPDT and ranged from 6.1% to 16.5% for iTAD scores. Internal consistency was high for both iTAD accuracy scores (ICC_(2,6) = 0.84; ICC_(2,4) = 0.86). No overt floor or ceiling effects were detected (all skewness z-scores < 3.29). Accuracy scores were only directly related to age (decreasing with increasing age) and sex (higher for men).

Discussion

Although reliability was similar, iTAD scores demonstrated less measurement error than TPDT indicating a potential for better responsiveness to treatment effects. Further, unlike previously reported for TPDT, iTAD scores appeared independent of anthropometry, which simplifies interpretation. Additionally, the iTAD assesses multiple aspects of tactile processing which may provide a more comprehensive evaluation of tactile acuity. Taken together, the iTAD shows promise in measuring tactile acuity, but patient studies are needed to verify clinical relevance.

Concurrent use of somatotopic and external reference frames in a tactile mislocalization task

Localizing tactile stimuli on our body requires sensory information to be represented in multiple frames of reference along the sensory pathways. These reference frames include the representation of sensory information in skin coordinates, in which the spatial relationship of skin regions is maintained. The organization of the primary somatosensory cortex matches such somatotopic reference frame. In contrast, higher-order representations are based on external coordinates, in which body posture and gaze direction are taken into account in order to localise touch in other meaningful ways according to task demands. Dominance of one representation or the other, or the use of multiple representations with different weights, is thought to depend on contextual factors of cognitive and/or sensory origins. However, it is unclear under which situations a reference frame takes over another or when different reference frames are jointly used at the same time. The study of tactile mislocalizations at the fingers has shown a key role of the somatotopic frame of reference, both when touches are delivered unilaterally to a single hand, and when they are delivered bilaterally to both hands. Here, we took advantage of a well-established tactile mislocalization paradigm to investigate whether the reference frame used to integrate bilateral tactile stimuli can change as a function of the spatial relationship between the two hands. Specifically, supra-threshold interference stimuli were applied to the index or little fingers of the left hand 200ms prior to the application of a test stimulus on a finger of the right hand. Crucially, different hands postures were adopted (uncrossed or crossed). Results show that introducing a change in hand-posture triggered the concurrent use of somatotopic and external reference frames when processing bilateral touch at the fingers. This demonstrates that both somatotopic and external reference frames can be concurrently used to localise tactile stimuli on the fingers.

Bilateral representations of touch in the primary somatosensory cortex

According to current textbook knowledge, the primary somatosensory cortex (SI) supports unilateral tactile representations, whereas structures beyond SI, in particular the secondary somatosensory cortex (SII), support bilateral tactile representations. However, dexterous and well-coordinated bimanual motor tasks require early integration of bilateral tactile information. Sequential processing, first of unilateral and subsequently of bilateral sensory information, might not be sufficient to accomplish these tasks. This view of sequential processing in the somatosensory system might therefore be questioned, at least for demanding bimanual tasks. Evidence from the last 15 years is forcing a revision of this textbook notion. Studies in animals and humans indicate that SI is more than a simple relay for unilateral sensory information and, together with SII, contributes to the integration of somatosensory inputs from both sides of the body. Here, we review a series of recent works from our own and other laboratories in favour of interactions between tactile stimuli on the two sides of the body at early stages of processing. We focus on tactile processing, although a similar logic may also apply to other aspects of somatosensation. We begin by describing the basic anatomy and physiology of interhemispheric transfer, drawing on neurophysiological studies in animals and behavioural studies in humans that showed tactile interactions between body sides, both in healthy and in brain-damaged individuals. Then we describe the neural substrates of bilateral interactions in somatosensation as revealed by neurophysiological work in animals and neuroimaging studies in humans (i.e., functional magnetic resonance imaging, magnetoencephalography, and transcranial magnetic stimulation). Finally, we conclude with considerations on the dilemma of how efficiently integrating bilateral sensory information at early processing stages can coexist with more lateralized representations of somatosensory input, in the context of motor control.

Within, but not between hands interactions in vibrotactile detection thresholds reflect somatosensory receptive field organization

Detection of a tactile stimulus on one finger is impaired when a concurrent stimulus (masker) is presented on an additional finger of the same or the opposite hand. This phenomenon is known to be finger-specific at the within-hand level. However, whether this specificity is also maintained at the between hand level is not known. In four experiments, we addressed this issue by combining a Bayesian adaptive staircase procedure quick estimation of threshold (QUEST) with a two-interval forced choice (2IFC) design in order to establish threshold for detecting 200 ms, 100 Hz sinusoidal vibrations applied to the index or little fingertip of either hand (targets). We systematically varied the masker finger (index, middle, ring, or little finger of either hand), while controlling the spatial location of the target and masker stimuli. Detection thresholds varied consistently as a function of the masker finger when the latter was on the same hand (Experiments 1 and 2), but not when on different hands (Experiments 3 and 4). Within the hand, detection thresholds increased for masker fingers closest to the target finger (i.e., middle > ring when the target was index). Between the hands, detection thresholds were higher only when the masker was present on any finger as compared to when the target was presented in isolation. The within hand effect of masker finger is consistent with the segregation of different fingers at the early stages of somatosensory processing, from the periphery to the primary somatosensory cortex (SI). We propose that detection is finger-specific and reflects the organization of somatosensory receptive fields in SI within, but not between the hands.