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Tag Archive: VPT screening

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

   October 23, 2022 11:10 am Leave a Comment

   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. Large Fiber Peripheral Neuropathy, Aging and Fall Risk

   February 5, 2016 9:40 am Leave a Comment

   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)