Tag Archive: quantitative vibration testing

  1. MIPS Quality Measure #126-Diabetic Foot Neurological Exam

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    CMS has recently updated its MIPS (Merit-based Incentive Payment System) Quality Measures. Measure #126 continues to be retained for performance of neurological exams on the feet of diabetic patients. As Measure Steward for this indicator, APMA (American Podiatric Medical Association) has done an excellent job creating a flowchart on implementation. Consistent with prior years, evaluation includes at least annual testing with the 10 gm monofilament plus one of the following:

    Vibration Test Using 128 Hz Tuning Fork
    Pinprick Sensation
    Ankle Reflexes
    Vibration Perception Threshold

    O’Brien Medical is gratified to see that CMS has included vibration testing in two of its four recommended adjunct tests. This decision also reflects current ADA (American Diabetes Association) recommendations.


  2. Vibration Testing Gauges Onset and Recovery from Surgical Anesthesia

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    Anesthesiologists have long observed that surgical anesthetic blocks tend to progress from smaller to larger diameter nerves. This onset of blockade results in a progressive loss of temperature (cold before hot), pain, light and deep touch, vibration and proprioception. Restoration of these sensations usually occurs in reverse order as patients recover from a block.

    128 Hz tuning forks have been used as a simple method of assessing vibration perception in patients undergoing surgical anesthesia. Tuning forks have proven useful as vibration perception is often one of the last sensations to be lost and one of the first to be regained. Vibration recovery is especially useful as it is associated with a return of motor function. This was highlighted in a study by Schulz-Stubner et al. In their study, they were able to correlate a return to baseline vibration sense with recovery from motor blockade after epidural anesthesia. They concluded that a return of vibration perception to baseline was a valid method of documenting recovery prior to discharge after surgery.

    In another more recent study by Jindal et al, the onset of sensory and motor blockade after brachial plexus block was assessed with a 128 Hz Rydel-Seiffer tuning fork and manual motor testing. The decision to use the Rydel-Seiffer instead of the traditional tuning fork was made based on its quantitative output. Jindal determined that vibration sense was a valid indicator for the onset of surgical anesthesia after brachial plexus block. They further advocated for the use of the Rydel-Seiffer tuning fork along with motor testing as objective tools for assessing onset of surgical anesthesia after brachial plexus block.

    These studies may signal a new role for quantitative vibration testing in the assessment of surgical anesthesia patients. Instruments like the Rydel-Seiffer tuning fork and the ETF128 are well-suited to this task due to their quantitative output and reliability. Given the results presented by Schulz-Stubner and Jindal, tuning fork testing could become the new standard for evaluating onset and recovery from surgical anesthesia.




  3. Vibration Testing Documents Outcomes After Neurosurgery

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    As many of our chiropractic customers know, tuning forks can be useful tools in detecting radiculopathy. This is especially apparent in unilateral cases. It is even noted, sometimes incidentally, in the podiatry clinic. The ETF is adept at detecting these disparities due to the quantitative results inherent in its timed vibration test (TVT). An example of this may be seen in patients with a 7-8 second differential between right and left limbs on the TVT. Further questioning of these patients often reveals an established history of a herniated disc or vague but recurrent complaints of low back pain or sciatica.

    Now recent research out of Austria’s Medical University Innsbruck has confirmed the value of  vibration testing in documenting sensation improvement after neurosurgery. In their 2017 article, The value of quantitative sensory testing in spine research, Tschugg et al. document pre- and postoperative values in a battery of quantitative sensory tests (QST) and self-assessment questionnaires in patients with MRI-confirmed single lumbar disc herniation undergoing sequestrectomy. Their findings confirmed significant postoperative improvement in vibration perception as detected by the Rydell-Seifer 64 Hz tuning fork. This quantitative vibration test along with “mechanical detection thresholds” (MDT) administered with customized von Frey hairs were noted to be the most important modalities for detecting and following sensory deficits in this patient population.

    These findings may expand the role of quantitative vibration testing to include routine pre- and postoperative assessment of neurosurgery patients. Products like the Rydell-Seifer tuning fork and the ETFMx are ideally suited to this task due to their quantitative output and 64 Hz vibration frequency. Given the results of Tschugg and colleagues, these point-of-care tests along with the patient self-assessments described in their study could become the new standard for evaluating patient outcomes after neurosurgery.

    Herniated Disc

  4. ETF Clinical Case: Combined Electrochemical Treatment (CET) Sensory Gains Quantified by ETF

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    Background on CET

    Combined Electrochemical Treatment (CET) is a newer form of therapy emerging from leading pain management providers for the treatment of neuropathic pain. CET combines a local anesthetic block with an Electronic Signal Treatment (EST), a sophisticated electrical cell signaling modality delivered to the affected aspects of the body transcutaneously (1).

    Clinical Case

    A diabetic male patient with a six year history of refractory pedal neuropathic pain underwent 28 EST treatments and 4 nerve blocks over a 10 week period. Painful sensory symptoms and numbness subsided by 90%. Pre-treatment ETF128 timed vibration tests (TVT) at the first metatarsal heads were 0 seconds bilaterally. Post-treatment TVT readings were 6.9s on the right and 10.6s on the left demonstrating a clear improvement in vibratory sensation. These findings correlate well with new research suggesting nerve regrowth after CET confirmed by Epidermal Nerve Fiber Density testing (2).

    1. Odell RH Jr, Sorgnard RE.Anti-inflammatory effects of electronic signal treatment.  2008 Nov-Dec;11(6):891-907.

    2. Carney, PM, et al. Regenerating Nerves Destroyed by Neuropathy. 5th International Congress on Neuropathic Pain. May 17, 2015. Nice, France.



    *ETF clinical cases are presented to demonstrate the diagnostic utility of the ETF128. Cases are derived from actual ETF customer practices. Customers are encouraged to submit their own cases for future posts.


  5. Large Fiber Peripheral Neuropathy, Aging and Fall Risk

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    Large fiber peripheral neuropathy (PN) impairing somatosensory feedback and normal motor responses can occur in a variety of diseases. It is generally acknowledged that most elderly patients will have some loss of peripheral neurological function though it is seldom formally diagnosed. This age-related or “senescent” form of neuropathy can result in the same loss of large fiber nerve function as its better known correlate diabetic PN (DPN).

    Regardless of the cause, large fiber PN can result in loss of proprioception, touch, vibratory sensation and muscle strength. These impairments can result in balance and postural control deficits predisposing patients to falls. Falls have long been acknowledged as a major healthcare issue affecting elderly and diabetic patients at higher rates than the general population. Large fiber PN has been determined to be a significant contributor to these falls. Recent research reveals that  assessement of the Vibration Perception Threshold (VPT), equivalent to the 25v setting on the standard Biothesiometer, is an effective PN screening method for a Fall Risk Assessment protocol among elderly patients.

    In light of these recommendations, the ETF can be seen as an appropriate choice when considering methods of performing recommended screening tests as part of a Fall Risk Assessment. This feature is available in the Contant Mode which provides the same vibration as the Biothesiometer at the 25v level. Using the ETF in Constant Mode, the patient can simply give a “yes” or “no” answer as to whether or not they feel the vibration. Superior portability and ease of use make the ETF ideally suited to point-of-care VPT screening in clinics and hospitals when evaluating patients for fall risk.

    (click here for more detail and references)