Sensorimotor and Gait Training
Design
The study was a two-arm, parallel group
randomized controlled trial with single
blinding (blinding of outcome assessor).
Subjects were randomly allocated to either
of the two groups using computer generated
random numbers. Subjects allocated to the
intervention group received sensorimotor
and gait training along with diabetes and
foot care education whereas subjects in the
control group received diabetes and foot care
education only. Both groups were assessed
at baseline and after eight weeks of the trial.
Enrolment and assignment of participants
were done by an investigator who was neither
part of assessment of outcome measures nor
of implementation of exercise or education.
Study design is presented in Figure 1.
Interventions
Sensorimotor and gait training
The exercise was conducted thrice a week
(alternate days with gap not exceeding
more than 48 hours) for eight weeks (total
24 sessions). Each session comprised 10
minutes of warm-up, followed by 50-60
minutes of exercise, followed by 5-10 minutes
of cool down. Warm-up exercise included
cycle ergometer or treadmill at intensity of
40-50% maximal heart rate [33] . Heart rate
was monitored using heart rate monitor
(Polar Electro, RS 400, Kempele, Finland).
Sensorimotor and gait training comprised
wall slides, bridging exercises, prone plank,
sit to stand, wobble board exercises, one
leg stance, heel and toe raise, tandem
stance gradually progressed to different
grades using unstable surface (Thera
Band® Stability Trainer) and gait training
(different patterns of walking) (Appendix
2 and 3). Following the training session,
subjects performed cool-down exercises,
which included deep breathing, abdominal
breathing and mild stretching. Their
participation in the exercise was modified,
postponed, or stopped based on the current
guidelines of American Diabetes Association.
The exercise level was increased after every
two weeks, but if the subject was not able to
perform at the next level, their exercise level
was maintained at the current level.
Materials
An oval-shaped foam (TheraBand® Stability
Trainer of soft green, blue and grey color),
round shaped foam (TheraBand® Stability
Trainer of soft blue and silver color), bosu ball
(TheraBand®), wobble board (bi-directional
and multidirectional TheraBand®) and gym
ball (red, green, and blue color TheraBand®)
made up of polyurethane foam were used.
Diabetes and foot care education
Sessions on diabetes and foot care education
was conducted once every two weeks
for 30 minutes. It comprised material to
understand diabetes, diabetes management
and foot care guidelines. The education was
provided by professional physiotherapist
specialized in diabetes care.
Outcome measures
Proprioception
Proprioception was examined using Pedalo®-
Sensamove Balance Test Pro with Miniboard.
Miniboard comprised of the circular board
with hemispherical shaped sensors placed
below the board. It is based on the method
of adjustment where the difference between
adjustable stimulus and reference stimulus
is recorded [34] . Prior to the actual testing,
patients were familiarized with the testing
procedure. They were asked to stand on the
miniboard with the cushion placed below
the board. Then, the subjects were asked to
Current Pedorthics | September-October | January/Feburary 2020
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