Sensorimotor and Gait Training
group. However, the patients reported better
balance during walking on treadmill after
the intervention and clinically found less
compensatory adaptive strategy used during
walking in the patients with DPN.
Interestingly, our study found reduction in
the activity of multifidus during treadmill
walking following the sensorimotor and gait
training. Sensory integration relayed lesser
motor response, therefore, multifidus activity
was reduced during treadmill walking. Also,
treadmill walking was challenging for the
patients with lesser ankle strategy; therefore,
the trunk leaned forward for maintaining
balance as a compensatory strategy,
consequently overloading the multifidus.
After intervention better sensory feedback
from foot and ankle helps proper use of ankle
strategy. Thus, improvement in activity of
the muscles around the ankle might have led
to lesser compensation by trunk musculature
with more erect trunk position, and
therefore, lesser activation of the multifidus
was found.
Clinical implications
Sensorimotor and gait training has
revealed positive effects on proprioception,
nerve function and activity of lower limb
musculature. These exercises are feasible,
easy and used in the clinical setup in patients
with DPN. Also, the exercises may be given
as home exercise protocol for patients
moderately affected with DPN, due to lesser
risk, better safety and exercises not requiring
much supervision. However, we would like
to mention the adverse events when one
patient complained about aggravated pain
in the leg during set of exercise intervention
and another patient had hypoglycemia in
only single session. The participants were
offered no financial compensation, although
the high compliance rate (86.36%) observed
in our study suggests that the patients were
satisfied with this form of therapy. These
exercises should be incorporated along with
glycemic control interventions, as they play
an effective role as a preventive strategy for
long term complications in patients with
diabetic neuropathy.
Limitations and future perspective
There were several limitations to the study,
including its small sample size, considering
the larger variability in the parameters of the
electromyographic activity. Also subjects in
the control group were not controlled with
home exercises during this period. Subjects
recruited for the study primarily suffered
from mild to moderate level of neuropathy,
while those with severe neuropathy were
relatively less in number, this limits the
generalizability of the results to the entire
population with DPN. In future, efficacy
of sensorimotor and gait training should
be assessed in sensory nerve function, in
patients with severe diabetic neuropathy and
with increase duration of exercise to see the
significant changes in the electromyographic
activity of the lower limb muscles.
Conclusions
Specific progressive sensorimotor and
gait training improves proprioception and
nerve conduction velocity. Due to better
proprioceptive feedback, these interventions
provide beneficial changes in the activity of
muscles around the ankle and multifidus
during postural control and walking in
patients with DPN.
Current Pedorthics | September-October | January/Feburary 2020
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