Auxiliary Sensory Cues Improve Automatic Postural Responses in Individuals With Diabetic Neuropathy

Noel Rao,Alexander S Aruin

doi:10.1177/1545968310376760

Abstract

Background. A loss of sensation in the lower limbs, observed in individuals with diabetes as well as elderly individuals, contributes to postural instability, altered gait patterns, increased risk of falling, and decreased quality of life. Objective. To determine if somatosensory cues delivered to sensate areas of the lower limbs above the ankle joints enhance the control of posture in individuals with peripheral neuropathy. Methods. Twelve subjects with sensory neuropathy due to diabetes participated in static and dynamic balance tests with and without auxiliary sensory cues provided to the lower limbs without stabilizing the ankle joints. During the tests the subjects were required to stand on a fixed or moving computer-controlled platform with their eyes open or closed. Equilibrium scores and response latency were obtained. Results. For all tests, equilibrium scores were significantly larger in experiments with auxiliary sensory cues in comparison with conditions without cues (P < .05). Smaller latency scores were recorded in conditions with auxiliary sensory information. The results indicate that auxiliary sensory cues improved automatic postural responses. Conclusions. The observed enhancement of automatic postural responses has clinical implications that aid in the understanding of postural control in individuals with peripheral neuropathy. Future controlled trials could examine whether devices that provide auxiliary sensory cues can improve balance, mobility, and the performance of daily activities.

Highlights

12 million people have been diagnosed with diabetes in the US
Post hoc analysis revealed that the effect of the auxiliary sensory information was statistically significant in SOT2 (F1, 23 = 9.67, p < 0.005) and SOT5 (F1, 23 = 5.30, p < 0.030) conditions
It was shown that ankle-foot orthoses (AFOs) improve automatic postural responses in individuals with peripheral neuropathy due to diabetes [33, 34]

Summary

Introduction

12 million people have been diagnosed with diabetes in the US. This number is projected to increase to around 14.5 million by 2010, raising the cost associated with medical expenses and lost productivity to an estimated $156 billion [1].Individuals with diabetic neuropathy frequently experience somatosensory deficits such as loss of position, vibration, light touch sense, and sensory ataxia with the loss of ankle reflexes [2]. Since ankle proprioception is a critical factor for postural stability [4, 5], peripheral neuropathy affects the way individuals with diabetes control their posture while standing. To find out if somatosensory cues delivered to the intact tissues of the lower limbs above the ankle joints enhance the control of posture in individuals with peripheral neuropathy. Twelve individuals with sensory neuropathy due to diabetes participated in static and dynamic balance tests with and without auxiliary sensory cues provided to the lower limbs without stabilizing the ankle joints. Equilibrium scores were significantly larger in experiments with auxiliary sensory cues in comparison to conditions without cues (p < 0.05). The results indicate that auxiliary sensory cues provided to the intact tissues of the lower extremities could improve automatic postural responses in individuals with diabetic peripheral neuropathy. The study outcome provides a basis for future investigations on whether specially designed assistive means that provide auxiliary sensory cues could improve balance, mobility, and the performance of ADLs in individuals with peripheral neuropathy

Objectives

Methods

Results

Discussion

Conclusion