The effect of wrist position sense and tactile recognition on manual skills in patients with upper extremity neuropathy.

Abstract

Background: Peripheral neuropathy affects fine motor skills in daily life. However, reports on the effects of position sense and tactile recognition on manual dexterity are quite scarce in the literature. The increasing focus on hand rehabilitation has created a need to examine the effects of sensation on manual dexterity.

Purpose: The purpose of this study is to compare the effect of tactile recognition and wrist position sense on manual skills in healthy and neuropathy individuals and to investigate the relationship between them.

Study design: Cross-sectional, non-randomized comparative clinical study.

Methods: Thirty-seven (50 hands) with median and ulnar nerve neuropathy between the ages of 18 and 65 years and 32 (64 hands) healthy individuals of similar age and gender were included in the study. Wrist position sense was assessed using the K-FORCE Sens electrogoniometer as target angle, 30° wrist flexion and extension, and 10° radial and ulnar deviation. Shape-Texture Identification Test (STI), Purdue Pegboard test (PPT), and Michigan Hand Outcome Questionnaire were applied for tactile recognition, manual dexterity, and hand functions, respectively. The independent-sample t test and Mann-Whitney U test were used for K-FORCE Sens, STI, and PPT to compare groups. Correlation coefficient was used to determine the relationship between variables.

Results: The mean age of individuals with neuropathy and healthy individuals was 45.7 ± 10.3 and 44.5 ± 9.2 years, respectively (p > 0.05). Seventy-three percent of individuals had median neuropathy and 27% had ulnar neuropathy. Totally, 33 dominant and 17 non-dominant hands of patients with neuropathy were affected. When healthy and neuropathic hands were compared, the mean error values in the dominant hand, flexion (4.4 ± 1.4; 6.5 ± 2.9), and radial deviation (2.4 ± 1.0; 3.3 ± 1.7) degrees were higher in the neuropathic hands (p < 0.05). Similar results were also found in the non-dominant hands. However, there was no difference between the mean error values in the extension and ulnar deviation degrees (p > 0.05). STI and PPT subtest results were also lower in the neuropathic hands (p < 0.05). There was a relationship between the mean error values of position sense in the flexion and radial deviation directions in the neuropathic dominant hands and all subtests of the PPT (p < 0.05), while there was a relation in the flexion direction in the non-dominant hand (p < 0.05). No relation was found in the Michigan Hand Outcome Questionnaire test (p > 0.05).

Conclusions: This study has shown that in neuropathy rehabilitation, the assessment of position and tactile sensations should not be ignored in determining participation in manual skills. This article can be used as a starting point for further studies and can be considered as one of the sensory focal points in rehabilitation in the development of manual skills.