IDF21-0192 Preliminary findings of plantar stimulation combined with balance training on postural stability in diabetic neuropathy

Abstract

Background: Diabetic peripheral neuropathy (DPN) is most common complication seen in the patients with type 2 diabetes mellitus. It is usually reduced sensation of plantar surface of foot. There are evidences demonstrate that patients with type 2 diabetes mellitus with DPN are associated with decline in postural stability in standing and increase risk of falls. Previous studies found that plantar electrical stimulation can improve plantar sensation. Recently, exercise is possibly an alternative intervention to improve balance in the adults. However, balance exercise is inappropriate for patients with type 2 diabetes mellitus with DPN who are impaired plantar sensation and concern about the potential risk of falls. However, no studies have explored whether plantar electrical stimulation combined with standing balance training has positive effects in patients with type 2 diabetes mellitus with DPN. Aim: The purpose of this pilot study was to determine the immediate and long-term effects of 4-week of plantar electrical stimulation combined with standing balance training on postural stability and walking ability in patients with type 2 diabetes mellitus with DP. Method: Four patients with type 2 diabetes mellitus with DPN were participated in this study. Each patient was completed plantar electrical stimulation combined with standing balance training 3 days per week for 4 weeks. Electrical stimulation (biphasic pulse current with a pulse duration of 0.1 ms, 100 Hz) was delivered via two self-adhesive surface electrodes for plantar of feet. The proximal electrode was placed over plantar forefoot area and the distal electrode was placed over plantar heel area. The current intensity was adjusted to produce tingling sensation without any discomfort. During plantar electrical therapy, each patient was performed simultaneously with standing balance training with both feet apart, feet together, tandem standing under eyes open and eyes closed conditions. Postural sway was assessed by total sway area using Lord’s sway meter during standing on 4 sensory conditions (eyes open and closed on a firm surface, eyes open and closed on a foam rubber mat) for 30 seconds of each condition. The walking ability was assessed by 10-meter walk test (10MWT) at preferred speed and maximum speed. All outcome measures were assessed before training, after 4-week training and 2-week follow-up. Results: Four weeks after training, all patients showed decreased total sway area during standing on 4 sensory conditions and increased walking speed on preferred and maximum conditions. Moreover, the results showed a trend toward decreased total sway area during standing on 4 sensory conditions and increased walking speed at 2-week follow-up period. Discussion: The findings from this pilot study showed that the immediate and long-term effects of 4-week of plantar electrical stimulation combined with standing balance training could help to improve postural stability and walking speed in patients with type 2 diabetes mellitus with DPN. This present method might be use as method for improving postural stability and reducing risk of falls in patients with type 2 diabetes mellitus with DPN. However, large sample sizes are still needed to confirm the finding in further study.