nhsManagers.net | Briefing | 17 March 2017 Medicine for Managers Dr Paul Lambden BSc MB BS BDS FDSRCSEng MRCS LRCP DRCOG MHSM FRSM We touch things all the time with all parts of our bodies – The touch of silk on the body: The touch of something soft: The touch of something hard Something that is hot, or cold, or sharp or blunt. You can map out what you feel. You can identify things simply by touch. Touch may cause pain, may carry you to the heights of eroticism or may indicate the sensation of pressure. Yet it is just ‘there’. Think next time you get home after work. You open the door, step inside the house, take off the uncomfortable tight shoes you have been wearing and stand on the prickly door mat; you walk onto the soft carpet and up the stairs to the bedroom. You feel the relief as you undo buttons and zips and remove the work clothes. You put on something warm, soft and comfortable. The cat is waiting and you stroke him affectionately. You go downstairs and in the lounge, collecting a gin and tonic from the cabinet. You slide into a leather sofa and feel the Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use. How Do I Feel Touch? Touch is a very underrated sensation. We all take it for granted. It is a pleasant, sometimes sensuous, sometimes painful part of our day-to-day life. It is what principally connects our bodies physically to the outside world and without those continual interactions a crucial part of the human experience would be missing.
Transcript
nhsManagers.net | Briefing | 17 March 2017
Medicine for Managers
Dr Paul Lambden BSc MB BS BDS FDSRCSEng MRCS LRCP DRCOG MHSM FRSM
We touch things all the time with all parts of our bodies – The touch of silk on the body:
The touch of something soft:
The touch of something hard
Something that is hot, or cold, or sharp or blunt. You can map out what you feel. You can identify things simply by touch. Touch may cause pain, may carry you to the heights of eroticism or may indicate the sensation of pressure.
Yet it is just ‘there’. Think next time you get home after work. You open the door, step inside the house, take off the uncomfortable tight shoes you have been wearing and stand on the prickly door mat; you walk onto the soft carpet and up the stairs to the bedroom. You feel the relief as you undo buttons and zips and remove the work clothes. You put on something warm, soft and comfortable. The cat is waiting and you stroke him affectionately. You go downstairs and in the lounge, collecting a gin and tonic from the cabinet. You slide into a leather sofa and feel the
Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.
How Do I Feel Touch? Touch is a very underrated sensation. We all take it for granted. It is a pleasant, sometimes sensuous, sometimes painful part of our day-to-day life. It is what principally connects our bodies physically to the outside world and without those continual interactions a crucial part of the human experience would be missing.
coldness of the ice in the glass. You close your eyes. Your body tells you all sorts of things about your environment, simply because of touch.
The sense of touch is mediated through the skin, which is a complex organ and which is estimated to have a total of about five million receptors. They are available to be activated by any appropriate stimulus but they do develop tolerance to sensation so, for example, you are
not continuously reminded that you are wearing clothes.
So, how does touch actually work? It all depends on the brain and spinal cord together with the nerves carrying signals from the skin (sensory or afferent nerves) to the central nervous system and nerves carrying signals to muscles and organs (motor or efferent nerves).
Consider the situation above where a pin is stuck into the skin. Pain receptors in the skin are activated carrying an impulse in sensory nerves to the spinal cord (entering through the posterior root (the back of the spinal cord). There the nerves link with a relay neurone (also called an intermediate neurone) which joins motor neurones which carry impulses to activate structures which make the response. So in the example above, if a pin is stuck in a finger, the response is sent to the appropriate muscles in the hand to move it out of the way.
Of course the system is much more complicated than that. In fact, thousands and thousands of nerves are involved travelling up and down the spinal cord to the brain where the response is mediated. That means it is adjusted to meet the particular circumstances, based on other current knowledge and past experience. So, if you discover that the plate of dinner you are carrying is hot, the reflex to let go and drop your plate of dinner on the floor can be overridden to put the plate down on a table quickly, even if that might mean burning your hand.
The skin is richly supplied with receptors which continually report changes to the local environment.
• Pain
• Touch • Light touch
Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.
• Cold
• Heat • Pressure • Vibration
The receptors protect and direct everything you do, consciously and unconsciously.
The sense of touch is well developed before birth and a new-born baby will turn the head to the side if something touches the cheek.
But touch is so much more than a protective system. We use physical contact to make and renew relationships. Shaking hands creates a connection; a hug can make you feel valued, safe, secure and important to that person.
This has led to the concept that touch is involved with two separate neurological systems for processing information about touch
1. A sensory pathway which provides facts about touch; pain, pressure, heat, cold, vibration, etc.
2. A socio-emotional pathway which identifies and processes information from interpersonal touching, which is transmitted from the sensors to the brain and which stimulates pleasure, pain and social centres.
Certainly a touch on the back from a lover produces a very different response from a similar touch on the back by a traffic warden trying to attract your attention. The two differ, not only in context but in sensation, and this is believed to be due to the brain drawing on diffent centres to process the information which it has received.
It is for this reason that we experience different ‘sorts’ of touch which shape our childhood and influence or adult relationships:
Sensation in all its modalities from round the body is not equally spread. Some areas of the body have much more developed ability to discriminate the nature and intensity of stimulation. If the body was redrawn to show the various parts by intensity of sensation (the sensory homunculus) reflected in the amount of sensory brain cortex allocated to each body area, it would appear as below.
Hands, lips, feet and genitalia have relatively profuse sensory innervation.
Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.
So we owe a lot to touch to explore, to learn, to enjoy and to keep us informed at all time. John Keats recognised that “Touch has a memory”, though he sought a way to kill it to be free. Touch is our link with our environment and without it our protection would be much diminished.
Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.
