The Effect of Daily Use of Plantar Mechanical Stimulation Through Micro-Mobile Foot Compression Device Installed in Shoe Insoles on Vibration Perception, Gait, and Balance in People With Diabetic Peripheral Neuropathy

Abstract

Objective: People with diabetic peripheral neuropathy (DPN) have impaired gait and balance performance. The aim of this study is to investigate therapeutic effectiveness of mechanical stimulation through a wearable foot compression device equipped in a shoe insole on vibration perception, balance control and gait performance in people with DPN. Methods: Using a single-arm 4-week intervention study design, we examined effectiveness of daily use of shoes equipped with the foot compression device (Footbeat™, AVEX, Grand Junction, CO, USA) on improving vibration perception threshold (VPTmax), skin perfusion pressure (SPP), ankle brachial index (ABI), lower extremities edema (circumferences in the calf and ankle), and motor performance (postural sway with eyes open and closed conditions, and gait performance during normal, dual-task and fast walking). Thirty people with type 2 diabetes and symptoms of PN completed the experimental protocol. Results: Improvements in VPTmax (before = 27.4 V, after = 23.3 V, P = .007, d = 0.33, where d denotes effect size), center-of-mass sway in the mediolateral direction with both eyes open and closed conditions (before = 0.94 cm, after = 0.76 cm, P = .020, d = 0.47; before = 1.10 cm, after = 0.83 cm, P = .033, d = 0.66, respectively), and stride velocity for normal walking, dual-task walking and fast walking tasks (before = 0.87 m/s, after = 0.96 m/s, P = .017, d = 0.41; before = 0.75 m/s, after = 0.91 m/s, P = .001, d = 0.77; before = 1.10 m/s, after = 1.20 m/s, P = .043, d = 0.33, respectively) were found post treatment. There was no significant improvement in SPP, ABI, and circumferences in the calf and ankle. Conclusions: Our findings suggest the wearable foot compression device may be effective for reducing neuropathic symptoms and enhancing motor performances in people with DPN.

Wearable Health Technology to Quantify the Functional Impact of Peripheral Neuropathy on Mobility in Parkinson’s Disease: A Systematic Review

“…De Bruin et al [ 41 ] found significant differences in speed, step length, and cadence when comparing DPN patients during dual-task walking on paved trajectories compared to single-task. Another study by Kang [ 42 ] showed improvement in stride velocity, stride length, and double limb support (%) during dual-task and fast walking, compared to single-task, after plantar mechanical stimulation. Differences from controls were found in step time, cadence, and gait speed but not in stride length in a study by Esser et al [ 17 ], and gait speed was also 10% decreased in DPN group compared to controls in a study by Ling et al [ 31 ].…”

“…Other tools to assess postural stability were clinical tests such as the functional reach test [ 45 ]. Functional tests (to investigate functional mobility, addressing both gait and balance characteristics) were performed in three selected studies [ 40 , 42 , 45 ]. They applied the timed up-and-go (TUG) test.…”

“…A second notable result is that COM-ML sway amplitudes are obviously a good predictor of falls. It has been shown that ML sway was associated with falls in PNP patients [ 42 , 44 ]. These data are consistent with other populations, such as elderly [ 71 ].…”

Does the Presence of Cognitive Impairment Exacerbate the Risk of Falls in People with Peripheral Neuropathy? An Application of Body-Worn Inertial Sensors to Measure Gait Variability

“…We assessed the severity of PN by measuring vibration perception threshold (VPT) in the plantar surface of the foot with a standard Biothesiometer (Bio-Medical Instrument, Newbury, Ohio) as performed previously [33][34][35][36][37]. For each participant, we measured VPT for the first and fifth metatarsal heads and heel in each foot with the probe of the Biothesiometer.…”

Sensor-Based Daily Physical Activity: Towards Prediction of the Level of Concern about Falling in Peripheral Neuropathy

“…In order to assess the severity of PN, we measured vibration perception threshold (VPT) in the plantar surface of the foot (the first and fifth metatarsal heads, and the heel) using a standard biothesiometer (Bio-Medical Instrument, Newbury, Ohio, United States) as performed in previous studies [23][24][25][26][27]. Briefly, the probe of the biothesiometer was placed on the plantar surface of the foot, and electrical vibration was gradually increased from 0 volts until participants felt the electrical vibration.…”