Abstract-Patients with type 2 diabetic neuropathy (DN) are at an increased risk of falls due to the decreased accurate proprioceptive feedbacks. Effective balance training should treat context-specific instabilities of postural control of patients with DN. For this purpose, evaluations and balance training were designed with a 3-week baseline with evaluation after 3 weeks, followed by training over 3 weeks with reevaluation. We acquired control scores for standing balance from the Biodex stability system and fluctuations of the center of pressure. We performed repeated measure analysis of variance to test mean differences in three sessions of assessments. In addition, we compared mean differences of each pair of sessions with the least significant difference test. We used the paired t-test to compare the pure effects of trainings. Our investigation showed that the results of Biodex stability scores and force platform medial-lateral sway measurements improved statistically. Significant higher open-eyes median and mean frequency values of postural sway in the medial-lateral direction indicated that balance training allowed patients to develop control over the degree of freedom at the hip joint. In conclusion, training that compensates for disordered balance indicated by subclinical constraints with respect to the guidance effect of external visual feedback improves standing postural control in patients with type 2 DN.Clinical Trial Registration: Clinical Trial Registration: UMIN-CTR Search Clinical Trials, UMIN000004485, "Dynamic stability training can promote quiet standing control in neuropathic patients with type 2 diabetes"; http:// www.umin.ac.jp/ctr/index.htm.

BackgroundThe aim of the present study is to have a detailed frequency analysis about the effect of balance training with respect to reactive movement strategies and sensory strategies in type 2 diabetic neuropathy (DN) patients. Also understand changes in the role of each postural subsystem for controlling quiet standing after balance training.MethodsA group of 19 patients were included in the quasi experimental, time- series study. Total frequency power, 99% power frequency, centroidal frequency and frequency spectrum in the intervals between 0.01-0.1, 0.1-0.5, 0.5-1 Hz and 1-3 Hz are reported. The training protocol consisted two patterns of limits of stability trainings, three approaches in weight shifting trainings and one stable standing practice on the biodex stability system. Results: Repeated measure ANOVA analysis and the LSD test indicated significant differences for the eyes open ML- frequency power and ML-FFT sway power within low-medium (0.1-0.5 HZ) frequencies.ConclusionsDecrease in postural sway at low-medium frequencies showed lower reliance on vestibular system. Also, better controlling hip muscles after balance training relieve DN patients’ requirement to more exploratory sway as a compensatory strategy and showed better balance performance after balance training in DN patients. Trial registrationUMIN-CTR Search Clinical Trials: UMIN000004485.

BackgroundIt is known that general gait training improves lower extremity muscle strength and endurance in Diabetes Neuropathy (DN). But, it is still unknown whether Task-Oriented (TO) gait training would change gait biomechanics and the risk of falling in DN. TO gait training focuses on promoting timing and coordination of lower extremity movements through goal-directed practices with sufficient repetition.MethodsA group of 14 patients with DN participated in a time-series study. All subjects participated in four sessions of assessments (Initial, Pre, Post and Follow-Up). Training was twice a week for 12 weeks. Vertical and horizontal Ground Reaction Forces (GRF), Time Get up and Go (TGUG) and Fall Efficacy Scale-International (FES-I) were evaluated. Gait training started with stepping patterns that progressively changed to complicated patterns of walking. Then, training continued combining walking patterns with upper extremity activities and then ended with treadmill-paced practice.ResultsDN patients significantly increased Second Vertical Peak Force and Horizontal Propulsive Force in addition decrease in Minimum Vertical Force. TGUG significantly decreased while FES-I reflected significant increase after gait training.DiscussionConclusively, training not only improved gait performance, confidence in daily activities and attenuated risk of falling, but also helped DN patients to improve feet biomechanics, muscles timing and coordination.ConclusionsGait training with respect to principles of motor learning allowed patients to effectively improve through sessions.

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