JOURNAL OF NEUROPHYSIOLOGY, VOL. 14, NO.
8, OCTOBER 2019
Two-Point Discrimination
J. Armando Lara R., Member, IEEE, Edgar R. López S., Member, IEEE,
and J. Héctor León C., Member, IEEE,
Abstract—The two-point discrimination test (2PD) is commonly used to detect muscular affections or early detection of paraesthesia.
In this article we focus on determining if there exists a significant difference in sensitivity for 2PD between men and women with similar
age ranges. It was concluded there are no statistically signiticant difference between sensitivity for 2PD for both genders.
Index Terms—Two-Point Discrimination, Sensitivity.
1 I NTRODUCTION
T HE cutaneous receptors are the types of sensory receptor
found in the dermis or epidermis. They are a funda-
mental part of the somatosensory system which is a part
of the sensory nervous system. Cutaneous receptors include
cutaneous mechanoreceptors (pressure and vibration), no-
ciceptors (pain) and thermoreceptors (temperature). One of
the main responsibilities of the somatosensory system is to
differentiate information through the sense of touch, which
is formally known as tactile discrimination [1].
There are various types of tactile discrimination. One of
the most well known and most researched is two-point
discrimination (abbreviated as TPD or 2PD), the ability to
differentiate between two different tactile stimuli which are
relatively close together. Other types of discrimination like
graphesthesia and spatial discrimination also exist but are
not as extensively researched. In general, the procedures
that are performed to evaluate tactile discrimination and
sensory abnormalities are covered in what is called as clini-
cal neurosensory testing [2].
As mentioned before, TPD is the ability to discern that
two nearby objects touching the skin are truly two distinct
points, not one. It is often tested with two sharp points
during a neurological examination and is assumed to reflect
how finely innervated an area of the skin is. In clinical set-
tings, two-point discrimination is a widely used technique
for assessing tactile perception. It relies on the ability and/or
willingness of the patient to subjectively report what they
are feeling and should be completed with the patient’s eyes
closed. The therapist may use calipers or simply a reshaped
paperclip to do the testing. The therapist may alternate
randomly between touching the patient with one point or
with two points on the area being tested (e.g. finger, arm,
leg, toe). The patient is asked to report whether one or two
points was felt. The smallest distance between two points
that still results in the perception of two distinct stimuli is
recorded as the patient’s two-point threshold [3].
In general, there are numerous studies of functional sensi-
bility on the upper extremities using TPD test as it has been
long considered the most common clinical neurosensory test
• A. Lara, E. López and H. León are MSc Artificial Intelligence
students in the School of Engineering at Universidad Autónoma
de Querétaro, México. Respective e-mails: jlara34@alumnos.uaq.mx,
edgar.lopez06@outlook.com and jleon08@alumnos.uaq.mx
1
[4]. Further studies using TPD have found axonal damage
and demyelination in subjects with major conditions such as
diabetes mellitus [5]. On the other hand, conditions such as
severe limb numbness can be diagnosed by using the TPD
approach [6]. Recent studies, such as [7], have focused to
study the sensibility on the orofacial region and have found
that results values can vary depending on test site, gender
and test modality.
This paper describes experimentation on TPD in four differ-
ent regions of the human body. Overall, the results clearly
indicate minimum dispersion for each of the regions men-
tioned above for young adults.
2 M ETHODOLOGY
For this study, the construct 1 was defined as the ability
of a person to discern that two nearby objects touching
the skin are truly two distinct points, not one [8]. This
construct will be called as sensitivity throughout the rest of
this document. Such construct is also assumed to reflect how
finely innervated an area of skin is. As operational definition
2
, it was chosen the smallest distance between two points
that still results in the perception of two distinct stimuli,
this is also named patient’s two-point threshold [9].
Some of the main lurking variables that could influence
sensitivity are:
1) Part of the body
2) Gender
3) Length of test
A bigger sample size makes statistics get closer to
population parameters, e.g., a sample mean gets closer
to population mean as sample size increases. Therefore,
it was decided to apply the test to 20 people randomly
selected students of a university campus. It is expected the
sensitivity to be equal between men and women.
2.1 Method
The process followed in this article is focused on an analysis
of the sensitivity in the different parts of the body, for this a
1. Phenomenon to be measured
2. Form in which the construct will be measured
JOURNAL OF NEUROPHYSIOLOGY, VOL. 14, NO. 8, OCTOBER 2019 2

preliminary examination was developed where the integrity

of the sensitive fibers was examined, in other words, that
the patient shows no signs of recent damage in the area of
interest to protect the integrity of the patient as well as to
ensure that readings are made on the epidermis.
In the experiment the subject had to identify if he was
touched in two points of the body with randomly separa-
tions

2.2 Subject
The subject were ten men and ten women with no symp-
toms of tearing or affection in the areas of interest ranging Fig. 2. Compass used in tests.
in age from 18 to 25. All of them were college students in
areas of exact Sciences. Testing procedures

2.3 Testing procedures

After this analysis of the area of interest, gnosis thresholds
were located in the different parts of the body. A detailed
description of the performance of the test must be provided Fig. 3. Vernier used for measurements of openings.
and for this the steps that were followed are shown.
1) Place the patient in an area free of distractions, TABLE 1
(isolated room with closed door and ensuring that Results for sex and body parts.
there are no disturbances).
2) Inform the patient what areas of the body will be Sex & Statistic Index Finder Back Forearm Calf
analyzed, ask for their consent and proceed with a Females x̄ 2.48 4.25 4.05 4.58
series of questions to be aware of chronic diseases. Females SD 0.47 0.44 0.42 0.41
3) Inform the patient with which area of the body will Males x̄ 2.51 4.27 3.95 4.80
proceed. Males SD 0.48 0.42 0.40 0.39
4) Inspect the area to ensure there are no visible t-test p 0.8914 0.9189 0.601 0.2464
injuries.
5) Inform the patient that his vision will be blocked TABLE 2
momentarily with the use of a disposable mask Body Part–Sex Interaction.
6) Develop a test to determine if the vision was
blocked successfully. Rank Body Part Females x̄ Males x̄
7) Proceed according to the diagram in Figure 1. 1 Index Finger 2.48 2.51
8) Perform 5 times step 7 (in the same area). 2 Forearm 4.05 3.95
9) Perform the process from step 3, changing the area. 3 Back 4.25 4.27
4 Calf 4.58 4.80

body a two-tailed t-statistic (Student’s t test) was applied.

Fig. 1. Flowchart of 2PD test in a general area.
The Figures 2 and 3 show the instruments —compass
and vernier— used during the experiment.
The results were p = 0.8914, p = 0.9189, p = 0.601
and p = 0.2464 for index finger, forearm, back and calf
respectively. Such p values represent a difference considered
to be not statistically significant by conventional criteria
(p < 0.05). In Table 2 the Body Part–Sex interaction is shown
along with their ranks according threshold distance. The
rank-order correlation 3 between the means of body parts
was 1, indicating no difference in rank orders for the sexes.
In Figure 4 the box and whisker plots are shown for each
of the body part, it includes the data from both genders. It
can be seen that dispersion is uniform in all body parts with
very few outliers.

3 R ESULTS
In Table 1 are shown the mean and standard deviation of
each gender and body part. To determine statistical sig-
nificant difference between each sex for each part of the
4 C ONCLUSION
It was found that as expected there is no statistically signifi-
cant difference between the means of two-point discrimina-
3. Spearman’s rank correlation coefficient
JOURNAL OF NEUROPHYSIOLOGY, VOL. 14, NO. 8, OCTOBER 2019 3

we just take five samples in four body parts. My proposal

for later works is to make a database with the raw data in
order to get the same results and similar conclusions.

ACKNOWLEDGMENTS
The authors would like to thank to the students of the
Universidad Autónoma de Querétaro for their collaboration
in this research.

Fig. 4. Box and whisker plots for index fingers, forearm, back and calf
respectively. Y axis: cm
tion threshold distance from males and females. In addition,
there was not difference either in the rank-order between
means of body parts for both genders either. Therefore, we
fail to reject the null hypothesis in both cases. For further
studies it is suggested to increase the sample size for males
and females along with their ages range. Also, in order to
better evaluate the difference in rank-order for body parts
between the sexes it is suggested to consider other parts of
the body as well, such as shoulder, breast and toes, among
others.
5 I NDIVIDUAL C ONCLUSIONS
5.1 Edgar R. López S.
Overall, this experiment represents an excellent way for
students to initiate and understand the fundamentals of
empirical research. In that sense, we understood the impor-
tance of a good methodology design in order to establish
the proper conditions and procedures to perform the testing.
We also realized the need for standardized tools to perform
the TPD test. In our case, the use of a drawing compass
introduced some variation in our measurements.
R EFERENCES
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Neurobiology of the Somatosensory Cortex. Birkhäuser Basel, 1996.
[3] H. Blumenfeld, Primary Sensation-Asymmetry, Sensory Level, 2nd ed.
MA, USA: Sinauer Associates, Inc., 2010.
[4] A. L. Dellon, S. E. Mackinnon, and P. M. D. Crosby, “Reliability of
two-point discrimination measurements,” Journal of Hand Surgery,
vol. 12, no. 5, pp. 693–696, 1987.
[5] M. Eryilmaz, A. Koçer, G. Kocaman, and S. Dikici, “Two-point
discrimination in diabetic patients,” Journal of Diabetes, vol. 5, no. 4,
pp. 442–448, 2013.
[6] T. Wolny, E. Saulicz, P. Linek, and A. Myśliwiec, “Two-point
discrimination and kinesthetic sense disorders in productive age
individuals with carpal tunnel syndrome,” Journal of Occupational
Health, vol. 58, no. 3, pp. 289–296, 2016.
[7] S. Y. Won, H. K. Kim, M. E. Kim, and K. S. Kim, “Two-point
discrimination values vary depending on test site, sex and test
modality in the orofacial region: A preliminary study,” Journal of
Applied Oral Science, vol. 25, no. 4, pp. 427–435, 2017.
[8] L. Bickley and P. Szilagui, Bates’ Guide to Physical Examination and
History Taking, 9th ed. Lippincott Williams & Wilkins, 2007.
[9] S. B. O’Sullivan and T. J. Schmitz, Physical rehabilitation,
5th ed. Philadelphia: F.A. Davis, 2007. [Online]. Available:
https://search.library.wisc.edu/catalog/9910018160802121

5.2 J. Armando Lara R.

Altogether, this experiment was very useful to become
familiar with the process of research. I do believe it is
adequate for leaning purposes since it includes all the parts
of research: data recollection, data analysis and writing. In
particular, the experiment is complex enough to carefully
plan during the preparation process the phenomenon to
observe and how it would be measured. Although it is im-
portant to meticulously define a experimentation procedure,
it is rather time consuming for this exercise. I would suggest
to experiment by obtaining data from social networks, e.g.,
measuring the approach of people towards an specific topic
or what a tweet or post should contain to be retweeted or
liked.

5.3 J. Héctor León C.

The main problem in this experiment is the time consump-
tion for each sample the repercussion is that we won’t be
able to take a significant count of samples for each body part