title: Prolonged mechanical noise restores tactile sense in diabetic neuropathic patients.
abstract: Acute application of stochastic resonance (SR), defined as a subsensory level of mechanical noise presented directly to sensory neurons, improves the vibration and tactile perception in diabetic patients with mild to moderate neuropathy. This study examined the effect of 1 hour of continuous SR stimulation on sensory nerve function. Twenty diabetic patients were studied. The effect of stimulation was measured at 2 time points, at the beginning and after 60 minutes of continual SR stimulation. This effect was measured using the vibration perception threshold (VPT) at the big toe under 2 conditions: a null (no SR) condition and active SR, defined as mechanical noise below the subject's own threshold of perception. The measurements under null and active conditions were done randomly and the examiner was blinded regarding the type of condition. Immediately after SR application, the VPT with SR in null condition was similar to baseline (32.2 +/- 13.1, P = nonsignificant) but was significantly lower during active SR (27.4 +/- 11.9) compared with both baseline (P = .018) and off position (P = .045). The 60 minutes VPT with active SR (28.7 +/- 11.1) reached significance comparing the baseline when one outlier was removed from the analysis (P = .031). It may be concluded that SR for a continuous 60-minute period can sustain the VPT improvement in diabetic patients with moderate to severe neuropathy. These results permit the conclusion that there is no short-term adaptation to the stimulation signal. Long-term application of this technique, perhaps in the form of a continually vibrating shoe insert, or insole, may result in sustained improvement of nerve function.
authors.affiliation: Joslin Beth Israel Deaconess Foot Center and Microcirculation Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Cloutier
authors.forename: Samuel
authors.initials: S
authors.lastname: Horr
authors.forename: James B
authors.initials: JB
authors.lastname: Niemi
authors.forename: Susan
authors.initials: S
authors.lastname: D'Andrea
authors.forename: Christina
authors.initials: C
authors.lastname: Lima
authors.forename: Jason D
authors.initials: JD
authors.lastname: Harry
authors.forename: Aristidis
authors.initials: A
authors.lastname: Veves
mesh_terms: D000368:Aged; D017719:Diabetic Foot / Q000628:therapy; D003929:Diabetic Neuropathies / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010812:Physical Stimulation / Q000295:instrumentation* / Q000379:methods*; D012684:Sensory Thresholds; D013269:Stochastic Processes; D055698:Touch Perception; D016896:Treatment Outcome; D014732:Vibration / Q000627:therapeutic use*