Influence of a comprehensive method of rehabilitation includes transcranial magnetic stimulation and balance therapy on the severity of neurological disorders, gate function and balance in patients with diabetic neuropathy

Abstract

Objective. To evaluate the effectiveness of a new method of rehabilitation of patients with diabetic polyneuropathy using balance therapy and transcranial magnetic stimulation against the background of a basic rehabilitation program to reduce neurological symptoms and improve the function of movement and balance. Material and methods. The study sample consisted of 34 patients with type 2 diabetes mellitus and with a severe degree of diabetic neuropathy, distal sensorimotor form, from which 2 groups were formed by randomization: the main group (n=17) and the control group (n=17). Patients of the main group received a new rehabilitation method, including rhythmic transcranial magnetic stimulation, No. 10, balance therapy on a simulator with biofeedback, No. 10, whirlpool baths for the lower extremities, No. 10, physical therapy, No. 10, and massage of the lower extremities, No. 10. The rehabilitation method for the control group included magnetic therapy for the lower extremities, No. 10, whirlpool baths for the lower extremities, No. 10, physical therapy, No. 10, and massage of the lower extremities, No. 10. Results. There were revealed a decrease in NSS scale values by 33.3% (from 6.0 [4.0; 7.0] to 4.0 [3.0; 6.0] points, p=0.029) and DN4 questionnaire scores – by 36.4% (from 5.5 [3.0; 7.0] to 3.5 [2.5.0; 5.0] points, p=0.034, p=0.045 in comparison with control), increase in walking speed by 10.7% (from 75.0 [59.0; 88.0] to 83.0 [68.0; 103.0] steps per minute, p = 0.047), decrease in time performing the “Up and go test” from 12.0 [7.0; 15.0] to 10.0 [5.0; 11.0] sec (p=0.039) and an increase in the time of maintaining balance in the “One leg standing test” with eyes closed on the right leg from 2.0 [1.0; 3.5] to 3.5 [1.5; 6.0] sec (p=0.041, p=0.022 compared with control) in patients of the main group, after completion of rehabilitation,. In the control group, there were no reliably significant changes in any of the studied indicators (p>0.05). Conclusion. A new rehabilitation complex, including transcranial magnetic stimulation and balance therapy with biofeedback against the background of standard therapy, helps to significantly reduce the severity of symptoms of distal diabetic polyneuropathy, increase walking speed and improve static balance.