Tuning fork 128 vs 64

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There is a discussion re the validity of using a 64 Hz tuning fork in the neurological assessment. Others say it is valid to use same, I say it ain't in the literature so we need numbers (obviously not the same as for a 128 Hz'er) for it, ie. no we shouldn't use it.
To use a cameron, "HOW SAY YOU"

 

exactly

 

Mark,

the Rydel Seiffer tuning fork is a 64/128Hz tuning fork, which vibrates at 64Hz, with the dampers, but at 128Hz without them, and this tends to be the commonest used graduated tuning fork

this may help
www.neurology.org/cgi/content/full/62/3/461
Background: In the standard neurologic examination, outcome measures of sensation testing are typically qualitative and subjective. The authors compared the outcome of vibratory sense evaluation using a quantitative Rydel-Seiffer 64 Hz tuning fork with qualitative vibration testing, and two other features of the neurologic evaluation, deep tendon reflexes and sensory nerve conduction studies.
Methods: The authors studied 184 subjects, including 126 with Waldenström’s macroglobulinemia and 58 controls, over the course of a weekend. Standard neurologic examinations and quantitative vibratory testing were performed. Sensory nerve action potentials (SNAP) were tested as a measure of sensory nerve function. Tests were carried out by different examiners who were blinded to the results of other testing and to clinical information other than the diagnosis of Waldenström’s macroglobulinemia.
Results: Quantitative vibration measurements in all body regions correlated with sural SNAP amplitudes. Quantitative vibration outcomes were more strongly related to sural SNAP results than qualitative evaluations of vibration. Quantitative vibration testing also detected a loss of sensation with increased age in all body regions tested.
Conclusions: Quantitative vibratory evaluation with Rydel-Seiffer tuning fork is rapid, has high inter- and intrarater reliability, and provides measures for evaluating changes in sensory function over time. Examinations with the quantitative tuning fork are also more sensitive and specific than qualitative vibration testing for detecting changes in sensory nerve function. Use of the quantitative tuning fork takes no more time, provides more objective information, and should replace the qualitative vibratory testing method that is now commonly used in the standard neurologic examination.


but Just to confuse things further

Vibration sensitivity testing with tuning fork—256 Hz or 512 Hz?
European Journal of Plastic Surgery, Volume 30, Number 1 / June, 2007

Abstract Outcome measures of vibratory sensitivity using a 256-Hz tuning fork depend on the perception of vibration by the patient and qualitative comparison with sensory threshold on the examiner. The authors present their experience of comparison of vibratory sensation using a 512-Hz tuning fork with the conventional 256-Hz counterpart in normal volunteers. The median visual analogue score achieved by the 512-Hz tuning fork was the same as the 256-Hz one in all the tested areas of the hand. The 512-Hz tuning fork is smaller and easier to carry and is more advantageous compared to the 256-Hz one. The authors strongly recommend the use of the 512-Hz tuning fork for the vibration sensitivity test.

 

Stephen, thankyou for your reply. Excuse my ignorance, I am confused. The tuning fork that is currently used at our clinic is a C64 with, what i assume are the dampers, with a scale 0-8, which appear to be fixed, not the ones with the screw on them. As I need the scale (=>6 perceived ok) then am I using a 64 Hz, and is this the correct instrument? Further the study you supplied the abstract for mentioned no scale used, no quantification? Sorry mate, early dementia my only excuse, mark c ... just remembered the other query was, the scale we used was it =>6 or =>4 was the 'line in the sand' for categorisation of high/low risk feet?, thanks again

 

Mark,

I am pretty sure the scale is 4 octals, but this is based upon a single study that is now 17 years old, that I don't think has been replicated.

Thivolet, C., Farkh, J. E., Petiot, A., Simonet, C., and Tourniaire, J. ‘Measuring vibration sensations with graduated tuning fork’ Diabetes Care 13(10): 1077-1080, 1990.

I really never though about your question until you raised it, but from fully reading the plastic surgery article, it is the amplitude of the vibration, rather than the frequency of vibration that affects the sensation.


Also we have one of the fixed damper tf as well as a removable damper one. The difference in cost is huge, we picked the removable damper ones up for A$30 from a medical supply company

 

Hi Mark,

If you're simply examining for 'at risk' status then the 10g monofilament test is recommended by Foot In Diabetes UK, International Diabetes Federation, SIGN and NICE guidelines. There are links to all of these these on the guidelines page on this website: http://www.footindiabetes.org

 

Tuning Fork

Hello,
Was just wondering if anyone is aware of validated studies reviewing graduating tuning fork in evaluation of diabetic peripheral neuropathy, and in particularly recommended testing sites?:wacko: