Leprosy Mailing List – August 12, 2013
Ref.: (LML) SW monofilaments and ball point pen
From: Hugh Cross, Nepal
Ball pens will certainly not give warning of the loss of normal touch sensation (of palm hands and sole feet), but failure to feel the light touch of a ball pen will at least indicate the definite loss of awareness of protective sensation.
The issue as I see it, however, is not the sensitivity of testing. It is whether any testing of peripheral nerve function is done at all. S-W monofilaments are not readily available in many, if not most, field situations. Ballpens, on the other hand, are ubiquitous. It is essential to be pragmatic about what can be expected of general health workers, particularly those working in remote locations under low resourced national programmes; and if using a ball pen means that a basic nerve function test is correctly undertaken and that those results are recorded accurately we should be content.
A debate about whether S-W mono filaments or ball pens should be used seems academic when many of us are concerned about far more basic issues of understanding and application of peripheral nerve function testing and WHO grading. In one country I recently visited, for example, WHO Grade 1 was recorded for a foot if the patient failed to feel pin prick on any patch anywhere on the leg.
Hugh Cross, BSc PhD
American Leprosy Missions
Regional Prevention of Disability Consultant (Asia)
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