Grewal Gurtej S, Sayeed Rashad, Schwenk Michael, Bharara Manish, Menzies Robert, Talal Talal K, Armstrong David G, Najafi Bijan
Interdisciplinary Consortium on Advanced Motion Performance, University of Arizona, College of Medicine, Tucson, AZ.
J Am Podiatr Med Assoc. 2013 Nov-Dec;103(6):498-507. doi: 10.7547/1030498.
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.
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.
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).
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.
糖尿病周围神经病变患者常伴有本体感觉受损和姿势不稳。传统运动训练已被证明对改善平衡有效，但未纳入针对关节感知的视觉反馈，而关节感知是帮助补偿糖尿病周围神经病变中本体感觉受损的重要机制。
这项前瞻性队列研究招募了29名参与者（平均±标准差：年龄，57±10岁；体重指数[计算方法为体重（千克）除以身高（米）的平方]，26.9±3.1）。符合纳入标准的参与者通过伸手任务进行预定义的踝关节运动，并在屏幕上显示踝关节的视觉反馈。使用附着在参与者小腿上的可穿戴传感器捕捉踝关节在内外侧和前后方向的运动。使用经过验证的可穿戴传感器技术，通过测量训练前后的重心摆动面积和相互补偿指数来量化姿势稳定性的改善情况。
研究结果显示训练后重心摆动显著减少（平均减少22%；P = 0.02）。基线时较高的姿势稳定性缺陷（高身体摆动）与姿势平衡训练的较高收益（重心摆动减少）相关（r = -0.52，P < 0.05）。此外，踝关节和髋关节之间的姿势协调性有显著改善（平均改善10.4%；P = 0.04）。
本研究实施了一种基于虚拟现实技术的新型平衡康复策略。该方法包括可穿戴传感器和基于踝关节运动的实时视觉反馈的交互式用户界面，类似于视频游戏环境，用于补偿受损的关节本体感觉。这些发现支持踝关节产生的视觉反馈与运动学习相结合可能有效改善糖尿病周围神经病变患者的姿势稳定性。
