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An Apparatus for Testing Devices Used for Determining Protective Foot Sensation

USPHS Scientific and Training Symposium Engineer Category Day. An Apparatus for Testing Devices Used for Determining Protective Foot Sensation. CAPT James Foto, PE, C.Ped jfoto@hrsa.gov. U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA)

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An Apparatus for Testing Devices Used for Determining Protective Foot Sensation

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  1. USPHS Scientific and Training Symposium Engineer Category Day An Apparatus for Testing Devices Used for Determining Protective Foot Sensation CAPT James Foto, PE, C.Ped jfoto@hrsa.gov U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) The Bureau of Primary Healthcare (BPHC)

  2. Lower Extremity Amputations > 82,000 / year “The primary objective of neuropathic foot care is to reduce the epidemic occurrences of lower extremity amputations.” - National Diabetes Fact Sheet, CDC, 2003

  3. Discussion Points • Loss of Protective Sensation • Monofilament Research • Automated Filament Tester (AFT) • Testing the AFT

  4. Discussion Points • Loss of Protective Sensation • Monofilament Research • Automated Filament Tester (AFT) • Testing the AFT

  5. “The whole problem is really one of mechanics, not of medicine. The biological responses of these denervated limbs are qualitatively similar to those of normal limbs. It is the permitted pattern of mechanical stress that is different.” Paul W. Brand

  6. Causes of Injury Resulting from Mechanical Stress • Acute Trauma • likely cause: nails, glass, accidents • Ischemia • likely cause: tight shoes, foreign objects in shoes, wrinkles in socks or hosiery • Repetitive Stress • likely cause: normal activities of daily living such as walking

  7. Loss of Protective Sensation

  8. Loss of Protective Sensation

  9. Discussion Points • Loss of Protective Sensation • Monofilament Research • Automated Filament Tester (AFT) • Testing the AFT

  10. Monofilament Research • 1890 – Von Frey used varying thickness horse hair • 1960 – Semmes & Weinstein used nylon filament material • 1985 – VonPrince, Werner, Omer, Bell, Brand, Buford • 1986 – Birke & Sims, HD and DM neuropathic feet • 1988 – Bell & Buford, filament repeatability and reliability • 1988 – Holewski et al, extent and progression of neuropathy • 1989 – Mueller et al, interrater and intrarater reliability • 1998 – Birke & Rolfson, Self Administer • 2000 – Booth and Young, bench test w/ load cell • 2004 – Lawrence et al, filament physical properties and wear • 2009 – Feng et al, variation in application methodology

  11. Semmes-Weinstein5.07 (10g) Monofilament • Designed to buckle at 10g force π2EI F = L2 b (Euler’s Buckling Formula)

  12. Semmes-Weinstein5.07 (10g) Monofilament • Designed to buckle at 10g force • Standard device for testing LOPS

  13. Semmes-Weinstein5.07 (10g) Monofilament • Designed to buckle at 10g force • Standard device for testing LOPS • “Feel” / “no feel” binary response

  14. Point of Application Holewski et al, 1988

  15. Discussion Points • Loss of Protective Sensation • Monofilament Research • Automated Filament Tester (AFT) • Testing the AFT

  16. Automated Filament Tester

  17. Bench Top Tester Components • 10 gram Load Cell & Signal Conditioner • AL Design ALD-MEGA-10G • Dataforth 8B38 Isolated Strain Gage SG • Linear Potentiometer • DAQ Programming Language • Data Acquisition Device • Ball Screw Actuator

  18. Bench Top Tester Components • 10 gram Load Cell & Signal Conditioner • Linear Potentiometer • Unimeasure LX-PA-3.8 • DAQ Programming Language • Data Acquisition Device • Ball Screw Actuator

  19. Bench Top Tester Components • 10 gram Load Cell & Signal Conditioner • Linear Potentiometer • DAQ Programming Language • National Instruments LabVIEW • Data Acquisition Device • Ball Screw Actuator

  20. Bench Top Tester Components • 10 gram Load Cell & Signal Conditioner • Linear Potentiometer • DAQ Programming Language • Data Acquisition Device • NI USB-6009 14bit / 48ks/sec Multifxn DAQ • Ball Screw Actuator

  21. Bench Top Tester Components • 10 gram Load Cell & Signal Conditioner • Linear Potentiometer • DAQ Programming Language • Data Acquisition Device • Ball Screw Actuator • Hennkwell PK22G2150-062 12v DC Gear Mtr

  22. Labview Programming

  23. Discussion Points • Loss of Protective Sensation • Monofilament Research • Automated Filament Tester (AFT) • Testing the AFT

  24. Automatic Filament Tester

  25. Output Data

  26. Packaged Filaments

  27. Thank You CAPTJamesFoto, PE, C. Ped The National Hansen’s Disease Programs 1770 Physicians Park Dr Baton Rouge, LA 70816 (225) 756-3789 jfoto@hrsa.gov

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