Biodex Balance System Training in Diabetic Neuropathy
Condition: Diabetic Neuropathies
MeSH terms: Diabetic Neuropathies
Study type: Interventional

Summary: 
      Type II-diabetic neuropathy is the most common and correlated problem with diabetes that
      deteriorates with the passage of time. Balance disorders are also resulting of movement
      strategy damage, biomechanical and mechanical disorientation. The balance disorder has been
      reported to be related to abnormal somatosensory feedback, which is utilized in the
      development of an interior depiction of body motion and position (inner model) in the central
      nervous system. The Biodex stability system offers a system that can deliver particular hip
      and ankle postural training strategy with external biofeedback as a monitor to enhance the
      reduced subclinical limitations of patients with diabetic neuropathy.
    

Detailed description: 
      Diabetes mellitus is one of the most common critical illnesses with a higher prevalence all
      over the world. Diabetic neuropathy is the most common and correlated problem with diabetes
      that deteriorates with the passage of time. Diabetic neuropathy is a progressive and complex
      disease, characterized by regular distal deterioration of peripheral nerves which lead to
      symptoms of sensory loss and pain. During normal situations, somatosensory inputs from the
      feet and legs participate in the stability of posture. Posture reflex and balance alignment
      are common findings in diabetic neuropathy because of reduced proprioception and rising time
      of reflex reactions. Balance disorders are also results of movement strategy damage,
      biomechanical and mechanical disorientation.

      About 20-30% of patients with diabetic neuropathy suffer from neuropathic pains.

      Neuropathic complications are prevalent among 39.6% of the diabetic population. Diabetic
      neuropathy lowers significantly the quality of life and considerably increases health
      expenses related to diabetes. Diabetic neuropathy patients exhibit stability disorders and
      are vulnerable to falls even with open eyes. The instability sources in patients with type-II
      diabetic neuropathy comprise the incapability of the central nervous system (CNS) to
      integrate properly available information of postural control and a shift of balance strategy
      from ankle-based to hip-based. Furthermore, a rise in the reliance on visual information and
      the use of vestibular information change the format of postural control in patients with
      diabetic neuropathy.

      Stability can be referred to as the warmth of a dynamic system to different worries, and
      local constancy is the sensitivity of the structure to internal distresses, for example,
      natural fluxes like variation in muscle activity respond to gravity which occurs during
      stability. The impacts of such natural variations were inspected for assessing diverse
      measures of postural influence. Multiple studies on diabetic patients by neuropathic postural
      instability recommend relative shortfalls in their capability to sustain posture and specify
      higher instability as compared to non-diabetics and positive relations between falling and
      postural instability.

      Moreover, studies of posture instability in diabetic patients with diabetic neuropathy have
      shown greater scores for postural stability indexes, area of sway, speed, greater ranges of
      the centre of pressure; increased values of the centre of mass variables and increase of sway
      power in less stable postures. Awareness and appropriately performing balance and stability
      training in patients involve comprehensive knowledge of the causes of postural complications.
      Postural control involves a composite organization that controls the equilibrium and
      orientation of the body during upright stand.

      In addition, posture control involves multiple underlying physiological organizations and
      dependent upon six contexts: (a) cognitive processing, (b) sensory approaches, (c) movement
      approaches, (d) dynamics control (e), space orientation and (f) biomechanical task
      limitations. The sensory afferents sources which seem to participate in postural control
      comprise proprioception, visual systems, and vestibular. Subclinical and pathological
      constrictions in patients with diabetic neuropathy are because of context-specific and
      distinct instabilities like sensory and movement approaches. Reactive movement approaches are
      helpful for patients in developing multi-joint coordinated movement, and sensory approaches
      for selecting proper sensory information to control posture. The hip and ankle reactive
      movement approach reported being helpful to return the equilibrium of the body and keeping
      the feet in position. When people stand on a rigid surface, the ankle approach maintains
      balance with little movements in the form of an inverted pendulum. Rehabilitation and
      reactive movement strategies comprise the patient's exposure to external perturbations which
      differ in direction, amplitude, and speed. However, few studies have reported the correlation
      between balance training and external response. These trainings are useful to progress the
      sensory integration and dynamic balance capabilities of aged adults with a falling history
      and support for frail aged women in domestic care.

      It also has been ideal to balance training at home. In addition, static-standing stability
      can be trained efficiently through weight-bearing exercise, and a visual guided
      weight-shifting drill can develop a standing balance mechanism of static balance in diabetic
      neuropathy patients. Like so, the BIODEX stability system offers a system that can deliver
      particular hip and ankle postural training strategy with external biofeedback as a monitor to
      enhance the reduced subclinical limitations of patients with diabetic neuropathy. As these
      patients are often of old age and have symptoms of instability identical to those of elder
      people, it is supposed that a balance-training platform with a BIODEX balance system may also
      improve balance in patients with diabetic neuropathy
    

Intervention name(s): Biodex balance system; conventional exercises
Intervention type(s): Other; Other
Intervention description(s): BIODEX stability system (BIODEX Medical Systems Inc; Shirley, New York) offers a system that can deliver particular hip and ankle postural training strategy with external biofeedback as a monitor to enhance the reduced subclinical limitations of patients with diabetic neuropathy; balance board exercises, walking on different surfaces, Wobble board exercise and parallel bars for ambulatory training, range of motion exercises, foot care as a home program. Same duration treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment