Effect of Transcranial Direct Current Stimulation on Sensory Integration

Study Overview
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Brief Summary
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To determine the effect of Transcranial direct current stimulation on sensory integration and risk of falling in diabetic polyneuropathy.

Detailed Description
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PURPOSE: To determine the effect of Transcranial direct current stimulation on sensory integration and risk of falling in diabetic polyneuropathy. BACKGROUND: Diabetic polyneuropathy is the most prevalent chronic complication affecting 30% - 50% of diabetic patients. Diabetic polyneuropathy usually affect the peripheral, autonomic, and central nervous systems with several clinical symptoms .About 80% of the cases of DN manifest as distal symmetrical sensorimotor polyneuropathy which is responsible for cases of chronic pain; impaired sleep quality; increase of the falling risk associated with weakness and increase of the risk of extremities amputation. Transcranial direct current stimulation is neurophysiologic intervention that alters cortical excitability to enhance lower extremity somato-sensation and thus improve functional outcomes. HYPOTHESES: There will be no effect of Transcranial direct current stimulation on sensory integration and risk of falling in diabetic polyneuropathy

Official Title
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Effect of Transcranial Direct Current Stimulation on Sensory Integration and Risk of Falling in Diabetic Polyneuropathy

Conditions
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Diabetic Polyneuropathy

Intervention / Treatment
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* Device: transcranial direct current stimulation and traditional physical therapy program
* Other: designed physical therapy program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1 - Patient will be diagnosed as having Diabetic Polyneuropathy (DPN) and all patients have type II diabetes. 2-The age of the patients ranged from 35 to 55 years. 3-Clinically all patients suffered from glove stock hyposthesia, numbness and burning sensation and mild distal moror weakness 4-Patients have sensorymotor peripheral neuropathy according to neurophysiological study to detect sensory and motor conduction velocity to confirm diagnosis. Exclusion Criteria: History of diabetic ulcer and amputation . Osteoporosis. Fractures of lower limbs. Gross musculoskeletal problems eg:burn. Significant Scar tissue or calluses on the feet. Peripheral vascular diseases (PVD) or Microcirculation problems. Balance disturbance rather than diabetic peripheral neuropathy as ear problems, labrynthinitis, stroke or cerebellar problems. Visual disturbance. Autonomic neuropathy. Advanced Osteoarthritis of lower limbs. Nerve root compression (Radicuolopathy) affecting lower limbs. Patients with implanted devices for pain control such as deep brain

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Group 1: transcranial direct current stimulation and traditional physical therapy program Group 2: the same traditional physical therapy program
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Transcranial direct current stimulation<br>Transcranial direct current stimulation will be applied to study group only . Anodal transcranial stimulation will be applied on left somatosensory cortex while the cathodal one will be applied on right supra-orbital area with frequency of 2m.A for 20 minutes.Stimulation will be applied three times per week for two months. | Device: transcranial direct current stimulation and traditional physical therapy program<br>* Transcranial stimulation will be applied only for the study group.<br>* Other names: Gymna- uniphy(phy-action 787);Other: designed physical therapy program<br>* sensory training and balance training<br>|
| Placebo Comparator: traditional physical therapy program<br>traditional physical therapy program will be applied to both the control group and study group. It will be consist of sensory re-education training and balance training.Exercises will be applied three times per week for two months | Other: designed physical therapy program<br>* sensory training and balance training<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| sway index of sensory integration test | sway index of sensory integration test will be measured by biodex balance system | two months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| risk of fall index | risk of fall index will be measured by biodex balance system | two months |