EFFECTIVNESS OF BALANCE TRAINING WITH VIRTUAL REALITY AND VIBROTACTILE DEVICE IN DIABETIC PATIENTS

Purpose (a): Patients with diabetic peripheral neuropathy experience different degrees of sensory loss in their feet and tend to rely heavily on visual inputs to maintain their balance. This is an efficient coping strategy for as long as they can attend to the placements of their feet, but becomes a high risk of falls when they have to visually attend to something else, like crossing a street or a conversation. The purpose of this research is to assess the effectiveness of a training program designed to improve balance through sensory reweighting based on the principles of stochastic resonance and using virtual reality (VR). Moreover, biomarkers for diabetic control and neuro-protection pre- and post- sensory retraining will be studied to identify possible correlations between balance control and specific lab values. In addition, membrane androgen receptor (mAR ) has been linked to poor cognitive performance in animal models and this link will be examined in terms of balance control in the human subjects. Methods (b): Subjects with peripheral neuropathy due to diabetes undergo 6 one hour long training sessions in which they practice increasingly more challenging task of balance and walking while their visual attention is engaged by the VR. During training subjects were fitted with vibratory devices placed above the level of sensory loss (around the ankles). The intended to enhance somatosensory perception in the feet vibration was constant and sub-threshold. At visit 1 and 8, Pre- and Post- training assessments of balance and gait function as well as blood values for mAR, follicle stimulating hormone, estradiol, estrogen, C reactive protein, glucose, and a lipid panel. Results (c): To date two subjects have been enrolled in the study and one diabetic subject has completed the entire 8 weeks training protocol. Comparison of pre- and post-training revealed an improved balance function expressed by increased anterior and lateral center of pressure movement (ability to reach forward and laterally without losing balance) and increased walking speed. At the end of the training subject was able to maintain a straight walking trajectory even in the presence of visual inputs entraining lateral movements. Conclusions (d): Preliminary results show that sensory retraining with VR and vibratory device is feasible in diabetic subjects and holds promise for improvement of balance due to an increased ability to integrate all sensory inputs available and a decreased reliance on visual inputs.