Tag Archive: vibration testing

  1. New Study Finds Vibration Testing More Reliable than Monofilament over Plantar Calluses

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    Wynands et al’s recently published “Does plantar skin abrasion affect cutaneous mechanosensation?” brings into focus the importance of plantar callus debridement.  This study measured skin thickness, hardness, monofilament threshold and vibration perception threshold (VPT) in healthy participants over plantar calluses before and after “abrasion” (debridement). The intervention group was compared to a matched control group without callus debridement. Findings included significantly reduced skin thickness and hardness as to be expected after callus debridement. Interestingly, VPTs at 30Hz and 200Hz were not significantly affected by debridement. Monofilament thresholds however were significantly improved after the intervention. This finding led the authors to conclude:

    “Since VPTs are not affected by skin properties, they are likely to be the best choice to analyze sensory deterioration in diabetic feet, where skin property changes could skew data of devices like monofilaments.”

    This recommendation aligns with American Diabetes Association Guidelines for using vibration(large-fiber function) and pinprick/temperature (small-fiber function) testing along with the 10g monofilament when testing for loss of protective sensation (LOPS) in patients with diabetes. Another conclusion drawn from this study is that callus debridement improves light touch perception in healthy study participants. Future studies might evaluate this intervention in patients with varying degrees of diabetic peripheral neuropathy (DPN). Perhaps in addition to reducing pressures on the skin, debridement also will be found to improve skin sensitivity in this at risk group. 

  2. ETF128 selected for vibration testing in Benfotiamine clinical trials

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    The company was please to learn that the ETF128 will be one of the vibration testing methods utilized in an international clinical trial assessing the effects of benfotiamine on patients with diabetic peripheral neuropathy (DPN). This randomized, double-blind, placebo-controlled study will compare  benfotiamine 300 mg twice per day to placebo over 12 months. Vibration testing with the ETF will be one of several nerve function tests measuring secondary endpoints. We are looking forward to the outcomes of this well-designed study as benfotiamine is one of the most promising supplements on the horizon for patients with DPN.

  3. New Study Recommends ETF as Best Choice in Vibration Testing for Diabetic Patients

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    We are excited to report the results of recently published research article utilizing the ETF. This study by Raymond et al. from the Journal of Diabetes Science and Technology has recommended the ETF as the best choice of vibration testing instruments to pair with Semmes-Weinstein monofilament testing when performing lower extremity sensation testing in diabetic patients.  This study protocol compared the ETF to the traditional 128 Hz tuning fork and biothesiometer in terms of ease of use, testing time and standardization of vibration output. The authors recommended the ETF over the other devices. We welcome the results of this study and look forward to more research papers validating the clinical use of the ETF.

     

  4. Vibration Testing Improves Post-Op Pain Relief

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    In our research into emerging uses for tuning forks, we came across an interesting study by Kothari et al. In their article, they hypothesized that improved timing of post-operative analgesics could be achieved by assessing the return of vibration perception. Specifically, they studied 60 male patients who had undergone inguinal herniorrhaphy under subarachnoid block. Patients were evenly divided into control and experimental groups. The experimental group was given medication upon return of vibration sense, controls were given their doses after complaining of pain. All patients had vibration testing performed at the anterior superior iliac spine (ASIS) reasoning that this large nerve fiber function would precede the recovery of small nerve fibers responsible for pain sensation. They suggested that optimal timing of analgesic administration could be achieved by monitoring the return of vibration perception thereby reducing patient pain and the need for additional pain medication.

    The results of this study were promising as Kothari noted in their discussion: “…we conclude that if analgesic is given with the return of vibration sense as compared to actual return of subjective pain at the surgical site, then not only patient compliance is better (low VAS Score) but the respiratory and haemodynamic parameters also remain stable.”

    Although this technique has not yet gained widespread popularity, it could develop into a helpful method of improving pain relief following surgery in the future.

  5. 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.