Sensorimotor and Gait Training
Introduction
Diabetic peripheral neuropathy (DPN) is the
most common complication associated with
diabetes mellitus, affecting sensory and
motor peripheral nerves. Loss of sensory
nerve function results a decrease in sensory
inputs sensitivity from the extremities [1-3] ,
while loss of motor axons with insufficient
re-innervation related to muscle strength
deficit and atrophy of lower limb muscles
[4]
. Somatosensory information from foot,
and proprioception are key determinants
for motor control during balance and gait.
Somatosensory loss in older patients with
peripheral neuropathy is associated with
greater proprioception thresholds [5,6] . Also,
researchers have observed decrease in the
compound motor nerve amplitude [5,7] , lower
conduction velocity [7-9] , and increase in the
latency [10] in DPN patients, in comparison to
healthy controls. Loss of proprioception and
motor nerve impairment deteriorate muscle
performance during static and dynamic
function [11,12] .
Both balance and gait are a complex interplay
of neural and muscular actions coordinated
with skeletal functions. An age-related
increase in the muscle activity during static
and dynamic postural tasks and gait has
been reported owing to decrease in the
somatosensory inputs from feet and legs [13-15] .
Study showed increase in muscle activity
during postural task in DPN patients [16] .
The greater muscle activation of agonist as
well as antagonist muscles acts as a balance
maintaining strategy during static stance or
in response to perturbations during dynamic
task [14,15,17] . This compensatory mechanism of
increased joint stiffness enhances stability
around the joint.
However, there are inconsistent results in
DPN patients regarding muscle activation
"Sensorimotor training is considered to be
a global approach for balance training."
Photo: @iStock.com/Nattakorn Maneerat
16 Pedorthic Footcare Association | www.pedorthics.org