What is the Sensory Functional Score (Sensory FS) with moderately decreased vibration sense in the right medial malleolus and lost vibration sense in the right hallux?

From the Guidelines

The Sensory Functional System (FS) score would be 2, reflecting moderate sensory loss in the right lower extremity. This score is based on the description of decreased vibration sense at the medial malleolus and absent vibration sense at the hallux (big toe) 1. The Functional System scores are used to grade sensory abnormalities from 0 (normal) to 6 (complete loss), with a score of 2 indicating moderate decrease in touch or pain sensation and/or moderate decrease in position sense and/or decreased vibration in one or two limbs. The pattern of sensory loss described is consistent with a length-dependent neuropathy pattern, typical of peripheral neuropathies affecting the longest nerve fibers first, which are those that supply the most distal parts of the extremities 1. Key points to consider in determining the Sensory FS score include:

• The presence of peripheral sensory neuropathy as a common component cause for foot ulceration 1
• The use of clinical examination and the 10-g monofilament test to identify the foot at risk for ulceration 1
• The assessment of small- and large-fiber function and protective sensation using simple clinical tests, such as pinprick, temperature sensation, lower-extremity reflexes, vibration perception, and 10-g monofilament 1. Given the information provided, a Sensory Functional System (FS) score of 2 is the most appropriate assessment of the patient's sensory loss.

From the Research

Sensory Assessment

To determine the Sensory FS score, we need to understand the assessment of vibration sense.

• The vibration sense is typically assessed using a tuning fork or a vibrometer.
• The results are often scored based on the patient's ability to perceive the vibration.

Vibration Sense Assessment

In this case, the patient has:

• Moderately decreased vibration sense in the right medial malleolus
• Lost vibration sense in the right hallux The Sensory FS score is not directly mentioned in the provided studies 2, 3, 4, 5, 6. However, the studies discuss the assessment of sensory function, including vibration sense, in various neurological conditions.

Clinical Utility of Sensory Measures

The study by 2 discusses the clinical utility of measures of sensation in neurological conditions, including the Erasmus MC modifications of the Nottingham Sensory Assessment and the Sensory section of the Fugl-Meyer Assessment.

• These measures have been shown to have good psychometric properties and clinical utility.
• However, the study does not provide specific information on how to calculate the Sensory FS score.

Quantitative Sensory Tests

The study by 3 discusses the use of quantitative sensory tests (QSTs) for temperature and vibratory sense in patients with multiple sclerosis.

• The study found that QSTs allow for a more objective evaluation of sensory function.
• However, the study does not provide information on how to calculate the Sensory FS score.

Vibration Therapy

The studies by 4 and 5 discuss the use of vibration therapy in the rehabilitation of neurological diseases.

• The studies found that vibration therapy can be effective in improving gait, balance, and motor function in patients with stroke.
• However, the studies do not provide information on how to calculate the Sensory FS score.

Neuromagnetic Oscillations

The study by 6 discusses the neuromagnetic oscillations in the human sensory systems.

• The study found that oscillatory neuronal activity supports synchronous interactions between anatomically distinct regions of the brain during cognitive tasks.
• However, the study does not provide information on how to calculate the Sensory FS score.

Since there is no direct information on how to calculate the Sensory FS score, we cannot provide a specific score based on the patient's vibration sense assessment.