Effect of stimulus force on perioral direction discrimination: clinical implications

Clinicians have used the same instrument (viz, Semmes-Weinstein pressure aesthesiometers [Research Design, Inc, Houston, TX] or "von Frey hairs") for tests of both contact detection and direction discrimination. However, patients' ability to discriminate direction may be underestimated by barely detectable moving stimuli. To determine whether the aesthesiometers underestimate direction discrimination, we evaluated the capacity of 13 normal subjects to distinguish opposing directions provided by 10 different hairs. The hairs were selected to deliver forces below and above the contact-detection threshold. Each was stroked over 1.0 cm of perioral skin at the velocity at which the subject was predicted to best discriminate direction of motion. It was found that valid estimates of perioral direction discrimination can be obtained with appropriately selected aesthesiometers. Specifically, the least stiff hair whose handle displays a manufacturer's marking two units greater than that of the contact-detection "threshold hair" should be used to deliver the moving stimuli. The resultant force applied by this hair will exceed 10 times the subject's contact-detection threshold force. If a less-stiff hair is used, the capacity to distinguish direction may be underestimated.