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Brief Peripheral Neuropathy Screening Tool

for Health Care Providers

ACTG Brief Peripheral Neuropathy Screening Tool

Source: NIAID Adult AIDS Clinical Trials Group

1. Elicit Subjective Symptoms

Ask the subject to rate the severity of each symptom listed in Question 1 on a scale of 01 (mild) to 10 (most severe) for right and left feet and legs. Enter the score for each symptom in the columns marked R (right lower limb) and L (left lower limb). If a symptom has been present in the past, but not since the last visit, enter "00 - Currently Absent." If the symptom has never been present, enter "11 - Always Been Normal."

Always Been NormalCurrently AbsentMild ←→ Severe
110001020304050607080910
SymptomsRL
a. Pain, aching, or burning in feet, legs
b."Pins and needles" in feet, legs
c. Numbness (lack of feeling) in feet, legs

2. Grade Subjective Symptoms

Use the single highest severity score from Question 1 above to obtain a subjective sensory neuropathy score. If all severity scores are "00" or "11," the subjective sensory neuropathy score will equal "0."

Subjective Sensory Neuropathy Score (based on highest severity rating)

01 - 03 = grade of 1
04 - 06 = grade of 2
07 - 10 = grade of 3
11 or 00 = grade of 0

RL
  

3. Evaluate Perception of Vibration

Compress the ends of a 128-Hz tuning fork just hard enough that the sides touch. Place the vibrating tuning fork on a bony prominence on the subject's wrist or hand to be sure that he/she can recognize the vibration or "buzzing" quality of the tuning fork. Again, compress the ends of the tuning fork just hard enough that the sides touch. Immediately place the vibrating tuning fork gently but firmly on the top of the distal interphalangeal (DIP) joint of one great toe and begin counting the seconds. Instruct the subject to tell you when the "buzzing" stops. Repeat for the other great toe.

Vibration perception

a. Great toe DIP joint perception of vibration in seconds
b. Vibration perception score

0 = felt >10 seconds (normal)
1 = felt 6-10 seconds (mild loss)
2 = felt <5 seconds (moderate loss)
3 = not felt (severe loss)
8 = unable to or did not assess

RL
  

4. Evaluate Deep Tendon Reflexes

With the subject seated, the examiner uses one hand to press upward on the ball of the foot, dorsiflexing the subject's ankle to 90 degrees. Using a reflex hammer, the examiner then strikes the Achilles tendon. The tendon reflex is felt by the examiner's hand as a plantar flexion of the foot, appearing after a slight delay from the time the Achilles tendon is struck. Use reinforcement by having the subject clench his/her fist before classifying the reflex as absent.

Ankle Reflexes Score

0 = absent
1 = hypoactive
2 = normal deep tendon reflexes
3 = hyperactive
4 = clonus
8 = unable to or did not assess

RL
  

From Peripheral Neuropathy
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009