Correlation between two-point discrimination with other measures of sensory loss in diabetes mellitus patients
01 Jul 2008-International Journal of Diabetes in Developing Countries (Int J Diabetes Dev Ctries)-Vol. 28, Iss: 3, pp 71-78
TL;DR: The TPD appears to be measuring different property of the foot compared to other measures, and the mechanism of this independence is not well understood and more investigation is required to understand the mechanism.
Abstract: Diabetic neuropathy is one of the most important factors for foot ulceration in diabetes mellitus (DM) patients. Among different sensibility measures of neuropathy, two-point discrimination (TPD) has been suggested as a reliable method; however, the correlation of TPD with other well-known measures is not known. We measured the loss of protective sensation using Semmes-Weinstein Monofilaments (SWMF), hardness of the foot sole using shore meter (sh), power ratio (PR) using pedopowergraph and TPD using esthesiometer in foot areas of both left and right legs in 14 DM subjects. We have found no correlation either between TPD and shore values (sh) or between TPD and PR. The SWMF (10 g) is found not to provide any additional value in measuring loss of sensation in comparison to TPD. The TPD appears to be measuring different property of the foot compared to other measures. The mechanism of this independence is not well understood and more investigation is required to understand the mechanism.
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TL;DR: The data show that using Braille can enhance development of the sensory median nerve in the blind, particularly in terms of the electrical sensory and pain thresholds, and make it difficult to explain the difference in tactility between groups.
Abstract: [Purpose] This study investigated two-point discrimination (TPD) and the electrical sensory threshold of the blind to define the effect of using Braille on the tactile and electrical senses. [Subjects and Methods] Twenty-eight blind participants were divided equally into a text-reading and a Braille-reading group. We measured tactile sensory and electrical thresholds using the TPD method and a transcutaneous electrical nerve stimulator. [Results] The left palm TPD values were significantly different between the groups. The values of the electrical sensory threshold in the left hand, the electrical pain threshold in the left hand, and the electrical pain threshold in the right hand were significantly lower in the Braille group than in the text group. [Conclusion] These findings make it difficult to explain the difference in tactility between groups, excluding both palms. However, our data show that using Braille can enhance development of the sensory median nerve in the blind, particularly in terms of the electrical sensory and pain thresholds.
9 citations
01 Dec 2010
TL;DR: There was variation in plantar pressure distribution because the contact area of the Men foot was larger than that of Women, which can provide suitable guidelines to biomedical engineers and doctor for designing orthotic devices for reliving the area of excessively high pressure.
Abstract: The purpose of this study was to analyze static foot pressure image to obtain the plantar pressure distribution variation between Men and Women using image processing in frequency domain Methods: We examined 38 feet of 19 healthy subjects (12 Men and 7 Women) aged between twenty to forty five years was recruited for our study Foot pressure distribution patterns while standing are obtained by using a portable PedoPowerGraph plantar pressure measurement system for foot image formation, a digital camera for image capturing, a TV tuner PC-add on card, a WinDvr software for still capture and Matlab software with dedicated algorithms have been developed Various PedoPowerGraphic parameters such as percentage medial impulse (PMI), Forefoot to Hind foot pressure distribution ratio (F/H), Big toe to forefoot pressure distribution ratio and Power ratio were evaluated Results: In Men, contact area was significantly larger in all regions of the foot compared with Women There were significant differences in plantar pressure distribution and F/H pressure distribution ratio but there was no significant difference in percentage medial impulse (PMI) Mean PR was significantly greater in Men than Women under the hind foot and fore foot F/H pressure ratio was greater in Men than Women As compared to men, women have maximum PR variations in the mid foot Conclusion: There was variation in plantar pressure distribution because the contact area of the Men foot was larger than that of Women Hence knowledge of pressure distributions variation of both feet can provide suitable guidelines to biomedical engineers and doctor for designing orthotic devices for reliving the area of excessively high pressure
8 citations
TL;DR: The 4-2-1 stepping algorithm demonstrates good intra- and inter-tester reliability at determining TPD thresholds on the plantar surface of the foot at the head of the first and base of the fifth metatarsal in young healthy adults.
Abstract: Purpose: A 4-2-1 stepping algorithm reliably captures light touch thresholds but has not been used to assess two-point discrimination (TPD) thresholds. Therefore, the purpose of this investigation was to determine the intra- and inter-rater reliability of a 4-2-1 stepping algorithm at determining TPD thresholds.Materials and methods: Fifteen healthy, physically active young adults were assessed twice over a 1-week period using digital calipers and a 4-2-1 stepping algorithm. TPD thresholds were assessed by an expert and a novice examiner at each time point. Reliability was assessed on the plantar surface of the foot at the head of the first and base of the fifth metatarsal.Results: Three intra-rater intraclass correlation coefficient (ICC) values exceeded 0.75 and were interpreted as good. The inter-rater reliability was good with ICC values ranging from 0.76 to 0.93 at both sites during both test sessions.Conclusions: The 4-2-1 stepping algorithm demonstrates good intra- and inter-tester reliabil...
7 citations
Cites background or methods from "Correlation between two-point discr..."
...In these two isolated cases, threshold was determined as the smallest inter-prong distance that was consistently perceived as a positive detection (i.e., the participant felt two points) (Periyasamy et al. 2008)....
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...Control trials, when only a single prong was applied, were used at random times to ensure participant response reliability (Periyasamy et al. 2008)....
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...Two-point discrimination (TPD) is another measure of somatosensory function (Periyasamy et al. 2008; Moseley and Wiech 2009; Franco et al. 2012; Cately et al. 2013) but specifically examines cortical somatosensory function (Shakoor et al. 2008b)....
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...The DPAS ranges from 0 to 64 with higher scores signifying increased disablement (Periyasamy et al. 2008)....
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01 Jan 2010
TL;DR: In this article, the authors analyzed static foot pressure image to obtain the plantar pressure distribution variation between Men and Women using image processing in frequency domain, and found that the contact area was significantly larger in all regions of the foot compared with Women.
Abstract: Objective: The purpose of this study was to analyze static foot pressure image to obtain the plantar pressure distribution variation between Men and Women using image processing in frequency domain. Methods: We examined 38 feet of 19 healthy subjects (12 Men and 7 Women) aged between twenty to forty five years was recruited for our study. Foot pressure distribution patterns while standing are obtained by using a portable PedoPowerGraph plantar pressure measurement system for foot image formation, a digital camera for image capturing, a TV tuner PC-add on card, a WinDvr software for still capture and Matlab software with dedicated algorithms have been developed. Various PedoPowerGraphic parameters such as percentage medial impulse (PMI), Forefoot to Hind foot pressure distribution ratio (F/H), Big toe to forefoot pressure distribution ratio and Power ratio were evaluated. Results: In Men, contact area was significantly larger in all regions of the foot compared with Women. There were significant differences in plantar pressure distribution and F/H pressure distribution ratio but there was no significant difference in percentage medial impulse (PMI). Mean PR was significantly greater in Men than Women under the hind foot and fore foot. F/H pressure ratio was greater in Men than Women. As compared to men, women have maximum PR variations in the mid foot. Conclusion: There was variation in plantar pressure distribution because the contact area of the Men foot was larger than that of Women. Hence knowledge of pressure distributions variation of both feet can provide suitable guidelines to biomedical engineers and doctor for designing orthotic devices for reliving the area of excessively high
5 citations
Dissertation•
23 Feb 2013
TL;DR: Variation of the acceleration between conditions to be dependent on parameters of vibration (amplitude and frequency) and footwear condition and level of training caused multiple differences in acceleration of certain axis at different locations without showing a consistent effect.
Abstract: Whole-Body Vibration Transmission Barefoot and with Shoes in Athletes and Sedentary Females
Nour Saade
Whole-Body Vibration (WBV) is used in various settings; a lack of consistency is noted in the set-up of individuals on these machines. Whether or not to wear shoes and which parameters to select are difficult questions to answer due to the lack of detailed biomechanical analysis of these conditions. The effects of footwear (shoe or barefoot) and athletic level (varsity athletes or sedentary) on acceleration were analyzed for the lower extremity and at the neck under different parameters (frequency and amplitude) while subjects performed a single-leg squat exercise. Thirty healthy college and university level athletes or sedentary females volunteered in this study. A two-by-two counterbalanced set-up was performed. The measures of acceleration at the different locations were analysed and compared using ANOVAs with a significance of p≤0.05. Results found variation of the acceleration between conditions to be dependent on parameters of vibration (amplitude and frequency). Footwear condition and level of training caused multiple differences in acceleration of certain axis at different locations without showing a consistent effect. These findings aid our understanding of vibration parameter effects on the human body and their interaction within each other. Further studies are warranted to improve our understanding of the global effects of vibration parameters.
4 citations
References
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TL;DR: The spatial distribution of densities supports the idea that the RA and SA I units account for spatial acuity in psychophysical tests, which is known to increase in distal direction along the hand.
Abstract: 1. Single unit impulses were recorded with percutaneously inserted tungsten needle electrodes from the median nerve in conscious human subjects. 2. A sample of 334 low threshold mechanoreceptive units innervating the glabrous skin area of the hand were studied. In accordance with earlier investigations, the units were separated into four groups on the basis of their adaptation and receptive field properties: RA, PC, SA I and SA II units. 3. The locations of the receptive fields of individual units were determined and the relative unit densities within various skin regions were calculated. The over-all density was found to increase in the proximo-distal direction. There was a slight increase from the palm to the main part of the finger and an abrupt increase from the main part of the finger to the finger tip. The relative densities in these three regions were 1, 1.6, 4.2. 4. The differences in over-all density were essentially accounted for by the two types of units characterized by small and well defined receptive fields, the RA and SA I units, whereas the PC and SA II units were almost evenly distributed over the whole glabrous skin area. 5. The spatial distribution of densities supports the idea that the RA and SA I units account for spatial acuity in psychophysical tests. This capacity is known to increase in distal direction along the hand. 6. On the basis of histological data regarding the number of myelinated fibres in the median nerve, a model of the absolute unit density was proposed. It was estimated that the density of low threshold mechanoreceptive units at the finger tip is as high as 241 u./cm2, whereas in the palm it is only 58 u./cm2.
1,148 citations
"Correlation between two-point discr..." refers methods in this paper
...Two-point discrimination The TPD test was originally used for innervations density test of afferent Þ bers.[14] Discriminating the two anatomical points by varying the distance between the two prong points measures the degree of sensation loss and detects progressive loss of sensation in the foot....
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TL;DR: Outcomes deteriorated with increasing grade and stage of wounds when measured using the University of Texas Wound Classification System and a significant overall trend toward increased prevalence of amputations was seen.
Abstract: OBJECTIVE To validate a wound classification instrument that includes assessment of depth, infection, and ischemia based on the eventual outcome of the wound. RESEARCH DESIGN AND METHODS We evaluated the medical records of 360 diabetic patients presenting for care of foot wounds at a multidisciplinary tertiary care foot clinic. As per protocol, all patients had a standardized evaluation to assess wound depth, sensory neuropathy, vascular insufficiency, and infection. Patients were assessed at 6 months after their initial evaluation to see whether an amputation had been performed. RESULTS There was a significant overall trend toward increased prevalence of amputations as wounds increased in both depth (χ 2 trend = 143.1, P 2 trend = 91.0, P P 2 = 31.5, odds ratio (OR) = 11.1, CI = 4.0–30.3). Patients with infection and ischemia were nearly 90 times more likely to receive a midfoot or higher amputation compared with patients in less advanced wound stages (76.5 vs. 3.5%, P 2 = 133.5, OR = 89.6, CI = 25–316). CONCLUSIONS Outcomes deteriorated with increasing grade and stage of wounds when measured using the University of Texas Wound Classification System.
982 citations
TL;DR: It is concluded that simple bedside investigations, such as measurement of the VPT alone, may be useful in identifying those patients at risk of foot ulceration, and foot pressure studies may then be used in such patients as a predictive and management aid by determining specific areas under the foot that are prone to ulcers.
Abstract: The pressures and loads under the feet during walking have been compared in three groups of 41 patients each, using a microprocessor-controlled optical system. Group A consisted of patients with diabetic neuropathy, group B of non-neuropathic diabetic patients, and group C of nondiabetic controls. Thirteen patients in group A had a history of neuropathic foot ulceration. Other investigations in the diabetic patients included motor conduction velocity (MCV) in the median and peroneal nerves, vibration perception threshold (VPT) in the great toes, the valsalva response (VR), skin resistance (SR), and the ankle pressure index (API). Fifty-one percent of neuropathic feet had abnormally high pressures underneath the metatarsal heads compared with 17% of the diabetic controls and 7% of nondiabetic subjects. All those feet with previous ulceration had abnormally high pressures at the ulcer sites. Of the other investigations, the VPT correlated most significantly with the presence of foot ulceration. In addition, a low median and peroneal nerve MCV, an abnormal VR, a high API, and the absence of sweating all correlated with the presence of foot ulceration. We therefore conclude that simple bedside investigations, such as measurement of the VPT alone, may be useful in identifying those patients at risk of foot ulceration. Foot pressure studies may then be used in such patients as a predictive and management aid by determining specific areas under the foot that are prone to ulceration.
411 citations
"Correlation between two-point discr..." refers background in this paper
...Boulton et al,[4] Patil et al[6] and Prabhu et al,[7] have deÞ ned peak foot pressures and shown that the loss of protective sensation is the cause for plantar ulcers in diabetic neuropathy....
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...The latter group is at risk of ulceration.[4] SWMF is less useful in screening the loss of protective sensation beyond the risk factor....
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...[5] Boulton et al,[4] Patil et al[6] and Prabhu et al,[7] have deÞ ned peak foot pressures and shown that the loss of protective sensation is the cause for plantar ulcers in diabetic neuropathy....
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TL;DR: The plantar pressure distributions for a large heterogeneous sample of feet were collected during barefoot standing using a capacitance mat and showed that the heel carried 60%, the midfoot 8%, and the forefoot 28% of the weightbearing load.
Abstract: The plantar pressure distributions for a large heterogeneous sample of feet (N = 107) were collected during barefoot standing using a capacitance mat. From these data, the function of the foot during standing was characterized. Peak pressures under the heel (139 kPa) were, on average, 2.6 times greater than forefoot pressures (53 kPa). Forefoot peak pressures were usually located under the second or third metatarsal heads. No significant relationship was found between body weight and the magnitude of peak pressure. The concepts of a transverse arch at the level of the metatarsal heads and a "tripod" theory of load distribution were not substantiated by this study. Load distribution analysis showed that the heel carried 60%, the midfoot 8%, and the forefoot 28% of the weightbearing load. The toes were only minimally involved in the weightbearing process. Examples of unusual distributions are shown; finally, a checklist is provided to aid the clinician in evaluating plantar pressure findings.
369 citations
TL;DR: The "moving two-point discrimination test" is shown to be a simple, quick, and valid diagnostic tool in nerve compression syndromes and nerve lacerations and an accurate prognosticator and monitor during sensory reeducation following nerve repair.
Abstract: As the Weber test evaluates the slowly adapting fiber-receptor system (constant touch), the "moving two-point discrimination test" evaluates the innervation density of the quickly adapting fiber-receptor system which mediates the perception of touch stimuli moving across the hand. Results with this test in 39 hands used as controls and in 63 patients with nerve injuries show it to be a simple, quick, and valid diagnostic tool in nerve compression syndromes and nerve lacerations and an accurate prognosticator and monitor during sensory reeducation following nerve repair.
287 citations
"Correlation between two-point discr..." refers background in this paper
...The precise physiological mechanisms that sub serve TPD itself remain poorly elucidated,[21,23] but may be said to be independent of skin compliance and pressure distribution....
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