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.
Citations
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TL;DR: There was variation in plantar pressure distribution because the contact area of the men foot was larger than that of women foot, which can provide suitable guidelines to biomedical engineers and doctor for designing orthotic devices for reliving the area of excessively high pressure.
33 citations
TL;DR: Subjective symptoms and objective peripheral nerve disturbances of both small and large fibers occurred at low ACDW (> 50 ppb), suggesting a threshold for the occurrence of peripheral neuropathy due to arsenic exposure, and indicating that the arsenic concentration in drinking water should be less than 10 ppB to ensure human health.
Abstract: More than 140 million people drink arsenic-contaminated groundwater. It is unknown how much arsenic exposure is necessary to cause neurological impairment. Here, we evaluate the relationship between neurological impairments and the arsenic concentration in drinking water (ACDW). A cross-sectional study design was employed. We performed medical examinations of 1867 residents in seven villages in the Thabaung township in Myanmar. Medical examinations consisted of interviews regarding subjective neurological symptoms and objective neurological examinations of sensory disturbances. For subjective neurological symptoms, we ascertained the presence or absence of defects in smell, vision, taste, and hearing; the feeling of weakness; and chronic numbness or pain. For objective sensory disturbances, we examined defects in pain sensation, vibration sensation, and two-point discrimination. We analyzed the relationship between the subjective symptoms, objective sensory disturbances, and ACDW. Residents with ACDW ≥ 10 parts per billion (ppb) had experienced a “feeling of weakness” and “chronic numbness or pain” significantly more often than those with ACDW 50 ppb). These data suggest a threshold for the occurrence of peripheral neuropathy due to arsenic exposure, and indicate that the arsenic concentration in drinking water should be less than 10 ppb to ensure human health.
30 citations
TL;DR: In this paper, the authors evaluated two-point discrimination (TPD) compared with nerve conduction studies in the early stages of type 2 diabetes mellitus and found that higher TPD values in the lower extremities indicate nerve damage in patients.
Abstract: Background
Diabetes mellitus (DM) is a common cause of polyneuropathy. The aim of the present study was to evaluate two-point discrimination (TPD) compared with nerve conduction studies in the early stages of DM.
Methods
Forty-eight patients with early diagnosed (<5 years) type 2 DM and 17 healthy controls were evaluated. Of the patients with DM, 26 had neuropathic pain and 22 were asymptomatic. TPD and electrophysiological evaluations was obtained for all subjects.
Results
Nerve conduction studies in patients showed findings related to both demyelination and axonal damage. Patients with neuropathic pain had higher TPD values on the plantar surface of the foot and both groups of DM patients had higher TPD values on the outer lateral malleolus compared with the control group (P < 0.05). There was a correlation between TPD and axonal damage in patients with neuropathic pain (P < 0.05). In patients without neuropathic pain, there was a correlation between TPD values and distal latencies of motor or sensory nerves (P < 0.05). In the control group, only third digit TPD values were related to the distal motor latency of the median nerve (P < 0.05).
Conclusion
In conclusion, the TPD method is a less painful, practical, costeffective, and more easily applicable method that was completed in less timethan nerve conduction studies. Higher TPD values in the lower extremities indicate nerve damage in patients. These findings suggest that increased TPD values can easily determine neuropathy starting in the early stages of diabetes in patients with DM.
摘要
背景
糖尿病是多发性神经病变最常见的病因之一。本研究的目的是在处于早期阶段的糖尿病患者中比较测定两点辨别力（two-point discrimination, TPD）与神经传导研究。
方法
评估了48名早期（< 5年）诊断的2型糖尿病患者以及17名健康对照者。在糖尿病患者中，26名患者有神经性疼痛，22名患者无症状。所有的受试者都要进行TPD与电生理学评估。
结果
患者的神经传导研究结果显示与脱髓鞘以及轴突损害都有关系。与对照组相比较，有神经性疼痛的患者足底面的TPD值更高，并且两组糖尿病患者外踝面的TPD值都更高（P < 0.05）。在有神经性疼痛的患者中，TPD与轴突损害具有相关性（P < 0.05）。在没有神经性疼痛的患者中，TPD值与运动或者感觉神经的远端潜伏期具有相关性（P < 0.05）。在对照组中，只有第三指的TPD值与正中神经的远端运动潜伏期具有相关性（P < 0.05）。
结论
总之，与神经传导研究相比较，测定TPD的方法是一种痛苦少、成本效益高、更容易施行的方法，并且可以在更短的时间内完成。患者下肢TPD值更高意味着神经损害。这些研究结果提示，在处于早期阶段的糖尿病患者中，从升高的TPD值可以很容易地判定是否有神经病变。
16 citations
TL;DR: Sensory changes after tongue reduction by the Harada-Enomoto method for macroglossia in a 20-year-old woman with Beckwith-Wiedemann syndrome are reported.
Abstract: We report sensory changes after tongue reduction by the Harada-Enomoto method for macroglossia in a 20-year-old woman with Beckwith-Wiedemann syndrome. Sensory tests were performed before surgery and 1 week and 2 months after surgery. We assessed the static tactile threshold, vibration sense, static 2-point discrimination, pain threshold, and taste. No sensory loss of any category tested was observed after tongue reduction.
14 citations
TL;DR: There was marked, significant postoperative improvement of mean touch pressure 1-point threshold, compared with preoperative values, for medial calcaneal, medial plantar, and lateral plantar nerves in both non-diabetic and diabetic patients.
13 citations
Additional excerpts
...The 2-point discrimination test may measure different properties of the foot than other tests [50]....
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References
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TL;DR: This paper is the first in Brazil to report the use of the Pressure-Specified Sensory Device to measure cutaneous sensibility in 3 areas of the foot: the hallux pulp, the calcaneus, and the dorsum, which are territories of the tibial and fibular nerves.
Abstract: Diabetic neuropathy is an important complication of the disease, responsible for ulceration and amputation of the foot. Prevention of these problems is difficult mainly because there is no method to correctly access sensibility on the skin of the foot. The introduction of the Pressure-Specified Sensory Device (PSSDTM) in the last decade made possible the measurement of pressure thresholds sensed by the patient, such as touch, both static and in movement, on a continuous scale. This paper is the first in Brazil to report the use of this device to measure cutaneous sensibility in 3 areas of the foot: the hallux pulp, the calcaneus, and the dorsum, which are territories of the tibial and fibular nerves. METHOD: Non-diabetic patients were measured as controls, and 2 groups of diabetic patients - with and without ulcers - were compared. The PSSDTM was used to test the 3 areas described above. The following were evaluated: 1 PS (1-point static), 1 PD (1-point dynamic), 2 PS (2-points static), 2 PD (2-points dynamic). RESULTS: The diabetic group had poorer sensibility compared to controls and diabetics with ulcers had poorer sensibility when compared to diabetics without ulcers. The differences were statistically significant (P <.001). CONCLUSION: Due to the small number of patients compared, the results should be taken as a preliminary report.
30 citations
"Correlation between two-point discr..." refers background or methods in this paper
...DTPD is usually measured with disk-criminator,[15] moving the prongs along the surface of the center....
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...Among the two types of TPD, static TPD (STPD) and dynamic TPD (DTPD), the former is commonly used in emergency departments to determine digital nerve integrity.[15] It is the current recommended method for physicians evaluating loss of sensation or degree of sensation loss in diabetic patients....
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TL;DR: A prospective case control study in a population of 255 diabetic subjects tested the combined sensitivity and specificity of the two most commonly utilized sensory testing modalities: the Semmes-Weinstein lOg monofilament (SWMF) and the Biothesiometer and determined that the lack of perception of 4 or more out of 10 sites on the bottom of the foot using the SWMF carried with it a 97% sensitivity and a 83% specificity.
Abstract: Peripheral sensory neuropathy is a pivotal element in the causal pathway to both foot ulceration and amputation in patients with diabetes (1-3). Therefore, selecting a quick, inexpensive, and accurate instrument to evaluate the highrisk patient is essential to make decisions about the allocation and distribution of medical resources and personnel. Although it is important to identify loss of protective sensation in patients with diabetes, the importance of defining the point at which sufficient protective sensory loss occurs had for many years not been well defined. Numerous studies have made great strides in identifying this elusive point by utilizing a variety of techniques to detect sensory neuropathy. However, all have used differing methods , different sites of testing, and different ways of interpreting the results (410). Recently, we have attempted to further clarify this issue by conducting a prospective case control study in a population of 255 diabetic subjects (1) which tested the combined sensitivity and specificity of the two most commonly utilized sensory testing modalities: the Semmes-Weinstein lOg monofilament (SWMF) and the Biothesiometer.' We determined that the lack of perception of 4 or more out of 10 sites on the bottom of the foot using the SWMF carried with it a 97% sensitivity and a 83% specificity in identifying patients at highest risk for diabetic foot ulcers. This was the optimum combination of sensitivity and specificity for this device. Another device commonly used in diabetic foot speciality clinics, the Biothesiometer, measures vibration perception (also known as vibration perception threshold ). The optimum vibration perception threshold was 25 V yielding a 90% sensitivity and
28 citations
"Correlation between two-point discr..." refers background in this paper
...[4] SWMF is less useful in screening the loss of protective sensation beyond the risk factor.[5]...
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TL;DR: Using a clinically relevant threshold of 2 mm, the authors found that a properly calibrated set of paper clips performed as well as the Disk-Criminator when assessing two-point discrimination of the index and long fingers of the dominant hand.
Abstract: Objectives: The primary objective of this study was to compare two different instruments for assessing digital nerve function; a secondary aim was to determine interobserver agreement among emergency physicians by using static two-point testing of digital nerve function. Methods: This was a prospective, blinded, observational study of static two-point discrimination involving healthy volunteers aged 18-59 years. The authors compared two instruments (paper clip set or Disk-Criminator) to assess two-point discrimination of the index and long fingers of the dominant hand. For each subject, the initial investigator and initial testing instrument were randomized. Two-point testing was conducted at 4, 5, and 6 mm by using six randomly selected stimuli (1 or 2 points) for each distal phalanx tested. The study was designed to detect a 25% difference in mean two-point distance with a power of 80%. Results: Seventy-five subjects were entered into the study, of which two were excluded. Interinstrument agreement for a given investigator ranged from 77% to 84% for absolute agreement and 98% to 100% within 2 mm. Weighted kappa values for interobserver differences of 2 mm or less was 0.79 to 1.00. There was no statistically significant difference between instruments. Conclusions: Using a clinically relevant threshold of 2 mm, the authors found that a properly calibrated set of paper clips performed as well as the Disk-Criminator.
22 citations
"Correlation between two-point discr..." refers methods in this paper
...Calipers or an opened paper clip with two parallel ends are used for Þ nding STPD.[16] Esthesiometer, a modiÞ ed form of vernier calliper, is clinically used for determining the TPD of touch, by moving the prongs into contact with the portion of the body part and then pressing until the patient feels a sensation....
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01 Jan 1996
TL;DR: In this article, a nouvelle technique barographique de mesure en ligne de la pression exercee sur la voute plantaire au cours de la marche or en station debout is presented.
Abstract: Dans ce travail, on presente une nouvelle technique barographique de mesure en ligne de la pression exercee sur la voute plantaire au cours de la marche ou en station debout. La methode peut etre employee pour analyser rapidement un grand nombre de patients normaux ou lepreux. L'analyse est utilisee pour determiner de nouvelles caracteristiques permettant de distinguer les pressions de pieds normaux de celles des sujets lepreux a differents stades de deformation ou de paralysie. Ces index sont aussi utilises pour quantifier la correction chirurgicale et pour surveiller les differentes etapes de reeducation.
21 citations
"Correlation between two-point discr..." refers methods in this paper
...In the literature, the foot is divided into ten standard signiÞ cant areas [Figure 1 (a)], as per method indicated in Cavanagh et al,[18] and Patil et al.[19] For our analysis, we have divided each foot into four areas as mentioned in Figure 1 (b)....
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...We used pedopowergraph (PPG) system as mentioned.[19] It is based on continuous transduction principle and measures pressure distribution parameter PR....
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TL;DR: A new parameter, the power ratio (PR, the ratio of high frequency power to the total power in an image), is used to distinguish between foot pressure image patterns of diabetic neuropathic subjects (at different levels of sensation loss) and those of normal feet.
Abstract: In this paper, studies are performed on a large number of diabetic patients belonging to different levels of plantar sensation loss, by analyzing the standing foot pressure images in the frequency domain. A new parameter, the power ratio (PR, the ratio of high frequency power to the total power in an image), is used to distinguish between foot pressure image patterns of diabetic neuropathic subjects (at different levels of sensation loss) and those of normal feet. The foot areas of the diabetic subjects are scanned in 10 specified areas using Semmes Weinstein's nylon monofilaments to quantify the diabetic neuropathy. A statistical study of the mean values of this parameter in different plantar areas of the feet for different levels of diabetic neuropathy indicates distinguishing trends. The result could help in the early detection of low-level sensation loss by establishing the threshold of the PR in a particular area above which there could be the possibility of plantar ulcer formation. This information could be utilized by orthopedic surgeons to devise early corrective methods to protect the feet from further damage due to plantar ulcers.
19 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.[7] The latter quantified loss of sensation into three levels[1] and reported good correlations between quantified levels of sensation loss and peak foot pressure....
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...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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...[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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