Subclinical finding in the perception of tactile sensation involvement after SARS-CoV2 infection: comparison with healthy controls using Semmes-Weinstein monofilament testing.

Background: Post-acute COVID-19 syndrome patients complain of sensory alterations, mainly positive symptoms such as paresthesia or neuropathic pain but also decreased tactile sensation. Using the Semmes-Weinstein monofilament test (SWMT), our study aims to confront recently infected SARS-CoV2 subjects with a control group. Methods: This is a cross-sectional, single-centric study. We performed the SWMT (North Coast Medical Inc.) on 30 patients with previous SARS-CoV2 infection (COVID group) and 46 controls (control group). These patients did not present comorbidities or sensory impairment and did not take any medications. The control group tested negative for SARS-CoV2 infection since the COVID-19 pandemic; the COVID group was examined for this study after the resolution of the infection. We tested the threshold of tactile sensation of the tips of the thumb, index, and little finger of each hand, one hand at a time; the dorsum and the hypothenar regions were also tested. Results: Both groups presented the perception of tactile sensation within the reference value. Despite this result, subclinical changes suggestive of the involvement in peripheral sensory nerve function have been identified in the tested sites in the COVID group compared to the control group. The overall mean target force (grams) was higher in the COVID group than in the control group: 27 (7) vs. 19 (10) mg, p < 0.001. Conclusion: Controls and the COVID group infection had normal tactile sensation thresholds. However, the COVID group presented a higher threshold than the control group, suggesting a possible subclinical perception of tactile sensation involvement of A-beta nerve fibers.

Association between interleg systolic blood pressure difference and apparent peripheral neuropathy in US adults with diabetes: a cross-sectional study.

BACKGROUND: Interleg systolic blood pressure difference (ILSBPD) is associated with peripheral artery disease, but the relationship between ILSBPD and apparent peripheral neuropathy in diabetic patients remains unclear. We explored the relationship between ILSBPD and apparent peripheral neuropathy and examined the possible effect modifiers in US adults with diabetes. METHODS: One thousand and fifty-one diabetic participants were included in the study with complete data on systolic blood pressure of the lower extremities and Semmes-Weinstein 10-g monofilament testing from the 1999-2004 National Health and Nutritional Examination Surveys. Systolic blood pressure in the lower extremities was measured using an oscillometric blood pressure device with the patient in the supine position. Apparent peripheral neuropathy was defined as the presence of monofilament insensitivity. RESULTS: Every 5-mmHg increment in ILSBPD is associated with an about 14% increased risk of apparent peripheral neuropathy in crude model, but after adjustment for covariates, the correlation became nonsignificant (P = 0.160). When participants were divided into groups based on ILSBPD cutoffs of 5, 10 and 15 mmHg in different analyses, there was a significantly increased risk of apparent peripheral neuropathy in the ILSBPD ≥ 15 mmHg group (OR 1.79, 95% CI 1.11-2.91, P = 0.018), even after adjusting for confounders. In subgroup analysis, no interaction effect was found (all P for interaction > 0.05). CONCLUSIONS: In US adults with diabetes, an increase in the ILSBPD (≥ 15 mmHg) was associated with a higher risk of apparent peripheral neuropathy.

Assessment of sensorimotor and strength related function of breast cancer patients during systemic drug therapy: a prospective observational study.

BACKGROUND: Chemotherapy is a well-known risk factor for sensorial and motor disturbances. Chemotherapy induced peripheral neuropathy (CIPN) which predominantly affects sensory nerves might cause a diminished fine motor function. This prospective observational study aimed to assess the sensorimotor functions of breast cancer patients before, during, and after chemotherapy. METHODS: A total of 56 breast cancer patients were evaluated at three different times as follows: T1 (before chemotherapy), T2 (middle chemotherapy), and T3 (completion of chemotherapy). Motor function was assessed with handgrip strength (HGS), peripheral muscle strength (PMS), and the Minnesota Manual Dexterity Test (MMDT). Semmes Weinstein Monofilament Test (SWMT) was performed to assess the sensory function. Fatigue was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Module Cancer Related Fatigue (EORTC-QLQ-FA12), respectively. RESULTS: HGS and MMDT were found significant (χ2: 11.279, p = 0.004 and χ2: 9.893, p = 0.007, respectively) whereas PMS was not found significant (F (2,110) = 1.914, p = 0.152). Pairwise comparisons with Bonferroni adjustments revealed that HGS was found significant between T1 and T3, while significant results were obtained between T1 and T2 as well as T2 and T3 in MMDT (p = 0.01 and p = 0.042). There were significant results in some reference points of SWMT, though they were not found after pairwise comparisons with Bonferroni adjustment (p > 0.05). Fatigue was found significantly increased from T1 through T3 (Median: 19.44 vs 27.77, z: -2.347, p = 0.019, Wilcoxon test). CONCLUSION: Our study showed that decreased handgrip strength and fine motor function, as well as increased fatigue, are evident during the chemotherapy. SWMT can be an optional assessment in the context of tracking changes in cutaneous sensation during chemotherapy due to its non-invasive, cheap, and easily repeatable features among cancer patients. To preserve functional capacity as well as independence in daily living, precautions and follow up assessments during the systemic therapy process should be integrated as early as possible to prevent future deteriorations in daily life for patients who undergo chemotherapy. TRIAL REGISTRATION: NCT04799080.

Early detection of sensory nerve function impairment in leprosy under field conditions.

AIM: To assess the fine sensation of palms and soles in field conditions, to enable early detection of nerve function impairment before the loss of protective sensation, thus preventing the development of disability. METHODS: A cross-sectional descriptive study was conducted at seven tertiary referral hospitals located in different states in India. This study included all newly diagnosed patients affected by leprosy, who were registered during the period between March 2011 and April 2012. A detailed history was taken along with charting and voluntary muscle testing /sensory testing (VMT/ST) for the diagnosed patients. The sensation was measured using 0.2 gm Semmes-Weinstein filaments for palms and 4 gm for soles first, followed by 2 gm Semmes-Weinstein filaments for palms and 10 gm for soles. RESULTS: Among the 374 patients, 106 were identified with sensory nerve function impairment. Of the 106 patients, 84 were identified with absence of both fine and protective sensation and 22 patients had a loss of fine touch sensation with protective sensation intact. LIMITATION: This study was conducted only among patients who were newly diagnosed with leprosy. Hence, future longitudinal studies in a larger population will add more validity to the study. CONCLUSION: The patients who had loss of fine sensation would have been missed by the normal leprosy programme protocol which uses 2 gm and 10 gm filaments for testing sensory loss before initiating steroid therapy. Further research is needed to determine whether testing for fine sensation with 0.2 gm Semmes-Weinstein filaments for palms and 4 gm for soles can be introduced at all specialized leprosy centres to detect nerve function impairment at an earlier stage followed by steroid therapy.

Validity and Reliability of Criteria for Plantar Sensation Assessment Using Semmes-Weinstein Monofilament as a Clinically Usable Index.

There is no standard clinically adaptable criterion for assessing plantar sensation for pre- and post-intervention comparisons. Studies using Semmes-Weinstein monofilaments (SWMs) to investigate intervention effects on plantar sensation vary in procedure and do not consider measurement errors. This study aimed to develop a simple criterion using SWMs to assess plantar sensation, determine the measurement error range, and identify areas of low error. Six examiners assessed 87 healthy young adults in Experiment 1, while two examiners assessed 10 participants in Experiment 2. Filaments were graded from 1 to 20 based on increasing diameter. The smallest grade that could be perceived for three sequential stimuli was used as the criterion (smallest perceivable grade, SPG). The SPG was significantly smaller at the hallux and larger at the heel than at other sites. There were no significant differences between the SPG of the repeated tests performed by the same versus different examiners. The interquartile range of the differences was <±3 at all sites. Thus, our criteria were reliable in evaluating the effects of plantar sensation interventions, especially at the heel and the middle of the metatarsal heads and could contribute to the development of more effective treatments for plantar sensations.

Automatic Segmentation of Monofilament Testing Sites in Plantar Images for Diabetic Foot Management.

Diabetic peripheral neuropathy is a major complication of diabetes mellitus, and it is the leading cause of foot ulceration and amputations. The Semmes-Weinstein monofilament examination (SWME) is a widely used, low-cost, evidence-based tool for predicting the prognosis of diabetic foot patients. The examination can be quick, but due to the high prevalence of the disease, many healthcare professionals can be assigned to this task several days per month. In an ongoing project, it is our objective to minimize the intervention of humans in the SWME by using an automated testing system relying on computer vision. In this paper we present the project's first part, constituting a system for automatically identifying the SWME testing sites from digital images. For this, we have created a database of plantar images and developed a segmentation system, based on image processing and deep learning-both of which are novelties. From the 9 testing sites, the system was able to correctly identify most 8 in more than 80% of the images, and 3 of the testing sites were correctly identified in more than 97.8% of the images.

Rapid and effective fusion repair of severed digital nerves using neurorrhaphy and bioengineered solutions including polyethylene glycol: A case report.

Peripheral nerve injuries (PNIs) that consist of simple nerve severance often result in severe motor impairment and permanent loss of function. Such patients face significant costs and pose major burdens to healthcare systems. Currently, the most promising surgical technique to achieve the best clinical outcome after such PNIs is immediate primary coaptation of severed nerve ends by microsutures (neurorrhaphy). However, recovery is often poor and delayed for many months due to Wallerian degeneration (WD) and slow (1-2 mm/day) axonal outgrowths from severed proximal axons that may not properly reinnervate denervated afferent/efferent targets that have atrophied. In contrast, recent pre-clinical studies using polyethylene glycol (PEG) to facilitate primary nerve repair have greatly improved the rate and extent of sensory and motor recovery and prevented much WD and muscle atrophy. That is, PEG-fused axons rapidly establish proximal-distal axoplasmic/axolemmal continuity, which do not undergo WD and maintain the structure and function of neuromuscular junction (NMJ). PEG-fused axons rapidly reinnervate denervated NMJs, thereby preventing muscle atrophy associated with monthslong denervation due to slowly regenerating axonal outgrowths. We now describe PEG-mediated fusion repair of a digital nerve in each of two patients presenting with a digital laceration resulting in total loss of sensation. The first patient's tactile perception improved markedly at 3 days postoperatively (PO). Two-point discrimination improved from greater than 10 mm at initial presentation to 4 mm at 11-week PO, and the Semmes-Weinstein monofilament score improved from greater than 6.65 to 2.83 mm, a near-normal level. The second patient had severe PO edema and scar development requiring a hand compression glove and scar massage, which began improving at 11-week PO. The sensory function then improved for 4 months PO, with both two-point discrimination and Semmes-Weinstein scores approaching near-normal levels at the final follow-up. These case study data are consistent with data from animal models. All these data suggest that PEG-fusion technologies could produce a paradigm shift from the current clinical practice of waiting days to months to repair ablation PNIs with autografts, anucleated nerve allografts, or conduits in which the patient outcome is solely dependent upon axon regeneration over months or years.

Surgical experience and different glove wearing conditions affect tactile sensibility.

Background: The fingers' tactile sensibility is essential in surgery, especially in microsurgery. Therefore, surgeons seeking to improve their performance often prefer certain glove brands and wearing habits. There is the need of objectively testing these glove wearing conditions and determine the effect of surgical experience with regard to tactile sensibility by comparing surgeons with non-surgeons. Methods: This cross-sectional single-center pilot-study was conducted between June and August 2021. Two groups of 27 surgeons and 27 non-surgeons underwent two-point-discrimination (2PD) and Semmes-Weinstein monofilament testing (SWMT) of both index fingers with bare hands and with wearing six different brands of surgical gloves. Different wearing conditions, such as single-gloving, double-gloving, well-fitted, under- and oversized gloves, were evaluated within and between the groups. Results: Most glove types decreased tactile sensibility (2PD and SWMT) of surgeons and non-surgeons. Interestingly, the thinnest gloves showed similar 2PD values to bare hands in both groups. Double-gloving negatively impacted SWMT, without influencing 2PD. Undersized gloves showed better 2PD and SWMT than well-fitted gloves, while oversized gloves showed no tactile drawbacks. With bare hands and certain glove conditions, the surgeons' 2PD and SWMT was significantly better than the non-surgeons', indicating a positive effect of surgical experience on tactile sensibility. Conclusion: Our study demonstrated the positive impact of surgical experience on tactile sensibility, as demonstrated by the surgeons. The sensibility of the gloved hand varies on the surgical glove type, but favors thinner gloves, single gloving (rather than double gloving) and undersized or well-fitted gloves.

PLANTAR SENSATION AND BALANCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS WITH AND WITHOUT PERIPHERAL NEUROPATHY.

The aim of the study was to investigate the effect of diabetes on plantar sense and balance in patients with type 2 diabetes mellitus (T2DM). The study included 300 subjects divided into three groups: 100 T2DM patients with diabetic peripheral neuropathy (group 1); 100 T2DM patients without peripheral neuropathy (group 2); and 100 subjects without DM (group 3). Berg Balance Scale (BBS), Timed Up and Go test (TUG), single leg test with eyes open and closed, and plantar sensory tests were applied in the subjects. Study results showed significant differences in plantar sensory tests, BBS, TUG and single leg test among the three groups (p<0.05). In addition, duration of DM and medication were negatively correlated with single leg test both with eyes open and closed, but showed positive correlation with plantar sense and TUG test. Furthermore, the length of insulin therapy showed positive correlation with plantar sense and TUG test and negative correlation with BBS (p<0.05). In conclusion, DM has an effect on plantar sense and balance, and there is a relation between the duration of DM and balance problems. Balance problems are observed more often in patients with neuropathy.

The Assessment of Nipple Areola Complex Sensation with Semmes-Weinstein Monofilaments-Normative Values and Its Covariates.

OBJECTIVE: To establish normative data for nipple-areola complex (NAC) sensibility examined with Semmes-Weinstein monofilament test (SWMT) and two-point discrimination (TPD) in women with varying breast sizes, including women with gigantomastia. We also aimed to identify clinical variables influencing NAC sensation. METHODS: A total of 320 breasts in 160 Caucasian women (mean age 33.6 years, SD 11 years) were examined (including 50 hypertrophic breasts). NACs sensation was examined using Semmes-Weinstein monofilaments (SWM) and the Weber Two-Point Discrimination Test. RESULTS: The nipple appeared to be the most sensitive part of NAC. In normal-sized breasts, sensation thresholds (SWM) correlated with: age, BMI, history of births, breast size and ptosis (for all locations), breastfeeding history (for nipple and upper areola) and areola diameter (for all locations apart from the nipple). Regression analysis showed that age, cup size and suprasternal notch-to-nipple distance are risk factors for diminished NAC sensation. Sensation thresholds in all NAC locations of hypertrophic breasts were significantly higher compared to normal-sized breasts, while TPD tests did not differ between the groups. CONCLUSIONS: We provided normative values of NAC sensation (tactile threshold and TPD) for different NAC areas. Our investigation indicated that SWM are useful diagnostic tools when the following factors are considered while examining NAC sensation: location (nipple vs. areola), age, breast size, suprasternal notch-to-nipple distance, history of births and breastfeeding. Hypertrophic breasts presented significantly higher sensation thresholds for all NAC locations. The report may serve as a reference data for further investigations regarding NAC sensation after different breast surgeries.

Acupuncture Relieved Chemotherapy-Induced Peripheral Neuropathy in Patients with Breast Cancer: A Pilot Randomized Sham-Controlled Trial.

Chemotherapy-induced peripheral neuropathy (CIPN) is a disabling side effect caused by neurotoxic chemotherapy. This randomized controlled trial aimed to evaluate the effect of manual acupuncture on CIPN. Twenty eligible breast cancer patients receiving taxane chemotherapy treatment were recruited and randomly divided into verum acupuncture and sham acupuncture groups. Each group received 15 treatments over 9 weeks. Quantitative tactile detection thresholds were measured using Semmes-Weinstein monofilament testing (SWM). The World Health Organization Quality of Life scale (WHOQOL-BREF), the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx), and the Brief Pain Inventory-Short Form (BPI-SF) were measured before and after treatment. The between-group comparison of SWM revealed that the verum acupuncture group had more improvement of touch perception thresholds compared to the sham acupuncture group. The average pain severity in the BPI-SF of the verum acupuncture group was significantly lower than that of the sham acupuncture group. There were no significant differences in the FACT/GOG-Ntx trial outcome index and WHOQOL-BREF scores between the acupuncture and sham groups. The results suggest that acupuncture can alleviate the neuropathic pain of CIPN and improve touch perception thresholds.

Semmes-Weinstein monofilament: A tool to quantify skin sensation in macular lesions for leprosy diagnosis.

INTRODUCTION: Hypochromatic macules with altered sensitivity are the first manifestations of skin leprosy. Validation of this sensory loss assists in the confirmation of the clinical diagnosis. AIMS: The aim of the study was to quantify the loss of sensation in leprosy lesions using the Semmes-Weinstein monofilament to strengthen the clinical diagnosis mainly of macular forms. METHODS: Seventy-four hypochromatic macules in the macular leprosy subgroup, 27 typical borderline leprosy subgroup lesions and 49 macules of other macular dermatoses (non-leprosy group) were evaluated using the 0.05 g force Semmes-Weinstein monofilament to quantify the alteration of sensitivity within and outside of the lesions. The esthesiometric change index was established as the total number of points with altered sensation divided by the total number of tested points within the lesions to calculate the internal esthesiometric change index and outside the lesions to calculate the peripheral esthesiometric change index; these indexes were calculated for all groups. The difference (Δ) between the esthesiometric change indices of the lesional area and the adjacent skin was calculated for the leprosy and nonleprosy groups. RESULTS: The percentage of points with touch sensitivity alterations within the macular and typical borderline leprosy lesions was higher in leprosy than in the non-leprosy group. The borderline and macular leprosy presented higher esthesiometric change index within injured areas than outside injured areas or in the nonleprosy group (P < 0.005). When internal esthesiometric change index values in the macular and borderline leprosy groups were higher than 0.53 and 0.5, respectively, the receiver operating characteristic curve showed 98% sensitivity and approximately 99% specificity for both groups (P < 0.0001). Regarding the difference between indices, borderline and macular leprosy had values that were higher and closer to one than in the nonleprosy group (P < 0.0001), with 100% sensitivity and 96.5% specificity for leprosy diagnosis when ΔLG was higher than 0.34. A limitation was the inability to perform a double-blind study. CONCLUSION: Semmes-Weinstein esthesiometry is a simple, useful and low-cost tool to quantify the focal alteration of cutaneous sensitivity to improve clinical leprosy diagnosis, especially for macular lesions.

Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer-related lymphedema receiving complex decongestive physiotherapy.

PURPOSE: The aims of this study were to investigate if/how the presence of lymphedema affects the sensation of the upper limb and to assess whether complex decongestive physiotherapy (CDP) has a favorable impact on sensory testing. METHODS: A total of 27 patients with unilateral stage 2 breast cancer-related lymphedema (BCRL) were included in the study. Bilateral circumferential measurements were taken with a tape measure at different levels. Based on these measurements, limb volumes were determined by summing segment volumes derived from the truncated cone formula. Circumferential measurements and ultrasonographic evaluations (epidermis, dermis, and subcutaneous fat thicknesses) were performed at 10 cm distal to the elbow crease. The Semmes-Weinstein monofilament (SWM), static and moving two-point discrimination, pressure pain threshold (PPT), and tactile localization tests were also applied at the same site. After an initial evaluation, all patients underwent CDP phase 1 program. All the evaluations were repeated at the end of the treatment period. RESULTS: Before CDP, affected sides had significantly higher values than the unaffected sides in terms of SWM (p < 0.001), static (p = 0.002) and moving (p = 0.011) two-point discrimination, PPT (p = 0.001), and tactile localization (p < 0.001) values. After CDP, SWM (p = 0.002), static (p = 0.009) and moving (p = 0.024) two-point discrimination, PPT (p = 0.014), and tactile localization (p < 0.001) values decreased significantly on the affected sides. CONCLUSION: BCRL seems to reduce light touch, static and moving two-point discrimination, PPT, and tactile localization sensations, whereas CDP seems to improve these sensory perceptions in women with BCRL. Ultrasonographic measurements also appear to be promising for prompt and convenient follow-up in the management of BCRL. TRIAL REGISTRATION: Clinical Trial Registration Number: NCT04296929 (date of registration: March 5, 2020).

Identification of Optimal Foot Tactile Sensation Threshold for Detecting Fall Risk Among Community-Dwelling Older Adults.

OBJECTIVE: Foot tactile sensitivity loss, commonly assessed by monofilaments, is a fall risk factor among older adults. The broadly used threshold of the monofilament for fall risk assessment in older adults is 5.07. However, this threshold originates from assessing foot ulceration risk in people with peripheral neuropathy. The primary purpose of this study was to identify the optimal filament size and its cutoff number of sensitive sites that can be used to best identify a high risk of falls in terms of the foot tactile sensitivity for community-dwelling older adults. METHODS: In this cross-sectional study, the foot tactile sensitivity was assessed by a 6-piece Semmes-Weinstein monofilament kit at 9 sites per foot among 94 older adults, including 38 fallers and 56 nonfallers. The number of sensitive sites was determined for each monofilament size as the cutoff. Logistical regression analyses were used to determine the monofilament size and number of sensitive sites best able to differentiate fallers from nonfallers. RESULTS: Fallers showed overall worse foot tactile sensory measurements than nonfallers. Logistical regression analyses identified 4.31 as the best monofilament size and 7 as the number of sensitive sites to differentiate fallers from nonfallers with an accuracy of 71.3%. CONCLUSION: The 4.31 monofilament could be the best filament to detect the risk of falls among older adults in terms of tactile sensory loss. Inability to feel the pressure from the 4.31 filament at more than 7 sites could indicate a high risk of falls. IMPACT: These findings could help physical therapists and other rehabilitation professionals improve decision making in detecting older adults with a high risk of falls, thus facilitating the effort of fall prevention in older adults.

Relationship Between Sensibility Tests and Functional Outcomes in Patients With Traumatic Upper Limb Nerve Injuries: A Systematic Review.

OBJECTIVE: To investigate which tests of hand sensibility correlate with functional outcomes in patients with upper limb traumatic nerve injuries and to assess if composite scales of sensibility correlate with functions. DATA SOURCES: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched in May 2020, with a supplementary search in July 2020. Reference lists of the included publications were hand searched. STUDY SELECTION: Database search found 2437 records. Eligible studies reported on inferential association between sensibility tests and functions pertaining to adults after upper limb nerve repair. Two reviewers independently assessed eligibility. Fifteen publications were included. DATA EXTRACTION: Extracted data contain patient characteristics, surgical procedure, follow-up duration, sensibility tests, and functional assessments. Two reviewers independently assessed data quality. DATA SYNTHESIS: Fifteen publications involving 849 patients were reviewed. All publications reported on median and/or ulnar nerve injuries. Monofilament tests correlated with Short-Form Health Survey (r=0.548, P<.05), pick-up test (r=0.45, P<.05), and function domain of Patient-Rated Wrist and Hand Evaluation Questionnaire (PRWHE) (r=0.58, P<.05). The 8 studies of static and moving 2-point discrimination provided conflicting correlations with activities of daily living (ADL) and/or the pick-up test. Data for area localization and object/shape identification were equivocal as well. No data were found for Ten test and vibration tests. Rosén score sensory domain correlated with ADL (r=0.59; 95% confidence interval [CI], 0.41-0.72) and PRWHE function domain (r=-0.56, P<.05). Medical Research Council sensory scale was related to pick-up test; return to work status; and Disabilities of the Arm, Shoulder, and Hand questionnaire. CONCLUSIONS: Monofilament tests allow practitioners to gather sensibility data meaningful to patients' overall recovery of functions after upper limb nerve trauma. For 2-point discrimination and other sensibility tests, practitioners should be aware that improvement in test performance does not necessarily translate to improved hand function. Findings from the composite scales indicate that hand sensibility, in general, is related to functions. Future research on other common sensibility tests is recommended to explore how the test relates to patients' functions.

The Correlation of Semmes-Weinstein Monofilament Test with the Level of P-75 Neurotrophin as Marker of Nerve Damage in Leprosy.

INTRODUCTION: Leprosy is a chronic infectious disease caused by Mycobacterium leprae that causes damage to the peripheral nerve, particularly Schwann cells. Treatment is useful only to kill bacteria but not to recover peripheral nerve damage. However, early detection of peripheral nerve damage is necessary. We examine P-75 neurotrophin (P75NTR) as an indicator of peripheral nerve damage in leprosy with the Semmes-Weinstein monofilament (SWM) test as the comparison. METHODS: This study uses a quantitative analytic observational study approach with cross-sectional design, conducted at Kediri Leprosy Hospital, Malang, East Java, Indonesia. All leprosy patients had a clinical examination and bacterial index to classify leprosy and then the SWM test to examine the presence of neuropathy in the palms and feet. P75NTR examination uses venous blood samples. An independent t-test was used to compare the SWM and P75NTR scores based on the type of leprosy, and then the Spearman correlation test was used to determine the correlation between SWM scores and P75NTR levels. RESULTS: In this study, SWM scores on the soles of the foot and palms and the P75NTR levels were higher in the PB group compared with MB (p<0.05). Also, a significant positive correlation was found between P75NTR and the SWM scores on the palms of the hand (r=0.864; p=0.000) and the soles of the foot (r=0.864; p=0.000). CONCLUSION: There is a strong positive correlation between P75NTR levels and SWM scores, so P75NTR levels are very likely to be a marker of neuropathy in leprosy, but further studies are still needed to examine the specific role of these biomarkers.

The correlation of gagging threshold with intra-oral tactile and psychometric profiles in healthy subjects: A pilot study.

Excessive gag reflex could be problematic for adequate dental care. Although various factors may increase the susceptibility to gagging, its contributing factors have not been fully determined. This study aimed to determine whether gag reflex was associated with tactile sensitivity and psychological characteristics. Fifteen volunteers of healthy males and females each were recruited for this study. After completing a questionnaire describing the self-perceived gag reflex activity, a disposable saliva ejector was inserted along the palate into the mouth until gagging was evoked. The ratio of the insertion depth to the palatal length was used as an index for the gagging threshold. The two-point discrimination (TPD) and Semmes-Weinstein monofilament (SWM) tests were performed to assess the tactile sensitivity of the palatal regions (hard palate, anterior and posterior soft palate). The Symptom Checklist-90-Revised was used to investigate the relationship between the gagging threshold and the psychological status. Our findings showed that the gagging threshold had a significant positive correlation with the TPD and SWM thresholds on the hard palate. The psychological profiles of psychoticism and hostility score were also significantly correlated with the gagging threshold. However, there were no significant differences in the tactile and gagging thresholds, as well as the psychological profiles, between males and females. Our results suggested that the tactile sensitivity of the anterior palate is a determining factor for the gagging threshold and implied that the initial response of the oral entry site to stimulation may lead to the development of gag reflex.

Validity and Reliability of the Semmes-Weinstein Monofilament Test and the Thumb Localizing Test in Patients With Stroke.

Background: Somatosensory impairment is common in patients who have had a stroke and can affect their motor function and activities of daily living (ADL). Therefore, detecting and treating somatosensory impairments properly is considered to be very important, and various examinations have been developed. However, the reliability and validity of few of them have been verified due to differences in the procedure of each examiner or poor quantification by the examination itself. Objective: We hypothesized that, with fixed procedures two convenient clinical examinations, the Semmes-Weinstein Monofilament Test (SWMT) and the Thumb Localizing Test (TLT), could provide reliable assessments of light touch sensation and proprioception. The purpose of this study was to verify the reliability and validity of these two examinations as indices of somatosensory impairment of the upper extremity (UE) in patients with chronic post-stroke hemiparesis. Methods: Fifty patients with chronic stroke (median time after onset of stroke, 848 [474-1708] days, mean age 57 [standard deviation 14] years) were enrolled at Keio University Hospital from 2017 to 2018. Examiners learned the original method of the SWMT and the TLT rigorously and shared it with each other. The TLT procedure was partially modified by dividing the location of the patient's thumb into four spaces. Two examiners evaluated the SWMT and the TLT for 2 days, and intra-rater and inter-rater reliabilities were calculated using weighted kappa statistics. In addition to this, the evaluator size score of the SWMT was assessed with Bland-Altman analysis to evaluate systematic bias. The Stroke Impairment Assessment Set (SIAS) sensory items were used to assess validity, and Spearman's rank correlation coefficients were calculated. Results: Intra/inter-rater agreements of the SWMT grade score were 0.89 (thumb, 95%CI: 0.83-0.95)/ 0.75 (0.60-0.91) and 0.80 (index finger, 0.67-0.93)/0.79 (0.66-0.92), and of the TLT they were 0.83 (navel level proximal space, 0.71-0.95)/ 0.83 (0.73-0.92), 0.90 (navel level distal space, 0.85-0.96)/ 0.80 (0.69-0.90), 0.80 (shoulder level proximal space, 0.68-0.92)/ 0.77 (0.65-0.89), and 0.87 (shoulder level distal space, 0.80-0.93)/ 0.80 (0.68-0.92) (P < 0.001, each item). All of them showed substantial agreement, but the MDC of the SWMT evaluator size was 1.28 to 1.79 in the inter-rater test and 1.94-2.06 in the intra-rater test. The SWMT grade score showed a strong correlation with the SIAS light touch sensation item (r = 0.65, p < 0.001), as did the TLT with the SIAS position sense item (r = -0.70-0.62, p < 0.001 each space). Conclusions: The reliability and validity of the SWMT and the TLT were verified. These tests can be used as reliable sensory examinations of the UE in patients with chronic stroke, and especially for the SWMT, it is more reliable for screening.

Tactile Sensitivity of Women with Turner Syndrome.

Physical manifestations of Turner syndrome include short stature, a webbed neck, and a shield chest with widely spaced nipples. An aspect of the disease which has not been sufficiently explored so far is the tactile sensitivity of Turner syndrome patients. Thus, the aim of the study was to assess the threshold of tactile sensitivity on hands and feet of women suffering from Turner syndrome. Information on the participants of the study was collected on the basis of questionnaires, as well as anthropometric measurements using a skinfold caliper. Semmes-Weinstein Aesthesiometer was used to find the tactile sensitivity threshold of hands and feet of study participants. Based on the results of the study, significant differences in tactile sensitivity between women with Turner syndrome and healthy women were found. Affected women seem be more sensitive to the touch on the feet than healthy volunteers. The results of the study showed that the tactile sensitivity of women with Turner syndrome is different from that of healthy women.

Comparison of tactile sensitivity measured with a new digital esthesiometer (Beam Test) relative to Semmes-Weinstein monofilament analog esthesiometer.

The assessment of tactile sensitivity uses many tests, of which monofilaments are considered the best. The aim of this study was to develop a tactile sensitivity test, similar to the monofilament test, which eliminates the error risk related to manipulations by the observer, and to establish a correspondence scale. We studied 29 healthy subjects (18 women and 11 men) with a mean age of 27.8 years. The Semmes-Weinstein monofilament (SWM) analog esthesiometer and a digital beam esthesiometer (DBE) were used. We evaluated the tactile sensitivity threshold on the fingertip of each subject's dominant index using the SWM and the DBE. The DBE test consisted of applying the index against the tip of the beam. During a cycle of four elevations/depressions, the subject would press a button each time he/she felt pressure. The test was repeated three times. The screen displayed an average force value between 0 and 200 allowing the result to be expressed in grams (g). The minimum perceived force was 0.06656g (0.023, 0.166) on average with the SWM test and 0.51773g (0.4824, 0.8062) with the DBE test. Our results confirm the DBE test suppresses the observer's manipulations and that a SWM correspondence scale can be established. With the DBE test, the normal sensation ranged from 0.4824g to 0.757g and light touch decreased from 0.758g to 0.8062g. The threshold value of pathological tactile sensitivity was 0.8063g. The DBE test could therefore be used for preventive diagnosis of carpal tunnel syndrome in occupational medicine.