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 Discrimination and Stereognosis
i

COMPARISION OF FINGER TWO-POINT DISCRIMINATION AND

STEREOGNOSIS AND THEIR INFLUENCE ON HAND FUNCTION

By
Joseph D. Dorini

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A thesis
submitted to the Faculty of D'Youville College
School of Health and Human Services
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in partial fulfillment o f the requirements

for the degree of
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Master o f Science

in

Occupational Therapy

Buffalo, NY

April 15, 1997

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 UMI Number: 1383830

Copyright 1997 by
Dorini, Joseph D.
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All rights reserved.
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UMI Microform 1383830

Copyright 1997, by UMI Company. All rights reserved.

This microform edition is protected against unauthorized

copying under Title 17, United States Code.

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 Discrimination and Stereognosis
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Copyright (c) 1997 by Joseph D. Dorini. All rights reserved. No part o f

this thesis may be copied or reproduced in any form or by any means without
written permission of Joseph D. Dorini.

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 Discrimination and Stereognosis
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THESIS APPROVAL

Thesis Committee Chairperson

Name:

Discipline: Occupational Therapy

Committee Members

Name:
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Discipline: Occupational Therapy
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Name: ______________

Discipline: Math and Natural Science_________

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Thesis Defended

on

April 15,1997

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 Discrimination and Stereognosis
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Abstract

This study was designed to compare two-point discrimination and stereognosis

and their influence on hand function. The model of human occupation was used

as the conceptual framework for the study of 100 volunteer college students.

Two-point discrimination measurements and object recognition times were

obtained, along with performance scores on a standardized test o f hand function.

The results o f a Pearson correlation coefficient analysis indicated that no

relationship existed between the variables of two point discrimination,

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stereognosis, and hand function. The results suggest that the performance of hand

function is not solely based on the components of two point discrimination and

stereognosis.
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 Discrimination and Stereognosis
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Acknowledgment

I dedicate this thesis to my parents, Lorenzo and Filomena, who always

had faith in my abilities, for you saw something in me that I never knew I had. I

thank you both for coming to America in search o f the "American Dream" and for

wanting your children to have a better life. I cannot begin to describe how much

you mean to me. To my sister and my parents, thank you for all the love that you

have given me and the many things that you have done for me. I could not have

succeeded without you. I love you all so much. God Bless all of you. Ti Amo.

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A special thank you to Nelson Cupello for pushing me to be the best I

could be athletically but most importantly academically. Thankfully you're not

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like all other coaches who just want players for their athletic ability. So, on behalf

o f me and the many players that you've coached and will coach, thank you for
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understanding the importance of education.

A special recognition goes to Dr. Merlene Gingher who has guided,

supported, and encouraged my work. I also want to thank my committee

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members, Dr. Klyczek and Dr. Hurley for their time, interest, and expertise.

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 Discrimination and Stereognosis
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Table of Contents

List o f Tables..................................................................................................... viii

List of Appendices............................................................................................. ix

Chapter

I. INTRODUCTION................................................................................... 1

Statement of Purpose............................................................................... 2
Conceptual Framework............................................................................ 2
Introduction.......................................................................................... 2
History.................................................................................................. 3

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Emerging Paradigm ............................................................................ 4
Systems Theory................................................................................... 5
Model of Human Occupation............................................................ 7
Significance and Justification................................................................. 11
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Assumptions.............................................................................................. 12
Research Question................................................................................... 12
Definition of T erm s................................................................................. 12
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Variables................................................................................................... 13
Limitations................................................................................................ 13
Summary................................................................................................... 13

II. REVIEW OF THE LITERATURE......................................................... 15

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Introduction............................................................................................... 15
Performance Component: Stereognosis.................................................. 16
Performance Component: Two Point Discrimination........................... 16
Performance Component: Hand Function............................................... 18
Tools to Measure Hand Function............................................................ 23
Summary................................................................................................... 27

III. PROCEDURES.......................................................................................... 28

Introduction................................................................................................. 28
Setting.......................................................................................................... 28
Population and Sam ple.............................................................................. 28
Data Collection Methodology................................................................... 28
Human Rights Protection........................................................................... 31
Treatment of D ata....................................................................................... 32
Summary..................................................................................................... 32

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 Discrimination and Stereognosis
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IV. RESULTS................................................................................................. 33

Introduction............................................................................................... 33
Description o f the Sample....................................................................... 33
T ools......................................................................................................... 34
Research Question................................................................................... 43
Serendipitous Findings............................................................................. 48
Summary................................................................................................... 49

V. DISCUSSION.......................................................................................... 50

Summary................................................................................................... 50
Conclusions............................................................................................... 50

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Relationship of the Results to the Conceptual Framework 50
Relationship of the Results to the Literature Review.................... 52
Relationship of the Results to the Research Question................... 53
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Relationship of the Results to the Testing Instruments................. 54
Implications for Practice and Education................................................ 55
Recommendations for Future Research................................................. 57
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References................................................................................................. 59

Appendices................................................................................................ 63
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 Discrimination and Stereognosis
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List o f Tables

Table

1. Means, SD, and Age Range of Subjects (N = 100)................................... 35

2. Means, SD, and Ranges for Two-Point Discrimination (in mm)

( N= 100)...................................................................................................... 36

3. Means, SD, and Ranges in Trial I of Stereognosis (in sec) for

Male Subjects (M = 50)............................................................................... 37

4. Means, SD, and Ranges in Trial I o f Stereognosis (in sec) for

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Female Subjects ( N= 50)............................................................................

5. Means, SD, and Ranges in Trial II o f Stereognosis (in sec) for

Male Subjects (Af = 50)...............................................................................
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6. Means, SD, and Ranges in Trial II o f Stereognosis (in sec) for

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Female Subjects (N = 50)............................................................................ 40
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7. Means, SD, and Ranges o f Hand Function (in sec) for

Male Subjects (A^= 50)............................................................................... 41

8. Means, SD, and Ranges o f Hand Function (in sec) for

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Female Subjects (N = 50)............................................................................ 42

9. Correlation Coefficients Between 2pd and Stereognosis for

Male Subjects ( N = 50)............................................................................... 44

10. Correlation Coefficients Between 2pd and Stereognosis for

Female Subjects (N = 50)........................................................................... 45

11. Correlation Coefficients Between Stereognosis, 2pd and Hand

Function for Male Subjects ( N= 50) ........................................................ 46

12. Correlation Coefficients Between Stereognosis, 2pd and Hand

Function for Female Subjects ( N= 5 0 ).................................................... 47

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 Discrimination and Stereognosis
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List o f Appendices

Appendix

A IRE Approval Letter..................................................................................... 63

B Script for Recruitment.................................................................................. 65

C Informed Consent......................................................................................... 67

D Screening Tool............................................................................................. 69

E Instructions and Scoring Sheet for Disk-criminator................................... 71

F Instructions and Scoring Sheet for Modified Picking-up T est.................. 73

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G Standardized Script for the Jebson-Taylor Hand Function Test............... 75
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 Discrimination and Stereognosis
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CHAPTER I

INTRODUCTION

In the United States, a total of 16 million upper extremity injuries occur a

year. These injuries result in 90 million days o f limited activity and 12 million

visits to physicians (Kasch, 1990). Upper extremity injuries also include those

injuries or diseases that occur to the hand. The hand plays an important role in

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the lives o f humans; although, the hand's value is often forgotten by people who

use their hands everyday but who may take this for granted. The hand allows the
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individual to be independent in society. Tasks such as eating, dressing, and

grooming appear simple, however, several complex processes of the hand are
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required to accomplish these tasks. Improving or increasing independence in the

performance o f these tasks are often functional goals that occupational therapy

tries to achieve with patients. With this in mind, occupational therapist utilize
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activities that require the use of the hand as modalities in treatment. Therefore, it

is important for occupational therapists to understand the components of the hand

and how they work.

Occupational therapists must be able to determine if a deficit in hand

function is a result o f a deficit in the neurological system or the musculoskeletal

system. This ability will allow the therapists to work on the needed components

o f the hand and not waste time on unnecessary rehabilitation. A review o f the

literature shows limited information on how components or systems of the hand

influence the hand's function. Hand function may be affected by the variations of

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 Discrimination and Stereognosis
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hand components or systems found in each person. Therefore, this study was

designed to examine if hand function was influenced by the varying components

o f the hand.

Statement of Purpose

The purpose o f this study was to determine if a relationship between two

point discrimination and stereognosis had an influence on hand function. The

study will determine if an association exists between two-point discrimination

and stereognosis. The study will also examine two-point discrimination in

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relation to hand function and stereognosis in relation to hand function.

Conceptual Framework
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Introduction

The purpose o f this study was to examine if a relationship between two

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point discrimination and stereognosis has an influence on hand function. The

ability o f individuals to explore and master their environment is dependent, in

part, on their ability to detect, manipulate, and recognize objects. This

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recognition o f objects is called stereognosis. Stereognosis as defined by Carr and

Shepherd (1980) is "the tactile recognition o f common objects held in the hand,

and to the recognition o f different textures" (p.l 15). However, the ability of the

hand to detect an object is the result of two point discrimination. Two point

discrimination refers to "the minimum distance by which two stimuli can be

separated and still be perceived as two stimuli" (Nolte, 1993, p. 107). Functional

loss of one skill may result in functional loss or deficit in the other. It is

hypothesized that the closer the two point discrimination, and the quicker the

object recognition, then the more functional the hand is. Both two point

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 Discrimination and Stereognosis

discrimination and stereognosis, are large components of hand sensation that are

assessed in occupational therapy. The conceptual model for this study is based on

the model o f human occupation, particularly the mind-brain-body performance

component.

History

Occupational therapy is a profession whose roots can be traced back to

the era o f moral treatment. Moral treatment was inspired by a humanitarian

philosophy or belief that various tasks and events o f everyday life could restore

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the mentally ill back to normal function (Kielhofner, 1985). In 1962, Reilly stated

that the profession is based on the assumption "that man, through the use o f his
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hands as they are energized by mind and will, can influence the state of his own

health" (p. 2). Eventually, occupational therapy wanted to increase its acceptance
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by the medical profession and therefore, to survive, occupational therapy became

more scientific. This caused a shift toward a more mechanistic view of human

beings and toward treatment of acute injuries and disease. As a result, Reilly
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(1962) warned the profession that the mechanistic notion was not beneficial to

occupational therapy, thus resulting in a profession that lacked vital and unique

services.

In her 1962 Slagle address Reilly urged the profession to return to early

models and theories. The development o f Reilly's paradigm is a reaction to the

mechanistic approach. Her paradigm included the concepts of occupational

behavior and at the same time the treatment o f functional deficits of the

individual. Kielhofner, a student of Reilly, continued to research her paradigm.

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 Discrimination and Stereognosis
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Kielhofner (1985) further acknowledged that the paradigm should contain the

overall knowledge o f the profession.

Emerging Paradigm

Kielhofner (1985) defines a paradigm as consisting o f the basic

assumptions and perspectives that unify the field. The paradigm also defines and

gives coherence or wholeness to the entire profession. The paradigm consists of

three components: (a) core assumptions, (b) focal viewpoints, and (c) central

values. Core assumptions specify a view of humans, identify the problems that

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occupational therapy addresses, and present a global rationale underlying therapy.

The focal viewpoint defines a shared view of phenomena with which members of
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the field are interested. Central values provide the therapist with information on

what ought to be done in therapy (Kielhofner, 1985).

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Kielhofner (1992), through the combination o f the paradigm of

occupation (1st paradigm) and the mechanistic paradigm (2nd paradigm), formed

the new emerging paradigm. This emerging paradigm creates a professional

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culture by introducing and intertwining the core assumptions, focal viewpoints,

and central values. The core assumptions consist o f three broad assumptions:

human beings have an occupational nature, human beings may experience

occupational dysfunction, and occupation can be used as a therapeutic agent. The

first core assumption is that human beings have an occupational nature.

Occupational therapy has given reason for its necessity and uniqueness by

identifying occupation as its primary area of concern. The second core

assumption is that humans may experience occupational dysfunction when a part

or system is altered in any way, thus, resulting in an essential system being

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 Discrimination and Stereognosis
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altered that interferes with normal, daily functioning. The third core assumption

states that occupation can be used as a therapeutic agent This is one o f the most

important concepts in occupational therapy because this assumption uses

occupation to increase function (Kielhofner, 1992).

The focal viewpoint in occupational therapy identifies the concern o f

professionals in the field in a broad sense. There are three themes that

characterize this focal viewpoint: holism, hierarchical order, and openness.

Holism is a process of looking at the human as a whole rather than a series o f

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parts. Occupational therapy sees the human as a physical, emotional, cognitive,

social, and cultural whole (Kielhofner, 1992). Hierarchical order is the second
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theme. There are four related parts that are organized in a hierarchical fashion. At

the base o f the hierarchy is the organic level, followed by the systemic level, then
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the personal level, and finally, the sociocultural level (Kielhofner, 1992). Two

terms need to be considered when discussing a hierarchy. These terms are

commanding and constraining. When the higher centers of the hierarchy control
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the actions of the lower centers, the term commanding is used. However,

constraining occurs when the lower centers cannot perform the task demanded by

the higher centers (Kielhofner, 1985). The last theme is openness. Openness is a

process where individuals influence their health through their own action

(Kielhofner, 1992).

Systems Theory

In the profession of occupational therapy there are different conceptual

practice models that can fit into the focal viewpoint of the paradigm. Kielhofner

(1992) defines a conceptual practice model as a theoretical framework that

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 Discrimination and Stereognosis
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explains some phenomena o f practical concern. These frameworks contain

theoretical arguments that provide rationale and methods for use by therapists in

their profession. Some of the practice models include: biomechanical, sensory

integration, and cognitive disabilities. These models may incorporate a process

that allows for input, throughput, output, and feedback; which is part o f open

systems theory. Kielhofner and colleagues (Kielhofner, 1980a; Kielhofner,

1980b; Kielhofner & Burke, 1980; Kielhofner, Burke, & Igi, 1980) originally

developed the model of human occupation to incorporate principles o f open

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systems theory.

Recently the dynamical systems theory is being used within the model of
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human occupation (Kielhofner, 1995). The dynamical system uses the concept of

soft assembly. Turvey (1990) stated that soft assembly accounts for how behavior
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adjusts to the changing demands o f tasks as they unfold. The process o f soft

assembly consists of three components that all contribute to behavior. These

components include: the task, the environment, and the human system
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(Kielhofner, 1995). The task is the occupation or activity that the individual is

trying to accomplish at the current time. Environment can be considered the

setting in which the occupation or activity is taking place. The human system

involves all the components necessary to make up an individual. According to

Kielhofner (1995) these components include volition, habituation, and mind-

brain-body performance subsystems as described in the model o f human

occupation. These subsystems help to motivate, organize, and perform the desired

occupational behavior.

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Model o f Human Occupation

The model o f human occupation is a practice model that uses the

throughput phase o f the human open system to define the three subsystems of

volition, habituation, and mind-brain-body performance. Kielhofner (1995)

describes the arrangement o f subsystems as a heterarchy, thus implying that these

areas are interdependent and any one of these can be initiated to influence

behavior.

Kielhofner (1995) defines volition as a system o f dispositions and self-

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knowledge that predisposes and enables persons to anticipate, choose,

experience, and interpret occupational behavior. The volitional subsystem is

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composed of personal causation, values, and interests. Personal causation is the

collection of disposition and self-knowledge concerning one's capacities for and

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efficacy in occupations; it encompasses knowledge o f capacity and sense of

efficacy. Values, according to Kielhofner, are a coherent set o f convictions that

assign significance or standards to occupations, creating a strong disposition to

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perform accordingly; values encompass personal conviction and sense of

commitments. Interests are dispositions to find pleasure and satisfaction in

occupations and the self-knowledge of one's enjoyment o f occupations therefore

encompassing attraction and preference.

The habituation subsystem is defined as an internal organization of

information that disposes the system to exhibit recurrent patterns of behavior.

This internal organization is found within the areas of habit, internalized roles,

and role scripts. Kielhofner (1995) defines these areas as follows: Habits are

"latent tendencies acquired from previous repetitions, mainly operating at a

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