****The Effect of Monochromatic Infrared Energy on Transcutaneous Oxygen Measurements and Protective Sensation: Results of a C
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A number of studies have investigated the effects of MIRE on protective sensation. Kochman et al1 performed a prospective study of consecutive patients, ages 35 to 80 years, with established diabetic peripheral neuropathy but no lower extremity ulcers. Of the 49 participants, 25 had type 1 diabetes and 24 had type 2 diabetes. Sensory testing was performed and MIRE treatments applied. Semmes Weinstein monofilament testing was performed randomly at three test sites on the plantar aspect of the foot (great toe, plantar arch, fourth toe) using several monofilament sizes; each site was tested three times. Participants were asked to respond when they felt the SWM and to describe the location. Hot/cold testing was performed at the same test sites of the feet. Hot/cold discrimination was rated absent when no correct responses were given, intact with three correct responses, and impaired with one or two correct responses. The MIRE treatments used four diode pads per leg placed on the dorsal/ventral surfaces of the foot and the distal anterior/posterior surfaces of the tibia (two diode pads were placed on the plantar surface of the foot if the subject was uncomfortable with the posterior tibia region placement). At baseline, all 49 subjects had peripheral neuropathy, impaired or absent hot/cold discrimination, and abnormal results of gait analysis and 42 had LOPS. After 12 treatments, all subjects had improved sensory perception (SWM <5.07) compared to baseline (P <0.001), indicating return of protective sensation. Additionally, 13 subjects achieved intact hot/cold discrimination.
Leonard et al2 conducted a double-blind, randomized, placebo-controlled study (N = 27) to assess the effects of MIRE on sensation using the 5.07 SWM, the 6.65 SWM, and a modified Michigan Neuropathy Screening Instrument (MNSI). Inclusion requirements included diagnosis of type 1 or type 2 diabetes along with peripheral neuropathy based on patient history and physical examination. Loss of protective sensation was defined as insensitivity at two or more sites on the foot as measured by the 5.07 log, or 10-g, SWM.3,4,8 Pain was measured using a 10-point visual analog scale. The 27 subjects, 18 insensate to the 5.07 SWM (group 1) and nine insensate to the 6.65 SWM (group 2), received a 40-minute sham treatment on one leg and an active treatment on the other leg three times a week for 2 weeks.2 All 27 subjects subsequently received 40-minute active treatments three times a week for 2 weeks to both legs. All treatments used four diode pads per leg placed on the dorsal and plantar surface of the foot and on each side of the calf just above the ankle. The active units delivered 1.3 J/cm2/min and the sham units delivered warmth at 37° C. Data (ie, measurements of sensation, a pain questionnaire answers, and a physical exam) were collected at baseline (before starting MIRE/sham treatments), within 3 days after the sixth treatment, and within 3 days after the twelfth treatment. All subjects served as their own control for the first six treatments and no difference in baseline sensitivity between feet assigned to active or sham treatment were found for group 1. The authors did not report if a baseline difference for group 2 was found.
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