Gregory Essick

Touching and feeling: differences in pleasant touch processing between glabrous and hairy skin in humans

Previous functional magnetic resonance imaging studies in two rare patients, together with microneurography and psychophysical observations in healthy subjects, have demonstrated a system of mechanosensitive C‐fiber tactile (CT) afferents sensitive to slowly moving stimuli. They project to the posterior insular cortex and signal pleasant aspects of touch. Importantly, CTs have not been found in the glabrous skin of the hand, yet it is commonly observed that glabrous skin touch is also perceived as pleasant. Here we asked if the brain processing of pleasant touch differs between hairy and glabrous skin by stroking the forearm and glabrous skin of the hand during positron emission tomography. The data showed that, when contrasting slow brush stroking on the forearm with slow brush stroking on the palm, there were significant activations of the posterior insular cortex and mid‐anterior orbitofrontal cortex. The opposite contrast showed a significant activation of the somatosensory cortices. Although concurrent psychophysical ratings showed no differences in intensity or pleasantness ratings, a subsequent touch questionnaire in which subjects used a newly developed ‘touch perception task’ showed significant difference for the two body sites. Emotional descriptors received higher ratings on the forearm and sensory descriptors were rated more highly on the palm. The present findings are consistent with the hypothesis that pleasant touch from hairy skin, mediated by CT afferents, is processed in the limbic‐related cortex and represents an innate non‐learned process. In contrast, pleasant touch from glabrous skin, mediated by A‐beta afferents, is processed in the somatosensory cortex and represents an analytical process dependent on previous tactile experiences.

Guidelines and recommendations for assessment of somatosensory function in oro-facial pain conditions - a taskforce report

The goals of an international taskforce on somatosensory testing established by the Special Interest Group of Oro-facial Pain (SIG-OFP) under the International Association for the Study of Pain (IASP) were to (i) review the literature concerning assessment of somatosensory function in the oro-facial region in terms of techniques and test performance, (ii) provide guidelines for comprehensive and screening examination procedures, and (iii) give recommendations for future development of somatosensory testing specifically in the oro-facial region. Numerous qualitative and quantitative psychophysical techniques have been proposed and used in the description of oro-facial somatosensory function. The selection of technique includes time considerations because the most reliable and accurate methods require multiple repetitions of stimuli. Multiple-stimulus modalities (mechanical, thermal, electrical, chemical) have been applied to study oro-facial somatosensory function. A battery of different test stimuli is needed to obtain comprehensive information about the functional integrity of the various types of afferent nerve fibres. Based on the available literature, the German Neuropathic Pain Network test battery appears suitable for the study of somatosensory function within the oro-facial area as it is based on a wide variety of both qualitative and quantitative assessments of all cutaneous somatosensory modalities. Furthermore, these protocols have been thoroughly described and tested on multiple sites including the facial skin and intra-oral mucosa. Standardisation of both comprehensive and screening examination techniques is likely to improve the diagnostic accuracy and facilitate the understanding of neural mechanisms and somatosensory changes in different oro-facial pain conditions and may help to guide management.

Perceptual and Neural Response to Affective Tactile Texture Stimulation in Adults with Autism Spectrum Disorders

Autism spectrum disorders (ASD) are associated with differences in sensory sensitivity and affective response to sensory stimuli, the neural basis of which is still largely unknown. We used psychophysics and functional magnetic resonance imaging (fMRI) to investigate responses to somatosensory stimulation with three textured surfaces that spanned a range of roughness and pleasantness in a sample of adults with ASD and a control group. While psychophysical ratings of roughness and pleasantness were largely similar across the two groups, the ASD group gave pleasant and unpleasant textures more extreme average ratings than did controls. In addition, their ratings for a neutral texture were more variable than controls, indicating they are less consistent in evaluating a stimulus that is affectively ambiguous. Changes in brain blood oxygenation level‐dependent (BOLD) signal in response to stimulation with these textures differed substantially between the groups, with the ASD group exhibiting diminished responses compared to the control group, particularly for pleasant and neutral textures. For the most unpleasant texture, the ASD group exhibited greater BOLD response than controls in affective somatosensory processing areas such as the posterior cingulate cortex and the insula. The amplitude of response in the insula in response to the unpleasant texture was positively correlated with social impairment as measured by the Autism Diagnostic Interview‐Revised (ADI‐R). These results suggest that people with ASD tend to show diminished response to pleasant and neutral stimuli, and exaggerated limbic responses to unpleasant stimuli, which may contribute to diminished social reward associated with touch, perpetuating social withdrawal, and aberrant social development. Autism Res 2012,5:231–244.

Food Oral Processing: Conversion of Food Structure to Textural Perception

Food oral processing includes all muscle activities, jaw movements, and tongue movements that contribute to preparing food for swallowing. Simultaneously, during the transformation of food structure to a bolus, a cognitive representation of food texture is formed. These physiological signals detected during oral processing are highly complex and dynamic in nature because food structure changes continuously due to mechanical and biochemical breakdown coupled with the lubricating action of saliva. Multiple and different sensations are perceived at different stages of the process. Although much work has focused on factors that determine mechanical (e.g., rheological and fracture) and sensory properties of foods, far less attention has been paid to linking food transformations that occur during oral processing with sensory perception of texture. Understanding how food structure influences specific patterns of oral processing and how these patterns relate to specific textural properties and their cognitive representations facilitates the design of foods that are nutritious, healthy, and enjoyable.

Discrimination and Scaling of Velocity of Stimulus Motion across the Skin

The capacity of human subjects to discriminate and to scale the velocity of tactile brushing stimuli was assessed. Signal detection and classical psychophysical techniques were employed to estimate the Weber fraction over a wide range of velocities (from 1.5 to 140 cm/sec). In addition, free magnitude estimates of (1) the velocity and (2) the duration of moving tactile stimuli were obtained. It was found that human capacity to discriminate stimuli delivered to a 4 to 6-cm chord of skin on the dorsal forearm and differing in velocity remains grossly constant over the range of velocities tested and is relatively poor (i.e., the Weber fraction = 0.2-0.25). A simple power function (exponent = 0.6) satisfactorily describes the psychophysical relation (1) between the perceived and actual velocity and (2) between the perceived and actual duration of these stimuli. Since a direct proportionality between the reciprocal of a subjects estimate of duration and his or her estimate of velocity was observed, it is suggested that these two sensory attributes may reflect the operation of a neural mechanism sensitive to the duration of stimulation. Moreover, the data are inconsistent with the hypothesis that the subjects computed estimates of mean velocity from the ratio of perceived distance to perceived duration.

Sensations Evoked by Microstimulation of Single Mechanoreceptive Afferents Innervating the Human Face and Mouth

Intraneural microneurography and microstimulation were performed on single afferent axons in the inferior alveolar and lingual nerves innervating the face, teeth, labial, or oral mucosa. Using natural mechanical stimuli, 35 single mechanoreceptive afferents were characterized with respect to unit type [fast adapting type I (FA I), FA hair, slowly adapting type I and II (SA I and SA II), periodontal, and deep tongue units] as well as size and shape of the receptive field. All afferents were subsequently microstimulated with pulse trains at 30 Hz lasting 1.0 s. Afferents recordings whose were stable thereafter were also tested with single pulses and pulse trains at 5 and 60 Hz. The results revealed that electrical stimulation of single FA I, FA hair, and SA I afferents from the orofacial region can evoke a percept that is spatially matched to the afferents receptive field and consistent with the afferents response properties as observed on natural mechanical stimulation. Stimulation of FA afferents typically evoked sensations that were vibratory in nature; whereas those of SA I afferents were felt as constant pressure. These afferents terminate superficially in the orofacial tissues and seem to have a particularly powerful access to perceptual levels. In contrast, microstimulation of single periodontal, SA II, and deep tongue afferents failed to evoke a sensation that matched the receptive field of the afferent. These afferents terminate more deeply in the tissues, are often active in the absence of external stimulation, and probably access perceptual levels only when multiple afferents are stimulated. It is suggested that the spontaneously active afferents that monitor tension in collagen fibers (SA II and periodontal afferents) may have the role to register the mechanical state of the soft tissues, which has been hypothesized to help maintain the bodys representation in the central somatosensory system.

Temporomandibular Disorder Modifies Cortical Response to Tactile Stimulation

UNLABELLED Individuals with temporomandibular disorder (TMD) suffer from persistent facial pain and exhibit abnormal sensitivity to tactile stimulation. To better understand the pathophysiological mechanisms underlying TMD, we investigated cortical correlates of this abnormal sensitivity to touch. Using functional magnetic resonance imaging (fMRI), we recorded cortical responses evoked by low-frequency vibration of the index finger in subjects with TMD and in healthy controls (HC). Distinct subregions of contralateral primary somatosensory cortex (SI), secondary somatosensory cortex (SII), and insular cortex responded maximally for each group. Although the stimulus was inaudible, primary auditory cortex was activated in TMDs. TMDs also showed greater activation bilaterally in anterior cingulate cortex and contralaterally in the amygdala. Differences between TMDs and HCs in responses evoked by innocuous vibrotactile stimulation within SI, SII, and the insula paralleled previously reported differences in responses evoked by noxious and innocuous stimulation, respectively, in healthy individuals. This unexpected result may reflect a disruption of the normal balance between central resources dedicated to processing innocuous and noxious input, manifesting itself as increased readiness of the pain matrix for activation by even innocuous input. Activation of the amygdala in our TMD group could reflect the establishment of aversive associations with tactile stimulation due to the persistence of pain. PERSPECTIVE This article presents evidence that central processing of innocuous tactile stimulation is abnormal in TMD. Understanding the complexity of sensory disruption in chronic pain could lead to improved methods for assessing cerebral cortical function in these patients.

Inferior alveolar nerve injury following orthognathic surgery: a review of assessment issues

The sensory branches of the trigeminal nerve encode information about facial expressions, speaking and chewing movements, and stimuli that come into contact with the orofacial tissues. Whatever the cause, damage to the inferior alveolar nerve negatively affects the quality of facial sensibility as well as the patients ability to translate patterns of altered nerve activity into functionally meaningful motor behaviours. There is no generally accepted, standard method of estimating sensory disturbances in the distribution of the inferior alveolar nerve following injury. Assessment of sensory alterations can be conducted using three types of measures: (i) objective electrophysiological measures of nerve conduction, (ii) sensory testing (stimulus) measures and (iii) patient report. Each type of measure with advantages and disadvantages for use are reviewed.

Frequency and site-dependent variations in vibration detection thresholds on the face

An adaptive psychophysical procedure was used to estimate the vibration detection threshold at seven spatially matched sites on the two sides of the face and at one scalp site. Repeated measurements over six testing sessions were made for stimuli vibrating at 1, 10 and 100 Hz for each of 21 neurologically healthy, young adult females. Approximately 14 stimulus trials were required to obtain each estimate of the threshold amplitude. Thresholds varied as a function of frequency ( p < 0.0001), side ( p < 0.001) and site ( p < 0.0001). Compared to stimulation at 100 Hz at which the estimates were lowest, thresholds were 3.1 times greater at 10 Hz and 5.4 times greater at 1 Hz. Thresholds were lowest on the vermilion and highest on the cheek and chin. The preauricular skin and scalp exhibited an intermediate level of sensitivity. Whereas thresholds were comparable on the two sides of the face for stimulation at 1 Hz, they averaged 1.33 times greater on the right side for stimulation at 10 and 100 Hz. Moreover, thresholds obtained during the last two sessions were 16% higher than those obtained during the first two sessions ( p < 0.02), suggesting that subjects on average became more conservative in reporting the presence of the stimulus. The sensitivity in discriminating differences in tactile function favors use of the rapidly administered testing procedure in a clinical setting.An adaptive psychophysical procedure was used to estimate the vibration detection threshold at seven spatially matched sites on the two sides of the face and at one scalp site. Repeated measurements over six testing sessions were made for stimuli vibrating at 1, 10 and 100 Hz for each of 21 neurologically healthy, young adult females. Approximately 14 stimulus trials were required to obtain each estimate of the threshold amplitude. Thresholds varied as a function of frequency (p < 0.0001), side (p < 0.001) and site (p < 0.0001). Compared to stimulation at 100 Hz at which the estimates were lowest, thresholds were 3.1 times greater at 10 Hz and 5.4 times greater at 1 Hz. Thresholds were lowest on the vermilion and highest on the cheek and chin. The preauricular skin and scalp exhibited an intermediate level of sensitivity. Whereas thresholds were comparable on the two sides of the face for stimulation at 1 Hz, they averaged 1.33 times greater on the right side for stimulation at 10 and 100Hz. Moreover, thresholds obtained during the last two sessions were 16% higher than those obtained during the first two sessions (p < 0.02), suggesting that subjects on average became more conservative in reporting the presence of the stimulus. The sensitivity in discriminating differences in tactile function favors use of the rapidly administered testing procedure in a clinical setting.

Patient response to sleep apnea screening in a dental practice

OBJECTIVE This study investigated patient response to a recommendation for physician evaluation following screening for obstructive sleep apnea (OSA) in a dental practice. METHODS In a community-based dental practice in Raleigh, North Carolina, 119 patients were recruited by nonprobability purposive sampling and administered both a validated subjective (STOP questionnaire) and objective (pulse oximeter) screening instrument for OSA. Patients who screened high-risk for OSA on either instrument were recommended to consult their physician within three months. All patients were contacted via telephone after three months to determine if they had consulted a physician regarding their screening results. Multivariate log-binomial models estimated prevalence ratios (PR) and 95 percent confidence limits (95% CL) for physician consultation according to OSA risk, adjusting for potential confounders. RESULTS Overall, 18.5 percent of patients screened high-risk on the STOP questionnaire alone, 26.1 percent on pulse oximetry alone, and 31.9 percent on both instruments. Follow-up of 111 subjects (93.3%) found that 40 (47.1%) of those high-risk for OSA on one or both instruments sought physician evaluation. Patients who screened high-risk on pulse oximetry were 2.55 times as likely to seek physician evaluation compared with those who screened low-risk on both instruments (PR = 2.55, 95% CL: 1.02, 6.37). Screening high-risk on the STOP questionnaire did not significantly increase the likelihood of physician evaluation. CONCLUSIONS Nearly, half of dental patients who screen high-risk for OSA may be responsive to a recommendation to seek physician evaluation.