The use of virtual reality and a sub-threshold vibratory noise as a tool to enhance sensory reintegration and postural control among patients with diabetic peripheral neuropathy


Purpose: Peripheral neuropathy frequently occurs among patients with diabetes and can result in many complications, including plantar sensory loss. Diminished sensation alters the sensory weighting mechanism, causing individuals to become increasingly reliant on visual stimuli to maintain adequate balance and postural control. The purpose of this study was to evaluate the clinical usefulness of a virtual reality- (VR) based sensory reweighting and balance training program that incorporates principles of the stochastic resonance theory in subjects with diabetic peripheral neuropathy. Methods: Seven subjects, ages 63 to 69 years old, with peripheral neuropathy due to type II diabetes have completed the study; enrollment is ongoing. This study was conducted using a V-Gait CAREN system. Subjects were fitted with vibratory devices placed around both ankles and underwent increasingly challenging postural stability activities over the course of 6 one-hour sessions. Visual dependency was reduced by manipulating the lighting conditions and applying visual distractions from the VR. Subjects received an acute application of a sub-threshold vibration throughout the duration of each session. Pre- and post- measurements of fall risk and standing balance were assessed at visits 1 and 8 using the Activity Balance Confidence (ABC), Falls Efficacy, and Clinical Test of Sensory Interaction for Balance (CTSIB). Data was analyzed using paired t-tests. Results: Post training analysis showed a significant improvement in ABC score (p=0.02) but not with Fall Efficacy score (p Conclusions: Subjects improved overall balance and sensory selection strategy as indicated by an improved ability to control both the amplitude and velocity of their sway during conditions of altered visual and somatosensory information. Preliminary results support the use of a sub-threshold background noise as an adjunct to a VR- based balance and sensory re-integration training program for individuals at risk for falls due to diabetic peripheral neuropathy.

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