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PubMed1999

Effect of facilitation of sensation from plantar foot-surface boundaries on postural stabilization in young and older adults.

BACKGROUND: One of the more pervasive effects of aging is loss of cutaneous sensation, which appears to correlate with impaired postural control and increased risk of falling. This study examined the potential for compensating for the destabilizing effects of reduced cutaneous sensitivity by placing a raised edge underneath the perimeter of the plantar foot surface, so as to facilitate sensation from the stability boundaries of the base of support. METHODS: The main experiment involved 14 healthy older adults (aged 65-73) selected because they were known, from a previous study, to have moderate plantar cutaneous insensitivity. We also report results of an initial experiment involving 7 healthy young adults (aged 23-31). In both experiments, we studied effects of the plantar facilitation on control of rapid stepping reactions evoked by unpredictable postural perturbation, applied via sudden platform movement in forward, backward, and lateral directions. We also studied effects on "feet-in-place" responses evoked by continuous pseudorandom platform motion in mediolateral and anteroposterior directions. Subjects were blindfolded in all tests. RESULTS: Plantar facilitation reduced the incidence of "extra" limb movements, beyond the initial step, during forward-step reactions in the older adults. There also appeared to be an improved ability to control feet-in-place reactions: young subjects were better able to recover balance without stepping when falling backward (given instructions to "try not to step"), and both young and older subjects reduced the extent to which the center of foot pressure approached the posterior foot boundary during continuous anteroposterior platform motion. CONCLUSIONS: This study provides evidence that mechanical facilitation of sensation from the boundaries of the plantar surface of the foot can improve the efficacy of certain types of stabilizing reactions evoked by unpredictable postural perturbation. The results may be directly transferable to the design of special footwear insoles to reduce instability and risk of falling in older adults.

Adult↗
PubMed1994

Local sensation changes and altered hip muscle function following severe ankle sprain.

BACKGROUND AND PURPOSE: Changes in sensory information have been shown to influence muscle function locally. Some clinicians, however, believe that the influence may be more extensive. To investigate this clinical concept, subjects with severe ankle sprain were assessed for local sensation changes and proximal hip/back muscle function. SUBJECTS: Of a total of 361 potential subjects whose medical histories were assessed, 20 men (age 18-35 years) who had previously sustained a severe unilateral ankle sprain and 11 matched "control" subjects with no previous lower-limb injury participated in the study. METHODS: Using this experimental model, tests of vibration sensation in the ankle (indicating sensation changes) as well as surface electromyography of muscle recruitment patterns for hip extension (indicating muscle function proximally) of the biceps femoris, gluteus maximus, and lumbar erector spinae muscles were made on both sides of the unilaterally injured and matched control subjects. RESULTS: Significant decreases in vibration perception and significant delays in gluteus maximus muscle recruitment during hip extension were found in the injured group. CONCLUSION AND DISCUSSION: The author concludes that both local sensory and proximal muscle function changes are associated with unilateral severe ankle sprain.

Adolescent↗
PubMed1987

Medial antebrachial cutaneous--lateral femoral cutaneous neurotization in restoration of sensation to pressure-bearing areas in a paraplegic: a four-year follow-up.

Loss of cutaneous sensation predisposes paraplegics to ulceration in pressure-bearing areas. We have previously described a method of restoring sensation to anesthetic trochanteric or ischial areas by neurotizing the cutaneous territory of the lateral femoral cutaneous nerve with the medial antebrachial cutaneous nerve of the forearm. After reinnervation of the anterior skin, a musculocutaneous flap is rotated to the desired anesthetic area. A four-year follow-up evaluation has shown good recovery of the quickly and slowly adapting fiber receptor system, mediated through innervated hair follicles and resulting in excellent protective sensation.

Adult↗
PubMed1992

The sensational transverse rectus abdominis musculocutaneous (TRAM) flap: return of sensibility after TRAM breast reconstruction.

Normal breast sensation was objectively quantitated with a biothesiometer, Semmes-Weinstein monofilaments, and two-point discrimination in 10 patients. Ten patients, 2 to 7 years after pedicled transverse rectus abdominis musculocutaneous flap (TRAM) breast reconstruction, were tested in a similar manner. The majority of these patients were found to have recorded measurable sensibility in the TRAM reconstruction. Recovered sensation was best in the medial and superior quadrants and improved with time. Although sensibility was present, it was still significantly different from normal sensory thresholds. A method to improve sensation by intercostal nerve repair is described. Three patients who have undergone this reconstruction have better sensibility in the reinnervated breast compared with the control breast. Sensory reeducation programs may also improve subsequent sensibility return.

Adult↗
PubMed1994

Changes in human respiratory sensation induced by acute high altitude hypoxia.

Respiratory sensation was studied in European low-landers at an altitude of 4382 m after a helicopter flight in order to investigate the acute and prolonged effects of high altitude hypoxia. At rest the ability to detect four inspiratory resistive loads can be used to create a sensitivity index P(A) without taking the response bias (B) into account, based on the Sensory Decision Theory. In 6 subjects respiratory sensitivity increased significantly under acute and prolonged hypoxia after 3-4 days of high altitude exposure. The respiratory sensitivity increased with the hyperventilation and mouth pressure increase induced by hypoxia. Hypoxia might also have feedback effects on the peripheral and central nervous integration of the respiratory sensation stimuli. One subject suffering from acute mountain sickness showed a severe decrease in his sensitivity index P(A) under hypoxic conditions, while the parameters of his cardiorespiratory function evolved in the same classical way as the other subjects who adapted well to altitude hypoxia. The increase in respiratory sensation may be the first necessary step in altitude acclimatization and might serve as a useful marker of this adaptation.

Altitude Sickness↗
PubMed1996

Improvement of corneal sensation and tear dynamics in diabetic patients by oral aldose reductase inhibitor, ONO-2235: a preliminary study.

The mechanism in the pathogenesis of diabetic corneal disease is unclear, but aldose reductase may be involved in the corneal disease. We studied the effects of an aldose reductase inhibitor (ARI) on the ocular surface of diabetic patients. Fourteen aphakic or pseudophakic patients with diabetes were treated with orally administered ONO-2235 (150 mg/day). Corneal sensation, vital staining of ocular surface, and tear production were examined before and 3 months after the administration. After a 3-month period of oral ARI, corneal sensation recovered significantly (from 4.1 +/- 4.8 to 3.0 +/- 3.1 g/mm2; p = 0.015), with parallel improvements in rose bengal and fluorescein staining scores (p < 0.05). Tear break-up time had also improved (p = 0.003). Results of Schirmer's test (p = 0.03) and the cotton-thread test (p = 0.0001) showed significant improvement in tear production. Improvement in the dynamics of tear production may be due to an improvement in corneal sensitivity. An oral ARI can improve corneal epithelial changes caused by diabetes, probably through recovery of corneal sensation and tear production.

Administration, Oral↗
PubMed1997

Indications for and outcomes of clean intermittent catheterization in children with normal genital sensation.

PURPOSE: Clean intermittent catheterization is generally accepted by parents and children with neurogenic bladder. We analyzed the indications for and feasibility of clean intermittent catheterization in children with normal genital sensation. MATERIALS AND METHODS: We reviewed the records of 2 girls and 15 boys 15 months to 15 years old (mean age 8 years) on clean intermittent catheterization with normal genital sensation. Indications for clean intermittent catheterization were urinary retention and poor urodynamic compliance with or without hydronephrosis. Parents evaluated the protocol via a questionnaire and the children were studied with age appropriate standard instruments to assess the consequences of clean intermittent catheterization on psychological development. RESULTS: There were no medical complications related to clean intermittent catheterization. Four of the 7 children with urinary retention and 7 of the 10 with poor bladder compliance continued the protocol. There was no difference in the results of psychological testing for patients who had success or failure (mean followup 5 years). Parent and patient comfort levels were most important for the success of clean intermittent catheterization. CONCLUSIONS: Our results show that clean intermittent catheterization is feasible in children with normal genital sensation but successful in only two-thirds.

Adolescent↗
PubMed1978

Use of a cross-forearm neurocutaneous flap to provide sensation and coverage in hand reconstruction.

A cross-forearm, neurocutaneous flap has been used in certain clinical situations to restore coverage and sensation over hand defects. Based on the superficial branch of the radial nerve, this flap provides a combination of handlike skin and subcutaneous tissue with sensation, which can be transferred. A fascicular neurorrhaphy between the superficial branch of the radial nerve and an appropriate recipient nerve stump has resulted in new epicritic sensation in the reconstructed area.

Adult↗
PubMed1994

Normal sensation of the human face and neck.

A total of 116 adult volunteers were studied to determine normal values for static two-point discrimination and sensation of pressure of the head and neck. Thirteen regions of the head and neck corresponding to major sensory innervation were examined bilaterally for static two-point discrimination with the Mackinnon-Dellon Disk-Criminator and for sensation of pressure with Semmes-Weinstein monofilaments. Perception of two-point discrimination improved from lateral and posterior areas (17 to 25 mm) to the midline toward the lips (3 to 7 mm). Semmes-Weinstein monofilaments proved inadequate in determining sensitivity to cutaneous pressure because of low thresholds in the face and neck. Static two-point discrimination is a reliably reproducible method for assessing sensation of the face and neck.

Adult↗
PubMed1996

Recovery of sensation in the radial forearm free flap in oral reconstruction.

The purpose of this study was to find out to what extent sensory function recovers in a free radial forearm flap used for intraoral reconstruction after surgery for oral cancer. In 40 free radial forearm flaps we investigated the perception of light touch, two-point discrimination, pain, directional sensation, and temperature between 6 months and 11 years after flap transfer to the oral cavity. Four flaps (10 percent) were anesthetic, 21 flaps (52.5 percent) recovered partly, and 15 flaps (37.5 percent) had perception of all sensory modalities tested in at least two-thirds of the flap area. All patients with positive sensation in the surrounding area subsequently had good sensory recovery in the flap. This suggests that recovery of sensation in a nonreinnervated free flap is due to nerve ingrowth from the surrounding mucosa. The present results suggest that sensory function in intraoral free radial forearm flaps returns again. Further study is necessary to define the use of neurofasciocutaneous radial forearm flaps in reconstruction of the oral cavity.

Carcinoma, Squamous Cell↗
PubMed2001

The recurrent neurotrophic buttock ulcer in the meningomyelocele paraplegic: a sensate flap solution.

A large percentage of meningomyelocele paraplegic patients have a distal zone of sensation-bearing skin on their thighs. This sensate skin can be used as a fasciocutaneous flap to resurface a recidivistic ulcer after excision. In this study, because the transposition distance was significant, the flap length-width ratio was greater than normal and, therefore, required a 3-week elevation delay. This also permitted appraisal of the sensate flap after the first stage. The wound-healing was excellent after both stages. This reconstructive procedure was completed in four patients, with an average follow-up period of 13 years. These patients remain chronic sitters in administrative jobs and have been pressure sore-free after flap repair.

Adolescent↗
PubMed2006

Effect of augmentation mammaplasty on breast sensation.

BACKGROUND: Studies of alterations in breast sensibility after augmentation mammaplasty have produced conflicting results. Such discrepancies may be attributed to unsophisticated measuring devices used in earlier studies leading to less accurate measurements and to the comparison of results to different surgical techniques. The primary purpose of our study was to conduct a prospective clinical trial to quantify specific sensory outcomes before and after submuscular breast augmentation. METHODS: Preoperative and postoperative questionnaires were used to assess patients' subjective observations on breast sensation. Quantitative data were collected using a very accurate device, the Pressure-Specified Sensory Device, to assess objective breast sensation. Thirty-three micromastia patients underwent quantitative measurements preoperatively (baseline), at 2 to 4 weeks and 6 months postoperatively to assess breast sensitivity. RESULTS: The quantitative data showed similar patterns of sensory change between both the periareolar and the inframammary surgical approach over time. The inferior region was the only region that showed a diminished sensitivity threshold of 9.5 +/- 2.9 gm/mm2 for the inframammary incision, a significantly poorer average than the periareolar incision of 1.7 +/- 0.6 gm/mm2 with p = 0.008 at 6 months. Older patients had significantly higher thresholds of sensitivity compared with younger patients (p < 0.02). CONCLUSIONS: Our study suggests that the periareolar incision may produce less sensory loss in the lower pole of the breast when compared with the inframammary incision. The outcome of this study provides both the surgeon and the patient with concrete information regarding mammary sensation after augmentation mammaplasty and leads to a better informed-consent process.

Adult↗
PubMed1987

The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance.

The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance was assessed in 15 subjects. A single blind parallel group trial was undertaken in 30 subjects, with lignocaine as the active drug, and normal saline as the placebo. Fifteen subjects were included in each group. Both agents were infiltrated bilaterally into the floor of the nasal vestibule on each side via the sublabial route. Local anaesthesia of the nasal vestibule by infiltrating lignocaine produced a sensation of nasal obstruction in 9 out of 15 subjects (P less than 0.02). The infiltration of normal saline had no such effect. The difference between the effect of the 2 agents on nasal airflow sensation was significant (P less than 0.05). Neither injection had any significant effect on nasal resistance to airflow as assessed by active anterior rhinomanometry.

Adult↗
PubMed1988

The effects of menthol isomers on nasal sensation of airflow.

The effects of inhalation of L-menthol, D-isomenthol and D-neomenthol, upon nasal resistance and sensation to airflow were investigated in 40 subjects. L-menthol caused a highly significant enhancement of nasal sensation of airflow but despite their great similarity in structure and a similar peppermint smell the isomers D-isomenthol and D-neomenthol had no effect on nasal sensation of airflow. These findings show that L-menthol has a specific pharmacological action on nasal sensory nerve endings which is not related to its peppermint smell.

Adolescent↗
PubMed1989

Nasal sensation of airflow following blockade of the nasal trigeminal afferents.

A matched-pair parallel, group trial was carried out on 2 groups of 13 subjects (26 subjects in total), using 2% aqueous lignocaine to anaesthetize both the nasal vestibule and the nasal mucous membrane. Both groups had lignocaine infiltrated into the nasal vestibule and lignocaine applied topically to the nasal mucous membrane. The groups differed in the order in which the medication was given, one group having the infiltration first and the other group the topical application first. Local anaesthesia of the nasal vestibule caused a marked decrease in the nasal sensation of airflow (P less than 0.05) with no accompanying change in nasal resistance to airflow. Topical anaesthesia of the nasal mucous membrane had no effect on either nasal sensation of airflow or nasal resistance. The study demonstrates that the nasal vestibule is the dominant area for sensing nasal airflow. The nasal cavum (the major part of the nasal cavities that is lined by respiratory mucosa) appears to be unimportant as regards the sensation of nasal airflow. The clinical significance of the study is discussed with reference to other work, in this field.

Adult↗
PubMed1993

Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate.

To determine the relationship between subjective sensation of nasal patency and objective measurement of nasal inspiratory peak flow rate, a longitudinal study was conducted using healthy volunteers. Five healthy medical practitioners, one woman and 4 men, aged 24-34 years, made daily subjective estimations of their sensation of nasal patency on a 10-cm visual analogue scale. This was followed immediately by measurements of nasal inspiratory peak flow rate using a Youlten meter, repeated on at least 25 days per subject. Correlation coefficient and regression lines for subjective nasal patency on nasal inspiratory peak flow rate were calculated. One hundred and sixty nine sets of observations were made, range 25-44 per subject. Each subject showed strong evidence (P < 0.01) of positive correlation between subjective nasal patency score and nasal inspiratory peak flow rate. There was strong evidence (P < 0.001) that different regression lines are needed for different subjects, but no evidence that the lines are not parallel. Subjective sensation of nasal patency is strongly correlated with objective nasal patency, as measured by peak inspiratory flow rate. This relationship varies between individuals. Measurement of nasal inspiratory peak flow rate may be a valuable objective test of nasal patency, and is quick and simple to perform.

Adult↗
PubMed1993

The effect of histamine challenge on nasal airflow sensation.

Objective nasal airflow resistance, as measured by the rhinomanometer, and the subjective sensation of nasal patency are usually regarded as showing poor correlation. However, previous population studies comparing nasal resistance and subjective nasal airflow sensation have failed to take into account the great individual variation in resting nasal resistance. To investigate the potential relationship between the two parameters, 20 healthy volunteers underwent histamine nasal challenge tests. Nasal resistance prior to the intra-nasal administration of histamine ('resting' nasal resistance, NRR) was compared with nasal resistance when the subject reported a subjective sensation of nasal blockage ('obstructed' nasal resistance, NR0) and the two were found to be significantly correlated using the Spearman rank correlation method (rs = 0.648, P = 0.002). Linear regression analysis using the method of least squares demonstrated an association between the two variables (P = 0.029), conforming to the formula NR0 = 1.26NR+0.478, (resistance units kPa.s.l-1). Subjective and objective measurements of nasal patency may be much more closely related than has previously been reported.

Administration, Intranasal↗
PubMed1992

Cold sensation and bladder instability in patients with outflow obstruction due to benign prostatic hyperplasia.

A series of 73 patients with bladder outflow obstruction caused by benign prostatic hyperplasia underwent urodynamic investigation, including the cold water test. The presence of detrusor instability was associated with a higher urethral opening pressure, maximum detrusor pressure and detrusor pressure at maximum flow. Instability was more common and more pronounced in patients with a lack of cold sensation, but there were some patients who, whilst lacking cold sensation, still possessed the cold reflex. This suggests partial denervation of the bladder or some form of altered modulation of sensory activity within the spinal cord or central nervous system. On the other hand, some of the patients lacked cold sensation but showed a stable detrusor and a high maximum cystometric capacity. This leads to the conclusion that there are different mechanisms by which the bladder reacts to outflow obstruction.

Aged↗