A laboratory exercise in somesthesis that is expeditious, inexpensive, and suitable for large classes

J. D. Greenspan
Advan in Physiol Edu 265:S2-S9, 1993. You might find this additional info useful... Updated information and services including high resolution figures, can be found at: http://advan.physiology.org/content/265/6/S2.citation Additional material and information about Advances in Physiology Education can be found at: http://www.the-aps.org/publications/advan

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Advances in Physiology Education is dedicated to the improvement of teaching and learning physiology, both in specialized courses and in the broader context of general biology education. It is published four times a year in March, June, September and December by the American Physiological Society, 9650 Rockville Pike, Bethesda MD 20814-3991. Copyright 1993 by the American Physiological Society. ISSN: 1043-4046, ESSN: 1522-1229. Visit our website at http://www.the-aps.org/.

A LABORATORY EXPEDITIOUS,

EXERCISE FOR LARGE

IN

SOMESTHESIS AND CLASSES

THAT

IS

INEXPENSIVE,

SUITABLE

Joel D. Greenspan Departments of Neurosurgery and Physiology, State University of New York: Health Science Center at Syracuse, Syracuse, New York I.3210

teaching laboratory is described that demonstrates two principles of the somatosensory system: 1) the spot-like nature of skin sensitivity and 2) tactile acuity. This laboratory has been used for a large medical school class (140-160 students). One reason for the success of this laboratory is the ability to provide a sufficient number of stimulating apparatuses. The two-point discrimination device used to measure tactile acuity can be made easily and cheaply. In addition, two other demonstrations are described that are suitable for smaller classes or that students can do on their own. Although this lab was designed for medical students, the content makes it suitable for undergraduate or high school students.
265 (ADI? PHKSIOL. EDUC. 10): S2-S9,

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AM. J. PHYSIOL.

1993.

teaching;

temperature

sense; touch; tactile acuity

Most educators agree that a hands on laboratory experience will enhance learning of scientific subjects. However, when classesare large, there is too much demand for time, space, and supplies to allow all students such an opportunity. The present student laboratory exercise was designed with these factors in mind and was presented to first-year medical students during the sensory systems portion of their neuroscience course. The classsize was approximately 150 students. The laboratory has been given each year since 1991 and was designed to demonstrate two properties of the somatosensory system: 1) the discrete nature of sensitive spots on the skin and 2) the concept of tactile acuity. Although this laboratory was designed for medical students, the phenomena and basic principles can easily be understood and appreciated by Jndergraduate or high school students. PROCEDURE Equipment One key to having a reasonable classroom aboratory exercise is having a sufficient number of: ppara1043 - 4046 / 93 - $2.00 - COPYRIGHT o 1993

tuses for the students to use. This laboratory uses two devices that are inexpensive enough to use in very large classes.The first is a ballpoint pen, which the students will provide themselves, and the second is a homemade two-point stimulator. The two-point stimulator is made from a 6-h. plastic ruler and two paper clips (Fig. 1). One of the paper clips is cut to produce two straight pieces. One of these pieces is taped (or glued) to the 0 edge of the ruler. The other piece is taped (or glued) to the intact paper clip, which is then clipped to the plastic ruler so that it can slide up and down the ruler. The intact clip is positioned on the ruler so that the two straight pieces can touch one another at the 0 end of the ruler. By sliding the paper clip up and down the ruler, the two straight pieces can be separated by any length indicated on the ruler. Protocol The students received a lecture on the somatosensory system before this laboratory and were assigned appropriate readings from the course textTHE AMERICAN PHYSIOLOGICAL SOCIETY

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FIG. Thls two-point threshold device made. Despite its unassuming reasonably accurate data.

1. is inexpensively appearance,

10

15

20

Number

of

cool

spots

and quickly it can provide

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Distribution of no. of cool school class (n = 146).

FIG. 2. spots mapped

by 1st.yr

medical

book (6; chapters 24-26). The students then met in the lecture hall normally used for this course and were instructed to review their handouts (reproduced in APPENDIX). After reading the handout, the students were given an overview of how to proceed with the laboratory, and any questions were answered. Next, 50 two-point devices were handed out, and students were told to form groups of three to carry out the exercise. After completing the data collection, the students turned in their data sheets (see APPENDIX) and were told that their group results would be presented at the next lecture period. Data Analysis For the cool spot mapping, the class distribution of the number of cool spots was determined. For the two-point thresholds, the class distribution of values was determined at each test site. Also, the mean and standard deviation of two-point threshold were calculated for each skin site. RESULTS The group results and other relevant information were presented to the students at the next class meeting. Cool Spot Mapping All students recognized the discrete nature of cool spots on the skin (See COOL SPOT MAPPING LAB

DATA SHEET in APPENDIX). The modal report from one class was 7 cool spots out of 20. The class distribution was unimodal and roughly normal (Fig. 2). This type of temperature spot mapping has a long history as both a research tool and a laboratory exercise. Examples of class data can be presented to the students that show the discontinuous distribution of both warm and cool spots (Fig. 3). It should be pointed out that our senses of touch and pain also show a punctate nature. The difference is that mechanoreceptors and nociceptors are more densely concentrated than warm or cool receptors, making it more difficult to find insensitive areas between sensitive spots. Two-Point Discrimination

All students observed an increase in two-point threshold as they progressed from the fingertip to the palm (Fig. 4). The class distribution of two-point thresholds at each site was unimodal and roughly normally distributed (Fig. 5). The class mean values can be compared with published data on two-point thresholds (Table 1 and Refs. 8 and 9). Furthermore, these thresholds can be related to the density of cutaneous mechanoreceptors in this part of the hand. The receptor density estimates reported by Johansson and Vallbo (5) were derived

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FICL IV.

Fro.

V.

FIU. W.-Map of the heat-spots rrrld cold-s Jots on the back of the left hand. Dots intlicnto co1a ; circles, heat ; the larger OIJCS Extent, 2 x 8 ems. represent the spots which give a strong rextion ; the smaller, those mhlclr the bottom central. ive a weak one. The top of the map is peripileral, 9 he right aide is the radial ; the left the ubr. FIQ. V.-Similar may for the symmetricd portion of the right hand of the mrne individual. In thiy case, of cowye, the left side is tile radial, and the right the ulnar.

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B
X

2 .b

C0 ld

Cbnposite
cold

Cbmpite w arm
PI&Am I

MAPS 01 COLD AND WARM SPOT m-t D hea f aq.cm. FIG. 3.

Examples of classic permission of Oxford Illinois Press (Urbana, temperature Univ. Press. IL).] spot B: from mapping. Dallenbach [A: from Donaldson (3) (1) by permission of Univ. by of

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Two-point

discrimination

TABLE 1. results

from

classic

papers

Weber, 1834 (Translated in Ross and Murray, Body site Distal phalanx of fingers Middle phalanx of fingers Palm of hand Weinstein, 1968 Body site Fingers (not specified) Palm of hand

1979) Two-point threshold 2.2 mm 4.5 mm 11.2 mm Two-point threshold 3-4 mm lo-11 mm

TIP

DISTAL

PROXIMAL

THENAR

Stimulus

site

Two-point

thresholds

FIG. 4. (means + SD) for each stimulus

site.

from two types of data. First, a single-unit electrophysiological survey of mechanoreceptors in the human median nerve produced a data set of > 300 units. There are four types of mechanoreceptors routinely described in the human glabrous skin,
Finger tip

each with its unique electrophysiological properties and each associated with a specialized structural ending: I) rapidly adapting (Meissners corpuscle), 2) slowly adapting type I (Merkel cell complex), 3) slowly adapting type II (Ruffini endings), and $) Pacinian corpuscle (9). The receptive fields of these units were precisely localized, and thus the relative density of each mechanoreceptor type could be calculated. Second, a section of human median nerve was examined histologically and found to
40 ul r

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Distal

phalanx

10

12

14

16

18

20

10

12

14

16

18

20

Probe

separation

(mm)

Probe

separation

(mm)

Proximal

phalanx

LU
c

Palm

of hand

10

12

14

16

18

20

10

12

14

16

18

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Probe

separation Distribution

(mm) FIG. of two-point 5. thresholds

Probe

separation

(mm)

for each site.

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160 m j m m Tip Distal Proximal Thenar of Digit Phalanx Phalanx

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RA-Meissner

SAI-Merkel

SAII-Ruffini

PC-Pacinian

Mechanoreceptor
Innervation Johansson density of cutaneous and Vallbo (5).] FIG. 6. mechanoreceptors

type
in the human hand. [Based on

contain 27,300 large myelinated nerve fibers. These two pieces of information were combined to estimate the absolute innervation density of the four types of mechanoreceptors for various parts of the human hand. One can see that there is an inverse relationship between two-point threshold and mechanoreceptor density that is most striking for the rapidly adapting and slowly adapting type I mechanoreceptors (compare Fig. 4 and Fig. 6).
DISCUSSION

always two points), they would have a bias toward giving that answer. The students should recognize that proper testing of sensation, whether in an experimental laboratory or in a clinic, should avoid giving the idea that a particular answer is correct or desired. At the conclusion of the class handout (see APPENDDE), there are some questions for the students to consider. The first and the fourth questions are explicitly addressed during the second class. The second and third questions, having to do with sources of error and procedural modifications to compensate or obviate these errors, should be a point of some discussion after the students have worked through the exercise. At least they should recognize the biasing effect that foreknowledge of the stimulus sequence can have. With a longer period in which to do this laboratory, the students could also incorporate a less predictable sequence of stimuli in the two-point threshold test. I also give the students two other demonstrations of temperature sensitivity to try on their own. These demonstrations could be done as class experiments

The experiential phenomena of these demonstrations are quite reliable and easily appreciated. Despite the simplicity of the observations, they often come asa surprise to people. Part of the class discussion on the second day centers on the reliability of the classdata. One thing that most students discover by doing this lab is that they are sometimes uncertain whether they felt cool or not, or whether they felt one or two points. They should realize that ambiguous sensations will occur in tests such as these. In this situation, because they knew what the correct answer was supposed to be (e.g., the probe was always cool, and there were

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with a smaller group. The first is an example of the relative vs. absolute nature of temperature sensation. Start with three buckets ofwater: one cold, one hot (but not painful), and one close to skin temperature (neutral). First, put one hand in the cold water and the other hand in the hot water. Leave them in for - 1 min, during which time the water will gradually feel less cold and less hot. This is the process of adaptation. Then, place both hands in the third bucket of water; one will experience a sense of warmth in the hand that was in the cold water, and coolness in the hand that was in the hot water. This demonstrates that thermoreceptors respond to the change in temperature that the skin undergoes rather than the absolute temperature per se. The second demonstration shows how our sense of touch influences our sense of temperature. Three coins will be needed, two chilled by refrigeration, and the third near skin temperature. Place the three coins in a row on a desk, with the cold coins on either side of the warmer coin. Then place the tips of three fingers on the three coins simultaneously. One will have a powerful illusion that all three coins are cold. Our sense of touch can localize events on the body very well. In contrast, our senses of warmth and coolness do not. Most of the time, we feel warm and cool from objects that touch us, and we localize the stimulated body site on the basis of the tactile information. In this artificial situation, the cool sensations are referred to all three tactile sites.
The temperature spot mapping laboratory exercise is not new. In Karl Dallenbachs classic paper (1)) he remarks, The localization and mapping of the cold and warm spots is usually the first

experiment performed Cornell (p. 402).

in the qualitative

laboratory

course

at

More recent scholars of somatosensation who have used this laboratory exercise include Drs. Dan R. Kenshalo, Sr., Glenn J. Giesler, and Ken D. Cliffer. My thanks to Dr. Cliffer for pointing out the usefulness of the inexpensive and readily available cool probe. The phenomenon of the three-coin scribed by Dr. Barry G. Green (4). Received 8 March
1993;

illusion

was originally

de-

accepted

in final form

9 July 1993.

References
1. Dallenbach, 2.

3. 4.

5.

6. 7. 8. 9.

10.

K. M. The temperature spots and end-organs. Am. J. Psychol. 39: 402-427, 1927. Dellon, A. L. Evaluation of Sensibility and Re-Education of Sensation in the Hand. Baltimore: Williams & Wilkins, 1981. Donaldson, H. H. On the temperature sense. Mind 10: 399--416,1885. Green, B. G. Thermo-tactile interactions: effects of touch on thermal localization. In: Sensory Functions of the Skin in Humans, edited by D. R. Kenshalo. NewYork: Plenum, 1979. Johansson, R. S., and A. B. Vallbo. Tactile sensitivity in the human hand: relative and absolute densities of four types of mechanoreceptive units in glabrous skin. J. Pbysiol. Land. 286: 283-300, 1979. Kandel, E. R., J. H. Schwartz, and T. M. Jessell. Principles of Neural Science. New York: Elsevier, 199 1. Rivers, W. H. R., and H. Head. A human experiment in nerve division. Brain 31: 323-450, 1908. Ross, H. E., and D. J. Murray. E. H. Weber: 7&e Sense of Touch. New York: Academic, 1978. Vallbo, A. B., and R. S. Johansson. Properties of cutaneous mechanoreceptors in the human hand related to touch sensation. Human Neurobiol. 3: 3-14, 1984. Weinstein, S. Intensive and extensive aspects of tactile sensitivity as a function of body part, sex, and lateral&y. In: Z%e Skin Senses, edited by D. R. Kenshalo. Springfield, MA: Charles C. Thomas, 1968.

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Teachers and their students may find the following articles from News in Physiological Sciences useful when exploring the physiology of the preceding paper:
Cervero, F., and J. M. A. Laird. One pain or many pains? A new look at pain mechanisms. NIPS 6: 268-273, 1991. D. L. New insights regarding organization of spinal cord pain pathways. NIPS 4: 98-101, 1989. Hammond,

Tenney, S. M. Itching. In Notes, NIPS 8:

Verley,

96,

1993.

R. Reorganization of the somatosensory cerebral cortex after peripheral damage. NIPS 1: 15-19, 1986.

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APPENDIX STUDENT HANDOUT FOR SOMATOSENSORY PSYCHOPHYSICS LAB AgeCOOL SPOT MAPPING Subject name MS1 Neuroscience Course, 1993 Dr. Joel D. Greenspan For this laboratory, you will work in groups of three. Each one of you will take turns being the experimenter, the subject, and the record keeper. Each person, then, will have hidher own laboratory data sheets to turn in at the end. I. Thermal sensitivity
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LAB DATA

SHEET

Sex-

Handedness

Indicate with a filled circle which spots provided a sensation of coolness, and use a hollow circle for spots that were otherwise.

We will begin this laboratory with a demonstration of the discrete nature of cutaneous sensitivity. If you use a stimulating probe that is small enough, you can determine spots on your skin that are particularly sensitive, and other spots that are less so. This phenomenon is most apparent with your sense of coolness, which we will examine today. You will be using a ballpoint pen to serve as your stimulator. Since the pen tip is a good heat sink, and is cooler than your skin, it provides an adequate cooling stimulus. The subject should be seated, and not able to see the stimulus application. Usually, the subject would be blindfolded, but in this case, well count on the subject keeping his/her eyes closed. The subject will place his/her left hand on the table, palm down. The experimenter will envision a twenty grid array on the middle phalange of digit three (see figure in lab data sheet). If digit three is injured, use another digit or the right hand. The experimenter will lightly touch the subjects finger at each of these twenty spots. He/she should maintain contact with the skin for 2-3 seconds (enough contact to indent the skin a slight amount), and then remove the pen. Then, the subject will say whether he/she felt a cool sensation or not, and the record keeper will write down the response. The experimenter should wait 5-6 seconds before the next stimulus. You may wish to practice at a few points first before collecting the data. At the end, you will have a map of cool spots, as well as a count of how many of the 20 spots felt cool. We will look at the class distribution of cool spot density at a later class. Consider what the anatomical and/or physiological basis of your results are (Kandel, Schwartz, and Jessell, Chap. 24).

Total # cool spots:Experimenter name Record keeper name II. Tactile (two-point)

/20

discrimination

The class will perform a set of experiments to evaluate one measure of tactile acuity: two-point discrimination. As before, you will work in groups of three, each taking turns at being the subject, the experimenter, and the record keeper. The basic question that you will be asking is, How much of a separation between two points is needed in order to perceive them as two distinct points? The minimal separation that is needed for perceiving two distinct points is called the two-point threshold. You will determine the two-point threshold on different sites of your hand, in order to demonstrate the extent of regional variability. The seminal work on tactile sensitivity was done over 100 years ago by the German experimental psychologist Ernst H. Weber. An English translation of his most influential works appears in E. H. Weber: The Sense of Touch (translated by H. E Ross and D.J. Murray, Academic Press, 1978). Since that time, there

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have been somerefinements in tools and protocols, but the basic approach hasbeen used for various purposes in research and in diagnostic medicine. For instance, A. Lee Dellon describesthe many sensory testing procedures that he uses when evaluating recovery from nerve damage(Evaluation of Sensibility and Re-education of Sensation in the Hand, Williams and Wilkins Pub., 1981). Also, the classic paper by W.H.R. Rivers and Henry Head, A Human Experiment in Nerve Division (Brain, 3 1:323-450, 1908) describesin considerable detail the sensory changesthat occurred over the course of several years following Dr. Heads voluntary division of his radial nerve. This lab will not be quite as demanding. The protocol that you will be using is the method of limits. For the sake of time, you will perform one ascending series of stimuli (e.g., progressively larger point separations),and one descendingseriesof stimuli for each skin site tested. Normally, one would repeat theseseriesseveral times and determine an average. The subject should be seated, with his/her eyes closed. To begin an ascendingseries,the experimenter setsthe two-point device so that the two probes are as close as possible. The experimenter applies the stimulus by pushing the probes down on the desired skin site for 2-3 sec. The subject then reports whether he/she felt one or two points. As long as the subject reports one, the experimenter increasesthe distance between the two points from stimulus to stimulus, being careful to use a consistent amount of force each time. When the subject gives a responseof two, the ascending series is over, and the record keeper notes the separation that was used to evoke the responseof two. Technically, the record keeper should use the value half-way between the separation that yielded a responseof two, and the previous separationthat was perceived as one. Thus, if you were increasing the separation in l-mm steps (ascending series), and the first response of two was given at a separation of 8mm, then the threshold value of that serieswould be 7Smm (since the previous stimulus of 7mm yielded a responseof one). To begin the descendingseriesof stimuli, adjust the two point device so that it has a separation several millimeters greater than the threshold determined by the ascendingseries. Then, the experimenter repeatsthe stepsdescribedabove, only this time the separationis reduced each time the subject reports two, until you reach a separationthat is perceived as one. You will then take the average of the ascending and the descendingseries thresholds to determine that subjectstwo-point threshold for that skin site. You will be testing four sites on each subjectsright hand (palmar surface). Site #l is the tip of digit 2; site #2 is the proximal half of the distal phalanx; site #3 is

the middle of the proximal phalanx of digit 2; site #4 is the middle of the thenar eminence. If a person has an injury on digit 2, another digit should be used. Group results will be presentedto you later. After conducting the experiments and recording the results on the attached lab sheet,consider the following questions: What were you able to determine about regional variation of tactile acuity? What sources of error could affect the results of these experiments? What procedural modifications could reduce or eliminate sucherrors? What neuroanatomical and neurophysiological features determine two-point threshold? (Refer to chapter 26 in Kandel, Schwartz, and Jessell)
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TWO-POINT DISCRIMINATION LAB DATA SHEET Subject name Age Sex ,-, Handedness right hand.

Site #l: Tip of digit # -

Ascending series threshold: mm Descending series threshold: mm Average two-point threshold: mm Site #2: Proximal half of distal phalanx of digit # right hand. Ascending series threshold: mm Descending series threshold:mm Average two-point threshold:,-mm Site #3: Middle of proximal phalanx of digit # right hand. Ascending series threshold: mm Descending series threshold: -mm Average two-point threshold:mm Site #4: Thenar eminence,right hand. Ascending series threshold: mm Descending series threshold: ,- mm Average two-point threshold: mm Experimenter name Record keeper name , ,

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