Sensorimotor and Gait Training
pattern while walking. Some researchers
report a reduction in the electromyographic
peak activation of tibialis anterior,
gastrocnemius, and vastus lateralis [18-21] ,
while others have observed no difference
in muscle activation in DPN patients in
comparison to controls [21-23] . Additionally,
some researchers have also found an increase
in the activity of tibialis anterior [18,21] . Also,
prolonged duration of activity of lower limb
muscles indicate co-contraction of these
muscles for the stabilization of ankle joint
and improvement of foot stability during foot
flat to mid-stance [19,20,23] . Although Akashi et
al. found no difference in the coactivation of
tibialis anterior and lateral gastrocnemius in
DPN patients as compared with control [20] .
Sensorimotor training is considered to
be a global approach for balance training.
It emphasizes the sensorimotor system
function as one unit, and works on enhancing
sensory inputs and proper recruitment
patterns of various muscles in maintaining
joint stability, regulating the movement
through central nervous system (CNS) [24] .
Any imbalance in the muscles responsible
for postural control leads to movement
impairments and ultimately changes the
motor programming in CNS. To correct these
impairments, sensorimotor exercises first
facilitate sensory inputs (proprioceptive and
somatosensory structures), then corrects
muscle imbalance and finally facilitates
correct motor programming [24] . Along with
improvement in balance and spatiotemporal
parameters of gait, balance exercises as a
part of sensorimotor training have also been
shown to improve trunk proprioception in
DPN patients [25] . However, there is a lack of
studies about the effect of these exercises on
the nerve function and muscular activity of
lower limb muscles.
Evidence shows that aerobic [26-28] and tai chi
exercises [29] modulate the nerve function
in DPN patients. Balducci et al. found that
simple exercises as brisk walking modify
the natural history of the DPN [30] . But
there is paucity of knowledge showing the
effect of sensorimotor and gait training
on neuromuscular functions. Our study
was undertaken to examine the effects
of sensorimotor and gait training on
proprioception, peroneal and tibial nerve
function, and electromyographic activity of
the lower limb and trunk muscles during
postural tasks and treadmill walking.
Materials and methods
Clinical trial was registered in the Clinical
Trials Registry - India, National Institute of
Medical Statistics (Indian Council of Medical
Research) and approved by the Institutional
Ethics Committee, Jamia Millia Islamia
(JMI), New Delhi. Subjects were recruited
during March 2016 to December 2017. The
procedures were explained to the subjects,
and written informed consent was obtained
from each patient before the procedures
began. A preliminary investigation was
completed in order to verify the participation
criteria which included anthropometric,
demographic measures and clinical data.
Participants
The eligibility criteria were: male and
female subjects aged between 45 and 75
years; diagnosed diabetes mellitus type 1
or 2 for at least 7 years; BMI was between
18.5 and 29.9 kg/m2; subjects had scored
more than 2/13 points in the Michigan
neuropathy screening instrument (MNSI)
questionnaire (Appendix 1), indicating the
presence of at least two DPN symptoms [31] ;
scored greater than 1/10 point scale of MNSI
physical examination (Appendix 1), including
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