Exercise Training for Diabetic Neuropathy

Exercise Training for Diabetic NeuropathyField of ResearchPreventive and RehabilitationTopic of ResearchEfficacy of exercise prep along with foot Orthotic intervention in shifting the natural course of diabetic peripheral neuropathy. sketch Introduction and Literature ReviewDiabetic Plantat UlcersDiabetic myelitis is a group of chronic metabolic diseases caused by insufficient production of Insulin, results in abnormal metabolism of carbohydrates, fats and proteins. Diabetic mellitus can be classified into Type I or Insulin dependent Diabetic mellitus occurs due to autoimmune destruction of insulin secreting cell in the pancreas. The Type II Diabetic mellitus or Non insulin Dependent Diabetic mellitus, which is characterized by summation insulin resistant and relative lack of insulin(Kumar et al 2005).It was estimated 381 billion population suffering globally from Diabetics in 2013, among which 90% cases are Type II. The South Asiatic countries are having the highest number of d iabetic longanimouss in the world, with highest numbers in India and China(IDF).The peripheral nerve damage often involved in diabetic longanimous, affecting 60% of patients with Type I and Type II diabetes. In many in statuss, most of the patient had already some mild to severe form of peripheral neuropathies at the time of diagnosis (Boulton AJ et al 1998). The symptom in includes numbness, tingling or burning sensation, extreme sensitivity to touch, and insensitive to hot and pain in hold and feet.Diabetic Neuropathic feet- Biomechancial fault.For normal tempo, everyone requires the integrated function of sensory and motor functions. The sensory input to adapt and modify the motor output to optimize ideal gait pattern. In addition, there should be a fully functional bone and joints with adequate muscle strength, are also vital(Aminian K at al., 2002).Futhermore, the muscle weakness, anaesthesia and loss of proprioception alters the foot biomechanics, often leads to changes i n mobility, gait and balance. In this way, peripheral neuropathy directly contributes to joint subluxation and lack of accommodation to ground reaction force. These changes put the patient vulnerable for foot deformities and foot injuries. buttocks injuries are being considered as dangerous to diabetics because peripheral neuropathy and superimposed impaired circulation makes wound healing delayed and complicated, increase the seek of repeated infection. These might ultimately lead to amputation of the affected limb.The structural changes occur within the ligament, capsule and tendons of foot joints. The collagens of ligament, capsule and tendon disorganized, lose its ginger nut and tensile strength, and become more stiff (Grant WP 1996). The resultant foot joint immobility, leads to abnormal biomechanics, thus further results in either joint subluxation or the risk of injury. Therefore, it is imperative to observe the biomechanical faults are an important component in the overa ll care of diabetic foot.The biomechanical examination includes neutral calcaneal stance position(NCSP), relaxed calcaneal stance position(RCSP), Rang of Ankle joint dorsiflexion, position and mobility of the first ray, Forefoot to rearfoot relationship, range of motion at first MTPJ, Foot Pasture Index, Functional Hallux test (FHT), Limb continuance examination and plantar cart examination. A direct correlation between ulceration and areas of high pressure has been established (Veves A 1992).A fundamental segmentation of the physical examine involves inspection of the plantar aspect of the foot for any discrete or diffuse calluses that may indicate focal areas of high pressure or areas of increased shear forces.The sensory testing with Semmes -Weinstein Monofilaments (SWFs) should be assessed to identify the people at high risk of ulcer. It was found that 5.07 Semmes -Weinstein Monofilaments more sensitive in detecting patient with risks of plantar ulcers(Pham H et al 2000).Foot Orthotics intervention for biomechnical faultThe functional and accomodative foot orthosis has been a well accepted method of handling for patient with neurologically impaired foot for a few decades(C. S. Nicolopoulos, B. W. Scott, P. V. Giannoudis 2000 .H Cross et al,1996 Hastings MK 2006). These foot orthotic intervention decreases peak plantar pressure by evenly distributing the soundbox weight into the ground.Foot orthosis is a biomechanical device that controls the degree of pronation and supination of the foot while walking and running. By addressing the foot biomechanical fault in patients with foot orthosis, not sole(prenominal) prevent the plantar ulcers and it also improve their bail to physical exercise, which can prevent or modify the peripheral neuropathy of a diabetic patient.Exercise and encircling(prenominal) NeuropathyBased on published evidence, can benefit from regular participation in mild to moderate aerobic, resistance, and balance activities in presenting the onset or modify the natural taradiddle diabetic peripheral neuropathy(Colberg SR 2014 Balducci S 2006). StefanoBalducci, et al found that a significant difference in nerve conduction parameters in Sural and peroneal nerves between experimental and control groups(StefanoBalducci, 2006)Outcome MeasureNerve Conduction Study (NCS)Compound Muscle Action Potentials(CMAP), Compound sensorial Action Potentials(CSNP), and distal latencies of Peroneal and Sural nerve of both lower limbs forget be measured as per the standardized procedure((DeLisa, 1994 Misra Kalita, 2006 Nasseri et al., 1998). cycle Perception Thershold (VPT)Sense of thrill of the plantar side of big toe will be assessed using Vibrometer. There are many published evidence to suggest that vibration knowledge threshold measure can be effectively and accurately identify risks of diabetic neuropathy(Garrow AP et al, 2006 Catherine L 2010)Quantitative Warmth Cold sensation Assessment shekels Diabetic Neuropathy ScoreOb jective of the StudyTo assess biomechanical deviation of foot in preventing foot related problem in diabetic feet.To develop clinical long term exercise regime in preventing diabetic induced peripheral neuropathyTo ascertain Orthotic intervention for biomechanical deviation of foot in enhancing patient adherence to exercise programs.To develop a clinical exercise tool to enhance functional outcome of diabetic induced peripheral neuropathy of the feet.To identify the effectiveness of clinical exercise tool to achieve treatment goalsTo study the reliability and validity of clinical exercise tool in the clinical setting.Methodology of the Study flesh IA systematic review and biomechanical analysis (Deformity, muscle patterns, and plantar pressure) are needed to understand biomechanial and functional aspect of neuropathic feet of a diabetic patient in comparison with healthy subjects. This analysis is crucial in developing an understanding of possible foot orthotic intervention to preve nt undue pressure of anesthetic(a) feet during weight being phase of gait.Phase IIThe effective exercise intervention protocol is needed to achieve desirable treatment goals. Therefore, in this phase, will focus development of the exercise protocol aimed to modify or prevent diabetic neuropathy. Besides, each patient with biomechanical deviation treated with appropriate functional and or accommodative foot Orthosis. Nerve conduction studies Amplitude, distal latency, velocity and Vibration Perception threshold (VPT) and Semmens- Weinstein monofilaments touch, pressure sensation of both lower limbs will be recorded for all patients as a baseline.Phase IIITo test the validity and reliability of exercise protocol and foot orthosis in preventing or modifying diabetic neuropathy Nerve Conduction studies, VPT and Semmens- Weinstein monofilaments touch, pressure sensationContributionThis study, perhaps, may lead to improve or modify the natural course of diabetic neuropathy in patients at the risk or diagnosed peripheral neuropathy in diabetics. Orthotics intervention by means of accommodative / functional foot orthosis for the biomechanically abnormal foot helps the patient in preventing tabular ulcers and aggravation of deformity. Besides, the foot orthotic intervention also might enhance the adherence to mild to moderate aerobic, resistance and balance activities. The finding from this study may give better understanding of long term exercise protocol along with foot functional othosis in preventing or modifying diabetic neuropathy.Timeline/ Plan of StudyBrief BibliographyBoulton AJ, Malik RA. Diabetic neuropathy.Med Clin North Am. Jul 199882(4)909-29Aminian K, Najafi B, Bula C, Leyvraz P, Robert P. Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes. J Biomech. 200235689-99.Shaw JE, van Schie CH, Carrington AL, Abbott CA, Boulton AJ. An analysis of dynamic forces catching through the foot in diabetic neuropathy. Diab etes Care. 199821(11)1955-9.Yavuzer G, Yetkin I, Toruner FB, Koca N, Bolukbasi N. tread deviations of patients with diabetes mellitus looking beyond peripheral neuropathy. Eura Medicophys. 200642(2)127-33.Mueller MJ, Minor SD, Sahrmann SA, Schaaf JA, Strube MJ. Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls. Phys Ther. 199474(4)299-308 discussion 309-13.Petrofsky J, Lee S, Bweir S. Gait characteristics in people with type 2 diabetes mellitus. Eur J Appl Physiol. 200593(5-6)640-7.Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. Grant WP, Sullivan R, Sonenshine DE, Adam M, Slusser JH, Carson KA, Vinik AI J Foot Ankle Surg. 1997 Jul-Aug 36(4)272-8 discussion 330.Colberg SR,Vinik AI, Exercising with peripheral or autonomic neuropathy what health care providers and diabetic patients need to know, Phys Sportsmed.2014 Feb42(1)15-23. doi 10.3810/psm.2014.02.2043.Bal ducci S,Iacobellis G,Parisi L,Di Biase N,Calandriello E,Leonetti F,Fallucca F.Exercisetraining can modify the natural history of diabetic peripheral neuropathy. JDiabetesComplications.2006 Jul-Aug20(4)216-23.The risk of foot ulceration in diabetic patients with high foot pressure a prospective study. Veves A, Murray HJ, Young MJ, Boulton AJ Diabetologia. 1992 Jul 35(7)660-3.Pham H,Armstrong DG,Harvey C,Harkless LB,Giurini JM,Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration a prospective multicenter trial. DiabetesCare.2000 May23(5)606-11.Cross H,Kulkarni VN,Dey A,Rendall G. Plantar ulceration in patients with leprosy. J Wound Care.1996 Oct5(9)406-11.Hastings MK,Mueller MJ,Pilgram TK,Lott DJ,Commean PK,Johnson JE. Effect of metatarsal pad placement on plantar pressure in people with diabetes mellitus and peripheral neuropathy. Foot Ankle Int.2007 Jan28(1)84-8.Misra, U. K., Kalita, J. (2006). clinical application of EMG and nerve conduction C linical neurophysiology (2nd ed.). New Delhi Elsevier, 8084.DeLisa, J. A. (1994). Lower extremity nerves. Manual of nerve conduction velocity and clinical neurophysiology (3rd ed.)USA raven Press Limited, 122144.Nasseri, K., Strijers, R. L. M., Dekhuijzen, L. S., Buster, M., Bertelsmann, F. W., et al. (1998). Reproducibility of different methods for diagnosing and monitoring diabetic neuropathy. Electromyography and Clinical Neurophysiology, 38, 295299.Garrow AP ,Boulton AJ. Vibration perception thresholda valuable assessment of neural dysfunction in people with diabetes. Diabetes Metab Res Rev.2006 Sep-Oct22(5)411-9.Catherine L. Martin, MS,Barbara H. Waberski, MS,Rodica Pop-Busui, MD, PHD,Patricia A. Cleary, MS,Sarah Catton, RN,James W. Albers, MD, PHD,Eva L. Feldman, MD, PHD,William H. Herman, MD, MPH,Vibration Perception brink as a Measure of Distal Symmetrical Peripheral Neuropathy in Type 1 Dia Vibration Perception Threshold as a Measure of Distal Symmetrical Peripheral Neurop athy in Type 1 DiabetesVibration Perception Therosholdas a Measure of Distal Symentrical Peripheral Neuropathy in Type 1 Diabetics, Diabetes Care.Dec 201033(12) 26352641.Vibration Perception Threshold as a Measure of Distal Symmetrical Peripheral Neuropathy in Type 1 DiabetesVibration Perception Threshold as a Measure of Distal Symmetrical Peripheral Neuropathy in Type 1 Diabetes