Effect of Ankle Proprioception Training in Type 2 Diabetic Neuropathy
Condition: Diabetic Neuropathies
MeSH terms: Diabetic Neuropathies
Study type: Interventional

Summary: 
      Diabetes mellitus is a metabolic disease described by hyperglycemia, which results from
      deficiencies in insulin secretion, the action of insulin on the target tissue, both. Chronic
      hyperglycemia can lead to long-standing damage and failure of various organs, including the
      kidneys, heart, eyes, blood vessels, and nerves. Diabetes mellitus is one of the world's
      biggest public health problems, affecting about 415 million people worldwide among adults
      aged 20 to 79 years. Patients with type 2 diabetic neuropathy (DN) are at increased risk of
      falls. This increased risk is likely because of the well-documented balance problems
      attributed to neuropathy and sensory ataxia, which is the lack of precise proprioceptive
      feedback. Sources of instability in patients with type 2 DN include loss or reduction of
      peripheral sensory information in the feet, the inability of the central nervous system (CNS)
      to appropriately integrate the available postural control information, and the shift from an
      ankle-based method to a hip-based balance strategy. In addition, increased use of vestibular
      information and reliance on visual information alter the style of postural control in
      patients with diabetic neuropathy. Individuals with diabetic peripheral neuropathy (DPN) are
      15 times more likely to experience falls compared to healthy subjects.
    

Detailed description: 
      Proprioception can help with joint stability, postural control, and many other conscious
      sensations. The diabetes mellitus patients showed a decrease in the reflex responses to
      postural disturbance followed by a decrease in the speed of nerve conduction which leads to
      disturbance of the balance and increases the risk of falls.The hip and ankle joints play
      important roles in the control of balance.The major functions of the ankle joint are control
      of balance against postural disturbances, shock absorption during walking, and movement of
      the lower limbs. To provide these, it is necessary to maintain a sufficient range of motion
      of the ankle joint, muscle strength, and proprioceptive sense.

      A study reported that both proprioception exercise training and backward walking training are
      effective in increasing the proprioception sensation of lower limbs. However, proprioception
      exercise training was better than backward walking training in improving the feeling of
      proprioception in the lower limbs of patients with diabetic neuropathy. a study was conducted
      to investigate the effectiveness of an ankle proprioceptive control program on the gait of
      patients with chronic stroke. The study results provide evidence to support the effectiveness
      of an ankle proprioceptive control program in improving gait ability of patients with chronic
      stroke. A study reported that the addition of ankle proprioceptive training to traditional
      physical therapy exercises could provide more improvement of gait ability and decrease the
      risk of falling in patients with diabetic neuropathy.

      Proper evidence behind ankle proprioception training in the improvement of balance in
      diabetic neuropathy patients is sparse and is based on different clinical experiences and
      fewer studies with limited methodological design. Despite the strong relationship between
      ankle proprioception and gait ability which has been reported in the previous research
      studies, up till now, there is no study to assess to what extent ankle proprioceptive
      training can improve balance in patients with diabetic neuropathy. So, the current study will
      investigate the effects of ankle proprioceptive training in improving the balance in patients
      with diabetic neuropathy.
    

Intervention name(s): Proprioceptive neuromuscular facilitation; conventional therapy
Intervention type(s): Other; Other
Intervention description(s): Weight shifting in each direction (anteriorly, posteriorly, and lateral side) combined with side-to-side head movements (5 times for each direction).
One-legged stance with slight knee flexion of another leg for 15 seconds (5 times for each leg).
One-legged stance with increasing knee flexion of the other leg for 15 seconds (5 times for each leg).
Standing on a balance pad with shifting weight (anteriorly, posteriorly, and lateral side) 10 times in each direction.
In standing position, moving the weight left and right maximally.
In standing position, moving the weight forward and backward maximally.
In standing position, moving both heels of feet up and down.
In standing position, bending and stretching both knees by squatting as much as possible.; (Dorsiflexion, planter flexion, eversion and inversion) 10 repetitions for each movement.
(A) Sit to stand (5 times). (B) Standing with shifting Weight anteriorly, posteriorly, and sideway (5 times for each direction). (C) Functional reach sideway and anterior for touching targets set by the therapist (5 times for each direction). (D) Standing on heels for 20 seconds (5 times). (E) Standing on toes for 20 seconds (5 times).
(A) Spot marching (2 min). (B) Walking over the heels, toes, lateral border of feet with the preferred speed (6 min). (C) Tandem walking in a straight line (2 min).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment