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Balance Rehabilitation

Promoting the Role of Virtual Reality in Patients with Diabetic Peripheral Neuropathy

Gurtej S. Grewal Interdisciplinary Consortium on Advanced Motion Performance, University of Arizona, College of Medicine, Tucson, AZ.
Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona, College of Medicine, Tucson, AZ.

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Rashad Sayeed Center for Lower Extremity Ambulatory Research at Scholl College of Podiatric Medicine of Rosalind Franklin University of Medicine and Science, North Chicago, IL.

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Michael Schwenk Interdisciplinary Consortium on Advanced Motion Performance, University of Arizona, College of Medicine, Tucson, AZ.
Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona, College of Medicine, Tucson, AZ.
Arizona Center on Aging, University of Arizona, College of Medicine, Tucson, AZ.

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Manish Bharara Interdisciplinary Consortium on Advanced Motion Performance, University of Arizona, College of Medicine, Tucson, AZ.
Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona, College of Medicine, Tucson, AZ.

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Robert Menzies Wound and Diabetic Foot Center, Department of Medicine, Hamad Medical Corp, Doha, Qatar.

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Talal K. Talal Wound and Diabetic Foot Center, Department of Medicine, Hamad Medical Corp, Doha, Qatar.

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David G. Armstrong Interdisciplinary Consortium on Advanced Motion Performance, University of Arizona, College of Medicine, Tucson, AZ.
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Bijan Najafi Interdisciplinary Consortium on Advanced Motion Performance, University of Arizona, College of Medicine, Tucson, AZ.
Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona, College of Medicine, Tucson, AZ.
Center for Lower Extremity Ambulatory Research at Scholl College of Podiatric Medicine of Rosalind Franklin University of Medicine and Science, North Chicago, IL.
Wound and Diabetic Foot Center, Department of Medicine, Hamad Medical Corp, Doha, Qatar.
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Background:

Individuals with diabetic peripheral neuropathy frequently experience concomitant impaired proprioception and postural instability. Conventional exercise training has been demonstrated to be effective in improving balance but does not incorporate visual feedback targeting joint perception, which is an integral mechanism that helps compensate for impaired proprioception in diabetic peripheral neuropathy.

Methods:

This prospective cohort study recruited 29 participants (mean ± SD: age, 57 ± 10 years; body mass index [calculated as weight in kilograms divided by height in meters squared], 26.9 ± 3.1). Participants satisfying the inclusion criteria performed predefined ankle exercises through reaching tasks, with visual feedback from the ankle joint projected on a screen. Ankle motion in the mediolateral and anteroposterior directions was captured using wearable sensors attached to the participant’s shank. Improvements in postural stability were quantified by measuring center of mass sway area and the reciprocal compensatory index before and after training using validated body-worn sensor technology.

Results:

Findings revealed a significant reduction in center of mass sway after training (mean, 22%; P = .02). A higher postural stability deficit (high body sway) at baseline was associated with higher training gains in postural balance (reduction in center of mass sway) (r = −0.52, P < .05). In addition, significant improvement was observed in postural coordination between the ankle and hip joints (mean, 10.4%; P = .04).

Conclusions:

The present research implemented a novel balance rehabilitation strategy based on virtual reality technology. The method included wearable sensors and an interactive user interface for real-time visual feedback based on ankle joint motion, similar to a video gaming environment, for compensating impaired joint proprioception. These findings support that visual feedback generated from the ankle joint coupled with motor learning may be effective in improving postural stability in patients with diabetic peripheral neuropathy. (J Am Podiatr Med Assoc 103(6): 498–507, 2013)

Corresponding author: Bijan Najafi, PhD, Interdisciplinary Consortium on Advanced Motion Performance, University of Arizona, College of Medicine, PO Box 245072, 1501 N Campbell Ave, Room 4402, Tucson, AZ 85724-5072. (E-mail: bnajafi@surgery.arizona.edu; najafi.bijan@gmail.com)