Background: Individuals with diabetic peripheral neuropathy (DPN) frequently suffer from concomitant impaired proprioception and postural instability. Conventional exercise training has been demonstrated effective in improving balance; however these exercises are often repetitive, causing patients to lose interest and not complete the long term rehabilitation process. In addition, these programs do not incorporate visual feedback targeting joint perception, which is an integral mechanism that helps compensate for impaired proprioception among DPN. Methods: This is a prospective randomized control trial study. Participants were randomized either in intervention or sham. The intervention group received twice per week an innovative exercise program based on virtual reality for 4 weeks. Their gait and balance were assessed at baseline prior initiating the intervention and after 4 weeks. Sham group were not included in balance training but their balance and gait were assessed at study visit and 4 weeks later. An innovative exercise program based on combination of wearable sensors technology and virtual reality was designed. The wearable sensors allow measuring lower extremity joint position in real-time which were used for the purpose of animation and real-time visual feedback to subject during exercise. Exercise program includes a series of ankle point-to-point reaching tasks in different direction as well as crossing a series of virtual obstacle with different heights, which were appeared on a computer screen in front of participants, Figure 1. Results: Forty-one eligible subjects have been recruited to date. However, the results of 15 participants (Age: 56.3±4.9, BMI: 30±15 m/Kg2) who completed the exercise program have been reported. Participants were diagnosed with diabetes by primary care and were confirmed to have peripheral neuropathy. The preliminary results suggest that active group reduced ankle sway by 76% (2.82±2.8deg to 0.66±0.47deg), hip sway by 81% (7.96±9deg to 1.48±1.2deg) and center of mass (CoM) sway by 76% (0.69±0.7deg to 0.16±0.11deg) during eyes open balance assessment. Similar reductions during eyes closed assessment were observed with reductions of 50%, 24% and 45% for ankle, hip and CoM sway. Conclusion: The current research implemented a novel balance rehabilitation strategy based on virtual-reality. Our methodology included wearable sensors and interactive user interface for real-time visual feedback based on ankle joint motion, similar to video gaming environment for compensating impaired joint proprioception. Findings support that visual feedback generated from ankle joint coupled with motor learning may be effective in improving postural control and gait among DPN patients.


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