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Journal ArticleDOI

Correlation between two-point discrimination with other measures of sensory loss in diabetes mellitus patients

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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01 Jan 2011
TL;DR: The two point discrimination test can be used to detect upper limb neuropathy in patients with type 2 diabetes, which can further be validated with nerve conduction velocity tests.
Abstract: Context: Sensory changes are associated with diabetic neuropathy and the assessment of sensation is commonly done in the foot to prevent ulcers. Though sensory changes may be present in the upper limb also, its documentation is not done routinely. Aims: To find out the two point discrimination values and other sensory changes in the upper limb in type 2 diabetic patients. Settings and design: This was a cross sectional design using a case control study, which was done in a hospital with both inpatients and outpatients.Methods and material: 75 subjects with type 2 diabetes were included in the case group; patients with a diagnosed case of neuropathy were excluded. These were compared with age and sex matched subjects in the control group with no diabetes. Vibration sensation, pressure threshold and two point discrimination were assessed on the hands in both the groups. The Duruoz’s Hand Index was used to assess the general functional status with regards to the abilities of daily living in both the groups. Statistical analysis: The data was analysed by using the SPSS package, version 13, with p values <.05 being taken as significant. Results: In the diabetic group, approximately 11 % of the patients had the loss of protective sensation; the median value of the vibration sensation was 11-14 volts as compared to 3-4 volts in the control group and the mean value of the two point discrimination was 4-5mm. The results were significantly different between the diabetic and the control groups. The median value of DHI was eight in the diabetic group. Conclusions: All the sensations which were checked were altered in the diabetic patients, thus indicating the possible underlying neuropathy changes. The two point discrimination test can be used to detect upper limb neuropathy in patients with type 2 diabetes, which can further be validated with nerve conduction velocity tests. A sensory evaluation should be done in the upper limb, especially with patients who had diabetes for more than five years, for the possible presence

1 citations

Journal Article
TL;DR: In this article, the Duruoz Hand Index was used to assess the general functional status with regards to the abilities of daily living in both the diabetic and non-diabetic groups.
Abstract: Context: Sensory changes are associated with diabetic neuropathy and the assessment of sensation is commonly done in the foot to prevent ulcers. Though sensory changes may be present in the upper limb also, its documentation is not done routinely. Aims: To find out the two point discrimination values and other sensory changes in the upper limb in type 2 diabetic patients. Settings and design: This was a cross sectional design using a case control study, which was done in a hospital with both inpatients and outpatients.Methods and material: 75 subjects with type 2 diabetes were included in the case group; patients with a diagnosed case of neuropathy were excluded. These were compared with age and sex matched subjects in the control group with no diabetes. Vibration sensation, pressure threshold and two point discrimination were assessed on the hands in both the groups. The Duruoz’s Hand Index was used to assess the general functional status with regards to the abilities of daily living in both the groups. Statistical analysis: The data was analysed by using the SPSS package, version 13, with p values <.05 being taken as significant. Results: In the diabetic group, approximately 11 % of the patients had the loss of protective sensation; the median value of the vibration sensation was 11-14 volts as compared to 3-4 volts in the control group and the mean value of the two point discrimination was 4-5mm. The results were significantly different between the diabetic and the control groups. The median value of DHI was eight in the diabetic group. Conclusions: All the sensations which were checked were altered in the diabetic patients, thus indicating the possible underlying neuropathy changes. The two point discrimination test can be used to detect upper limb neuropathy in patients with type 2 diabetes, which can further be validated with nerve conduction velocity tests. A sensory evaluation should be done in the upper limb, especially with patients who had diabetes for more than five years, for the possible presence of neuropathy

1 citations

References
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Journal ArticleDOI
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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Journal ArticleDOI
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

Journal ArticleDOI
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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Journal ArticleDOI
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

Journal ArticleDOI
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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