Comparison of Joint Position Sense in Diabetic and Traumatic Transtibial Amputees
Condition: Diabetic Polyneuropathy; Amputation
MeSH terms: Polyneuropathies; Diabetic Neuropathies
Study type: Interventional

Summary: 
      This study evaluated the effect of joint position sense on compliance with the prosthesis,
      balance and functional performance in individuals with lower extremity amputation due to
      diabetic polyneuropathy. Study group consisted of 16 subjects with unilateral transtibial
      amputation due to diabetic polyneuropathy and control group consisted of 16 subjects with
      unilateral transtibial amputation due to traumatic reasons.
    

Detailed description: 
      Proprioception is defined as the ability to distinguish the position of various body parts
      relative to each other and the ground through the sensory system (kinesthesia) and to
      perceive the forces acting on these body parts. Proprioception is a function that takes place
      mainly on a subconscious level. Information about the external environment we live in is
      obtained from the combination of nerve terminals in muscles and tendons, fibrous capsules
      around joints, vestibular and visual systems. The proprioceptive information obtained about
      the external environment through the peripheral nervous system is transferred to the central
      nervous system. The integration of these data collected from different sensory receptors is
      performed, and appropriate motor responses are initiated to ensure postural balance. Sensory
      loss due to pain, fatigue, effusion, trauma, or various neurological, musculoskeletal
      disorders and metabolic diseases such as diabetes often causes a decrease in proprioceptive
      sensation in these case groups. Peripheral nerve damage due to diabetic polyneuropathy (DPN),
      varies depending on the type of nerve fiber affected. As a result of damage to unmyelinated
      and small myelinated nerve fibers, light touch, pain and temperature senses are impaired
      while vibration and proprioception senses are decreased as a result of damage to large
      myelinated nerve fibers. Recent studies have shown that individuals with DPN are more likely
      to apply to the emergency department due to complications from fall accidents because they
      experience balance loss during activities of daily living compared to healthy non-diabetic
      individuals. Furthermore, foot biomechanics, which deteriorates owing to the loss of the
      normal neural feedback system caused by DPN, causes foot ulcerations by creating aberrant
      pressure distribution in the foot. In these people, non-healing lower limb ulcers account for
      85% of planned lower extremity amputations. Due to the predicted loss of soft tissue, bone,
      and sensory receptors in the amputated limb following a prior lower extremity amputation,
      which results in musculoskeletal system degradation and destruction of the mechanoreceptors
      innervating these tissues, the way these individuals experience their surroundings changes
      and differentiates them from individuals who have been amputated due to traumatic causes.
      Diabetic amputees are unable to utilize their prostheses functionally following amputation
      due to their physical problems, which results in the majority of patients discontinuing usage
      of prosthesis. Although the number of test batteries developed to assess proprioceptive sense
      and the effectiveness of rehabilitation protocols used to assess proprioceptive sense in
      individuals with musculoskeletal disorders such as amputation is insufficient in the
      literature, it is believed that the existing batteries do not adequately assess
      proprioceptive sense. Additionally, no study has been conducted to determine the extent to
      which these patients' proprioceptive sensibility is altered following lower limb amputation
      due to DPN. For this reason, the study was planned to examine the effect of joint position
      sense on compliance with the prosthesis, balance and functional performance in individuals
      with lower extremity amputation due to DPN.
    

Intervention name(s): Joint Position Sense Analysis
Intervention type(s): Diagnostic Test
Intervention description(s): The Xsens DOT Motion Capture System will be used to analyze joint position sense.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Screening
Keywords: Diabetic Polyneuropathy; Lower Extremity Amputation; Joint Position Sense; Compliance With The Prosthesis; Balance; Functional Performance