The RSTF method is no more time consuming than routine vibratory testing and and is less cumbersome than timed vibratory testing some have suggested it replace traditional testing. The RSTF is increasingly used in neuropathy research studies. A chart provides reference values for various ages and for both upper and lower extremities. The vibratory sensation is the number readable when the patient reports loss of the sensation. As the vibrations attenuate, the display becomes readable and the intersection of the arrows points to progressively higher value numbers. Rydel-Seiffer tuning fork When the tines are set in motion, the numbers and arrows blur out (Video). There is a black and white display of two arrows and two sets of numbers from 2 to 8 (Figure). The 64 Hz Rydel-Seiffer tuning fork (RSTF) provides a more quantitative assessment of vibratory sensation. There have been attempts to standardize timed vibration testing.(2) In a large series of patients, routine clinical vibratory testing was compared to quantitative vibratory testing (QVT).(1) Neuromuscular physicians more often overestimated than underestimated vibratory loss when compared to QVT. Neuromuscular physicians more often overestimated than underestimated vibratory loss when compared to QVT. In a large series of patients, routine clinical testing was compared to quantitative vibratory testing (QVT). More precision requires manipulating both the tuning fork and a stopwatch. Counting “one Mississippi” provides a semi-quantitative estimate. Since vibratory sensibility normally declines with age, a control of similar age, often the spouse, is helpful. Perception for less than 10 seconds at the great toe is abnormal at any age. ” This is better than “mildly decreased.” A normal young adult should perceive vibration for at least 15 seconds at the great toe this value decreases by about 1 second per decade. Vibratory sensation can be quantitated fairly simply by noting where the patient can perceive it and for how long, e.g., “absent at the great toes and first metatarsal heads, present for 5 seconds over the medial malleoli.
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