Article | Published:

Validation of a novel cone tool for pinprick sensation examination in patients with spinal cord injury


Study Design

Psychometrics study.


The objective of this study was to introduce a novel tool for pinprick sensation examination and validate its usefulness in patients with spinal cord injury (SCI).


China Rehabilitation Research Center, Capital Medical University School of Rehabilitation Medicine, China.


A set of cone tools with different tapers (22.5°, 45°, 67.5°, 90°, 112.5°, 135°, 157.5°, and 180°) was made. The cone tool was validated first in 91 able-bodied individuals and then in 30 patients with SCI. The reliability and validity of the cone tool were analyzed by comparing the results of a pinprick sensation examination with the results of the International Standards for the Neurological Classification of SCI (ISNCSCI), the cone tool, and the thermal analyzer.


The intraclass correlation coefficient (ICC) of the cone tool in able-bodied individuals was between 0.48 and 0.94 while that of the cone tool and the ISNCSCI tool ranged between 0.43 and 0.78. Pinprick sensation in patients with SCI can be graded into five levels using four tapers (22.5°, 45°, 67.5°, and 90°): normal, slight impairment, moderate impairment, severe impairment, and complete loss of sensation.


This easy-to-use cone tool can produce a reliable semi-quantitative pinprick test result and is useful for pinprick sensation examination in patients with SCI.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    American Spinal Injury Association. International Standards for Neurological Classification of Spinal Cord Injury. Atlanta, GA, USA: Christopher Reeve Paralysis Foundation; 2008.

  2. 2.

    Vasquez N, Gall A, Ellaway PH, Craggs MD. Light touch and pin prick disparity in the International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI). Spinal Cord. 2013;5:375–8.

  3. 3., Accessed March 23 2019

  4. 4.

    Gu S, Du D. Clinical applications and limitations of quantitative sensory testing. Shanghai Med J. 2012;35:341–2.

  5. 5.

    Shi X, Wang S, Liu X. Thermal quantitative sensory testing and clinical application. Pain Clin J. 2008;4:223–8.

  6. 6.

    Semmes J, Weinstein S, Ghent L, Teuber HL. Performance on complex tactual tasks after brain injury in man: analyses by locus of lesion. Am J Psychol. 1954;67:220–40.

  7. 7.

    Lee S, Kim H, Choi S, Park Y, Kim Y, Cho B. Clinical usefulness of the two-site semmes-weinstein monofilament test for detecting diabetic peripheral neuropathy. J Korean Med Sci. 2003;18:103–7.

  8. 8.

    Kumar S, Fernando DJ, Veves A, Knowles EA, Young MJ, Boulton AJ. Semmes-Weinstein monofilaments: a simple, effective and inexpensive screening device for identifying diabetic patients at risk of foot ulceration. Diabetes Res Clin Pract. 1991;13:63–7.

  9. 9.

    Hayes KC, Wolfe DL, Hsieh JT, Potter PJ, Krassioukov A, Durham CE. Clinical and electrophysiologic correlates of quantitative sensory testing in patients with incomplete spinal cord injury. Arch Phys Med Rehabil. 2002;83:1612–9.

  10. 10.

    Ellaway PH, Catley M. Reliability of the electrical perceptual threshold and Semmes-Weinstein monofilament tests of cutaneous sensibility. Spinal Cord. 2013;51:120–5.

  11. 11.

    Velstra IM, Bolliger M, Baumberger M, Rietman JS, Curt A. Epicritic sensation in cervical spinal cord injury: diagnostic gains beyond testing light touch. J Neurotrauma. 2013;30:1342–8.

  12. 12.

    Zhang Y, Zhou HJ, Liu GL, Zhang HL, Zheng Y, Hao CX, et al. Treatment of neuropathic pain after spinal cord injury with neurotropin: quantitative sensory testing at the level of human spinal cord injury. Chin J Pain Med. 2014;20:737–40.

  13. 13.

    Hübscher M, Moloney N, Leaver A, Rebbeck T, McAuley JH, Refshauge KM. Relationship between quantitative sensory testing and pain or disability in people with spinal pain-A systematic review and meta-analysis. Pain. 2013;154:1497–504.

  14. 14.

    Huang LL, Yu SY. Mechanism of central sensitization in the neuropathic pain. Chin J Pain Med. 2011;8:463–5.

  15. 15.

    Wang Q, Ni JX. Neuropathic pain after spinal cord injury. Chin J Rehabil Med. 2011;6:588–91.

  16. 16.

    Cruz-Almeida Y, Felix ER, Martinez-Arizala A, Widerström-Noga EG. Decreased spinothalamic and dorsal column medial lemniscus-mediated function is associated with neuropathic pain after spinal cord injury. J Neurotrauma. 2012;29:2706–15.

  17. 17.

    Hari AR, Wydenkeller S, Dokladal P, Halder P. Enhanced recovery of human spinothalamic function is associated with central neuropathic pain after SCI. Exp Neurol. 2009;216:428–30.

  18. 18.

    Liu GL, Li JJ, Zhou HJ, Yun XP, Zheng Y, Zhang Y, et al. The comparison between monofilament test and light touch exam of spinal cord injury and its clinical significance. Chin J Rehabil Theory Pract. 2015;21:990–2.

Download references


We appreciate the assistance of all participants.


This study was supported by grants from China Rehabilitation Research Center (NO. 2015CZ-17).

Author information

JL was responsible for designing and writing the study protocol and interpreting the results. GL and HZ were responsible for collecting data and writing the paper. YZ, CH, YZ and BW were responsible for creating “summary of findings” tables and figures. YW, HK and XL were responsible for extracting and analysing data.

Correspondence to Jianjun Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of ethics

Our study was approved by the ethics committee of Capital Medical University School of Rehabilitation Medicine. Written informed consent was obtained from all participants.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplementary table 1

Supplementary table 2

Supplementary table 3

Supplementary table 4

Supplementary table 5

Supplementary table 6

Supplementary table 7

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark
Fig. 1
Fig. 2
Fig. 3