Changes in Two Point Discrimination and the law of mobility in Diabetes Mellitus patients

Abstract

BackgroundDiabetic neuropathy is a family of nerve disorders with progressive loss of nerve function in 15% of diabetes mellitus (DM) subjects. Two-point discrimination (TPD) is one method of quantitatively testing for loss of nerve function. The law of mobility for TPD is known for normal subjects in earlier studies but has not been studied for diabetic subjects. This is a pilot study to evaluate and plot the law of mobility for TPD among DM subjects.MethodsThe Semmes Weinstein monofilament (SWMF) was used to measure the loss of protective sensation. An Aesthesiometer was used to find the TPD of several areas in upper and lower extremities for normal and diabetic subjects. All the subjects were screened for peripheral artery occlusive disease with ankle brachial pressure index (0.9 or above).ResultsTPD of normal and diabetic subjects for different areas of hands and legs from proximal to distal is evaluated for 18 subjects. TPD values decrease from proximal to distal areas. Vierodt's law of mobility for TPD holds good for normal subjects in the hand and foot areas. The law of mobility for TPD in DM subjects holds well in the hand but doesn't hold well in foot areas with or without sensation.ConclusionTPD is a quantitative and direct measure of sensory loss. The TPD value of diabetic subjects reveals that the law of mobility do not hold well for Diabetic subjects in foot areas. The significance of this result is that the TPD of the diabetic subjects could provide direct, cost effective and quantitative measure of neuropathy.

Massage therapy as an effective treatment for carpal tunnel syndrome

“…This delayed response to treatment is consistent with a study that found greater significant improvement in neural latencies six months post-operatively, compared to one month (Mondelli et al, 2000). Since two-point discrimination is a quantitative, effective measure of sensory perception (Periyasamy et al, 2008), the changes are expected to parallel those of neural conduction, both being linked to the health of the median nerve.…”

Postural Steadiness and Ankle Force Variability in Peripheral Neuropathy

“…Two point discrimination was performed in a subset of fourteen O-PN at the point of the great toe, though only five O-PN subjects had the ability to feel the points for the test. The average distance at which these five O-PN subjects could discern two points of pressure was 1.03 ± 0.32 cm (average of both feet) compared with values from another study of healthy older subjects of approximately 0.5 cm (Periyasamy, Manivannan, & Narayanamurthy, 2008). Peripheral neuropathy patients in other studies have previously demonstrated a two point discrimination distance of 2.5 cm (Periyasamy et al, 2008).…”

“…The average distance at which these five O-PN subjects could discern two points of pressure was 1.03 ± 0.32 cm (average of both feet) compared with values from another study of healthy older subjects of approximately 0.5 cm (Periyasamy, Manivannan, & Narayanamurthy, 2008). Peripheral neuropathy patients in other studies have previously demonstrated a two point discrimination distance of 2.5 cm (Periyasamy et al, 2008). While this is greater than the average distance noted in our subjects, it must be reinforced that the majority of our subjects could not feel the points of pressure at all, indicating substantial decline in cutaneous sensation.…”

Sensitivity of ventrolateral posterior thalamic nucleus to back pain in alcoholism and CD4 nadir in HIV

“…Motor functions evaluated included balance using an ataxia battery (stand heel to toe, walk 10 steps on line, balance on one leg in eyes open and eyes closed conditions) (Fregly, ) and upper limb motor function using Grooved Pegboard (Trites, ) and Fine Finger Movement (Fama et al, ). Objective signs of neuropathy (Cornblath et al, ; Kaku & Simpson, ) comprised perception of vibration [right or left great toe; normal = 0, impaired (<10 s unilaterally or bilaterally) = 1], deep tendon ankle reflexes [right or left ankle; normal = 0, impaired (absent or hypoactive at least unilaterally or bilaterally) = 1], and 2‐point discrimination (performed on right or left soles of feet) (Periyasamy, Manivannan, & Narayanamurthy, ).…”

“…comprised perception of vibration [right or left great toe; normal = 0, impaired (<10 s unilaterally or bilaterally) = 1], deep tendon ankle reflexes [right or left ankle; normal = 0, impaired (absent or hypoactive at least unilaterally or bilaterally) = 1], and 2-point discrimination (performed on right or left soles of feet)(Periyasamy, Manivannan, & Narayanamurthy, 2008).…”