title: Sensor-Based Interactive Balance Training with Visual Joint Movement Feedback for Improving Postural Stability in Diabetics with Peripheral Neuropathy: A Randomized Controlled Trial.
abstract: BACKGROUND
  Individuals with diabetic peripheral neuropathy (DPN) have deficits in sensory and motor skills leading to inadequate proprioceptive feedback, impaired postural balance and higher fall risk.
  
  
  OBJECTIVE
  This study investigated the effect of sensor-based interactive balance training on postural stability and daily physical activity in older adults with diabetes.
  
  
  METHODS
  Thirty-nine older adults with DPN were enrolled (age 63.7 ± 8.2 years, BMI 30.6 ± 6, 54% females) and randomized to either an intervention (IG) or a control (CG) group. The IG received sensor-based interactive exercise training tailored for people with diabetes (twice a week for 4 weeks). The exercises focused on shifting weight and crossing virtual obstacles. Body-worn sensors were implemented to acquire kinematic data and provide real-time joint visual feedback during the training. Outcome measurements included changes in center of mass (CoM) sway, ankle and hip joint sway measured during a balance test while the eyes were open and closed at baseline and after the intervention. Daily physical activities were also measured during a 48-hour period at baseline and at follow-up. Analysis of covariance was performed for the post-training outcome comparison.
  
  
  RESULTS
  Compared with the CG, the patients in the IG showed a significantly reduced CoM sway (58.31%; p = 0.009), ankle sway (62.7%; p = 0.008) and hip joint sway (72.4%; p = 0.017) during the balance test with open eyes. The ankle sway was also significantly reduced in the IG group (58.8%; p = 0.037) during measurements while the eyes were closed. The number of steps walked showed a substantial but nonsignificant increase (+27.68%; p = 0.064) in the IG following training.
  
  
  CONCLUSIONS
  The results of this randomized controlled trial demonstrate that people with DPN can significantly improve their postural balance with diabetes-specific, tailored, sensor-based exercise training. The results promote the use of wearable technology in exercise training; however, future studies comparing this technology with commercially available systems are required to evaluate the benefit of interactive visual joint movement feedback.
authors.affiliation: Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, University of Arizona, Tucson, Ariz., USA.
authors.forename: Gurtej Singh
authors.initials: GS
authors.lastname: Grewal
authors.forename: Michael
authors.initials: M
authors.lastname: Schwenk
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Lee-Eng
authors.forename: Saman
authors.initials: S
authors.lastname: Parvaneh
authors.forename: Manish
authors.initials: M
authors.lastname: Bharara
authors.forename: Robert A
authors.initials: RA
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: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint; D003929:Diabetic Neuropathies / Q000503:physiopathology / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D056228:Feedback, Sensory; D005260:Female; D006621:Hip Joint; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D004856:Postural Balance / Q000502:physiology*; D016037:Single-Blind Method; D014584:User-Computer Interface