title: Balance rehabilitation: promoting the role of virtual reality in patients with diabetic peripheral neuropathy.
abstract: BACKGROUND
  Individuals with diabetic peripheral neuropathy frequently experience concomitant impaired proprioception and postural instability. Conventional exercise training has been demonstrated to be effective in improving balance but does not incorporate visual feedback targeting joint perception, which is an integral mechanism that helps compensate for impaired proprioception in diabetic peripheral neuropathy.
  
  
  METHODS
  This prospective cohort study recruited 29 participants (mean ± SD: age, 57 ± 10 years; body mass index [calculated as weight in kilograms divided by height in meters squared], 26.9 ± 3.1). Participants satisfying the inclusion criteria performed predefined ankle exercises through reaching tasks, with visual feedback from the ankle joint projected on a screen. Ankle motion in the mediolateral and anteroposterior directions was captured using wearable sensors attached to the participant's shank. Improvements in postural stability were quantified by measuring center of mass sway area and the reciprocal compensatory index before and after training using validated body-worn sensor technology.
  
  
  RESULTS
  Findings revealed a significant reduction in center of mass sway after training (mean, 22%; P = .02). A higher postural stability deficit (high body sway) at baseline was associated with higher training gains in postural balance (reduction in center of mass sway) (r = -0.52, P < .05). In addition, significant improvement was observed in postural coordination between the ankle and hip joints (mean, 10.4%; P = .04).
  
  
  CONCLUSIONS
  The present research implemented a novel balance rehabilitation strategy based on virtual reality technology. The method included wearable sensors and an interactive user interface for real-time visual feedback based on ankle joint motion, similar to a video gaming environment, for compensating impaired joint proprioception. These findings support that visual feedback generated from the ankle joint coupled with motor learning may be effective in improving postural stability in patients with diabetic peripheral neuropathy.
authors.affiliation: Interdisciplinary Consortium on Advanced Motion Performance, University of Arizona, College of Medicine, Tucson, AZ.
authors.forename: Gurtej S
authors.initials: GS
authors.lastname: Grewal
authors.forename: Rashad
authors.initials: R
authors.lastname: Sayeed
authors.forename: Michael
authors.initials: M
authors.lastname: Schwenk
authors.forename: Manish
authors.initials: M
authors.lastname: Bharara
authors.forename: Robert
authors.initials: R
authors.lastname: Menzies
authors.forename: Talal K
authors.initials: TK
authors.lastname: Talal
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Bijan
authors.initials: B
authors.lastname: Najafi
mesh_terms: D000886:Anthropometry; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000534:rehabilitation*; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D004856:Postural Balance; D011446:Prospective Studies; D012380:Role; D012678:Sensation Disorders / Q000534:rehabilitation*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D063367:Virtual Reality Exposure Therapy / Q000379:methods*