Sensor-Based Interactive Balance Training with Visual Joint Movement Feedback for Improving Postural Stability in Diabetics with Peripheral Neuropathy: A Randomized Controlled Trial

Abstract

Background: Individuals with diabetic peripheral neuropathy (DPN) have deficits in sensory and motor skills leading to inadequate proprioceptive feedback, impaired postural balance and higher fall risk. Objective: This study investigated the effect of sensor-based interactive balance training on postural stability and daily physical activity in older adults with diabetes. Methods: Thirty-nine older adults with DPN were enrolled (age 63.7 ± 8.2 years, BMI 30.6 ± 6, 54% females) and randomized to either an intervention (IG) or a control (CG) group. The IG received sensor-based interactive exercise training tailored for people with diabetes (twice a week for 4 weeks). The exercises focused on shifting weight and crossing virtual obstacles. Body-worn sensors were implemented to acquire kinematic data and provide real-time joint visual feedback during the training. Outcome measurements included changes in center of mass (CoM) sway, ankle and hip joint sway measured during a balance test while the eyes were open and closed at baseline and after the intervention. Daily physical activities were also measured during a 48-hour period at baseline and at follow-up. Analysis of covariance was performed for the post-training outcome comparison. Results: Compared with the CG, the patients in the IG showed a significantly reduced CoM sway (58.31%; p = 0.009), ankle sway (62.7%; p = 0.008) and hip joint sway (72.4%; p = 0.017) during the balance test with open eyes. The ankle sway was also significantly reduced in the IG group (58.8%; p = 0.037) during measurements while the eyes were closed. The number of steps walked showed a substantial but nonsignificant increase (+27.68%; p = 0.064) in the IG following training. Conclusion: The results of this randomized controlled trial demonstrate that people with DPN can significantly improve their postural balance with diabetes-specific, tailored, sensor-based exercise training. The results promote the use of wearable technology in exercise training; however, future studies comparing this technology with commercially available systems are required to evaluate the benefit of interactive visual joint movement feedback.

Effects of Wearable Sensor-Based Balance and Gait Training on Balance, Gait, and Functional Performance in Healthy and Patient Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…RCTs were performed in patients with PD ( n = 2) [27,28] , stroke ( n = 1) [29] , PD/stroke ( n = 1) [30] , peripheral neuropathy, either relating to diabetes ( n = 1) [31] or chemotherapy ( n = 1) [32] , and healthy ( n = 1) [33] , or frail older adults with confirmed fall risk ( n = 1) [14] . The average age of the samples ranged from 52.1 to 84.9 years.…”

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

“…Note: The exercises above improve balance in patients with peripheral neuropathy. 24,41 3. In sessions 1-12, perform an ankle reaching task (Figure 1).…”

“…Note: This task is designed to enhance coordination between ankle, knee, and hip joints during weight shifting tasks. 24,41 4. In sessions 2-12, perform an obstacle crossing task with increasing degrees of difficulty.…”

“…Thus, several factors need to be considered during development and implementation of exercise for older HIV adults including compensation for lost joint perception, improving motor-cognitive performance, controlling the intensity of training to avoid overtaxing and finally, personalization of exercise by adapting exercises in their intensity and timing to account for physical limitations. Exergaming and virtual-reality techniques have been evaluated for training of motor control in the elderly [22][23][24] with benefits including concordance of visual and proprioceptive information, salient feedback from joint movement as well as activation of motor related areas in the brain. [24][25][26] In this study we evaluated the effectiveness and acceptability of tailored sensor-based interactive exercises of the lower extremities with real-time feedback and their effect on improving postural stability and activities of daily living in HIV-infected older adults.…”

“…Exergaming and virtual-reality techniques have been evaluated for training of motor control in the elderly [22][23][24] with benefits including concordance of visual and proprioceptive information, salient feedback from joint movement as well as activation of motor related areas in the brain. [24][25][26] In this study we evaluated the effectiveness and acceptability of tailored sensor-based interactive exercises of the lower extremities with real-time feedback and their effect on improving postural stability and activities of daily living in HIV-infected older adults. The exercise training specifically focused on ankle joint and lower extremity range of motion with both cognitive and motor components.…”