密歇根神經病變篩查表

1、How to Use the Michigan Neuropathy Screening Instrument密歇根神經病變篩查表使用指南History 病史The history questionnaire is self-administered by the patient. Responses are added to obtain the total score. Responses of “yes” to items 1-3, 5-6, 8-9, 11-12, 14-15 are each counted as one point. A “no” response on items

2、 7 and 13 counts as 1 point. Item #4 is a measure of impaired circulation and item #10 is a measure of general aesthenia and are not included in scoring. To decrease the potential for bias, all scoring information has been eliminated from the patient version.病史調查表由病人自己填寫，回答將計入其篩查總分中，1-3, 5-6, 8-9, 1

3、1-12, 14-15題每回答一個“是”將加1分，7和13題每回答一個“否”將加1分，4和10題不計分。為了減少潛在的誤差，在病史調查表上將不出現(xiàn)得分信息。Physical Assessment 體格檢查For all assessments, the foot should be warm (>30°C). 所有評估必須建立在足部溫度>30°C的基礎上Foot Inspection: The feet are inspected for evidence of excessively dry skin, callous formation, fissures,

4、 frank ulceration or deformities. Deformities include flat feet, hammer toes, overlapping toes, halux valgus, joint subluxation, prominent metatarsal heads, medial convexity (Charcot foot) and amputation.足部檢查：足部檢查的項目包括：足部皮膚干燥程度、胼胝體、龜裂、潰瘍或畸形?；伟ǎ罕馄阶?、錘狀趾、重疊趾、足外翻、關節(jié)半脫位、拇外翻、夏科特關節(jié)和截肢。Vibration Sensation

5、: Vibration sensation should be performed with the great toe unsupported. Vibration sensation will be tested bilaterally using a 128 Hz tuning fork placed over the dorsum of the great toe on the boney prominence of the DIP joint. Patients, whose eyes are closed, will be asked to indicate when they c

6、an no longer sense the vibration from the vibrating tuning fork. In general, the examiner should be able to feel vibration from the hand-held tuning fork for 5 seconds longer on his distal forefinger than a normal subject can at the great toe (e.g. examiners DIP joint of the first finger versus pati

7、ents toe). If the examiner feels vibration for 10 or more seconds on his or her finger, then vibration is considered decreased. A trial should be given when the tuning fork is not vibrating to be certain that the patient is responding to vibration and not pressure or some other clue. Vibration is sc

8、ored as 1) present if the examiner senses the vibration on his or her finger for < 10 seconds, 2) reduced if sensed for ³ 10 or 3) absent (no vibration detection.)振動覺：振動覺應在大拇趾上檢查，用128 Hz音叉放在大拇趾遠端第一關節(jié)突起的上方進行雙側檢查，同時病人閉起眼睛，這時再詢問患者何時感覺不到音叉在振動了。通常，當患者不能感受到振動，而檢查者把音叉放在自己示指上仍能感受到音叉振動超過10秒鐘，那么就要考慮振動

9、覺減退了，同時必須進行一個試驗來證實受檢者是否誠實反應確切的感受而非受暗示，即使用未振動的音叉來檢驗。振動覺將被記錄為1）正常檢查者感覺音叉振動的時間<10秒；2）減退 感覺音叉振動的時間³10秒；3）缺失 受檢者未察覺振動的存在。Muscle Stretch Reflexes: The ankle reflexes will be examined using an appropriate reflex hammer (e.g. Trommer or Queen square). The ankle reflexes should be elicited in the sit

10、ting position with the foot dependent and the patient relaxed. For the reflex, the foot should be passively positioned and the foot dorsi-flexed slightly to obtain optimal stretch of the muscle. The Achilles tendon should be percussed directly. If the reflex is obtained, it is graded as present. If

11、the reflex is absent, the patient is asked to perform the Jend-rassic maneuver (i.e., hooking the fingers together and pulling). Reflexes elicited with the Jendrassic maneuver alone are designated “present with reinforcement.” If the reflex is absent, even in the face of the Jendrassic maneuver, the

12、 reflex is considered absent.肌肉牽張反射：使用適當的反射錘來檢查踝反射，同時應在患者坐位、精神放松且足有依靠的情況下進行該檢查。通過叩擊跟腱如果反射出現(xiàn)則視為正常，如在強化措施(如：抓住腳趾來回拉動)下出現(xiàn)，則視為強化正常，如在強化措施下仍未出現(xiàn)則視為缺失。Monofilament Testing: For this examination, it is important that the patients foot be supported (i.e., allow the sole of the foot to rest on a flat, warm su

13、rface). The filament should initially be prestressed (4-6 perpendicular applications to the dorsum of the examiners first finger). The filament is then applied to the dorsum of the great toe midway between the nail fold and the DIP joint. Do not hold the toe directly. The filament is applied perpend

14、icularly and briefly, (<1 second) with an even pressure. When the filament bends, the force of 10 grams has been applied. The patient, whose eyes are closed, is asked to respond yes if he/she feels the filament. Eight correct responses out of 10 applications is considered normal: one to seven cor

15、rect responses indicates reduced sensation and no correct answers translates into absent sensation.單絲檢測：此檢查的重點在于患者的足必須被有效的支撐，同時應休息在平坦和溫暖的支撐物上。開始檢查前應在患者的足背進行4-6次的預加應力。細絲的應用位置在甲褶和第一關節(jié)的中點。在細絲上加以垂直短暫且均勻的力，當細絲彎曲時對肢體產生的壓力為10g?；颊唛]上眼睛開始檢查，10次檢查中患者能感到細絲8次則屬于正常，1-7次感到細絲的存在則屬于減弱，未感覺到細絲的壓力則屬于缺失。Patient Version患

16、者版本MICHIGAN NEUROPATHY SCREENING INSTRUMENT密歇根神經病變篩查表A. History (To be completed by the person with diabetes) 病史（由糖尿病患者親自完成）Please take a few minutes to answer the following questions about the feeling in your legs and feet. Check yes or no based on how you usually feel. Thank you.請回答以下有關你下肢和足感覺的幾個問

17、題，在你日常感覺的基礎上選擇是或不是，非常感謝你的配合。1. Are you legs and/or feet numb? Yes No你的下肢或足部有麻木感嗎？是 否2. Do you ever have any burning pain in your legs and/or feet? Yes No你的下肢或足部曾經有過灼痛的感覺嗎？3. Are your feet too sensitive to touch? Yes No你的雙足有感覺過敏的現(xiàn)象嗎？4. Do you get muscle cramps in your legs and/or feet? YesNo你的下肢或雙足出現(xiàn)

18、過肌肉痛性痙攣的現(xiàn)象嗎？5. Do you ever have any prickling feelings in your legs or feet? Yes No你的下肢或雙足出現(xiàn)過刺痛的感覺嗎？6. Does it hurt when the bed covers touch your skin? Yes No當被褥接觸皮膚時你有被刺痛的感覺嗎？7. When you get into the tub or shower, are you able to tell the hot water from the cold water? 當你淋浴時，能清楚的感知水溫的變化？ YesNo8.

19、Have you ever had an open sore on your foot? Yes No你曾經有過足部潰瘍嗎？9. Has your doctor ever told you that you have diabetic neuropathy? Yes No你的醫(yī)生診斷過你患有糖尿病神經病變嗎？10. Do you feel weak all over most of the time? Yes No你大部分時間會感到虛弱無力嗎？11. Are your symptoms worse at night? Yes No你的癥狀在夜間是否會更嚴重？12. Do your legs h

20、urt when you walk? Yes No你的下肢在走路時受過傷嗎？13. Are you able to sense your feet when you walk? Yes No你行走時能感覺到你的雙足嗎？14. Is the skin on your feet so dry that it cracks open? Yes No你足部的皮膚會因為太干燥而裂開嗎？15. Have you ever had an amputation? Yes No你被進行過截肢手術嗎？Total:總分：MICHIGAN NEUROPATHY SCREENING INSTRUMENT密歇根神經病變篩查表B. Physical Assessment (To be completed by health professional)體格檢查（由醫(yī)療人員填寫）1. Appearance of Feet足部外觀檢查Right 右Left左a. Normal 0 Yes 1 No Normal 0 Yes 1 No