Analysis of postural balance in type-2 diabetic individuals after sensory-motor training: a double-blind randomised clinical trial

Author(s)

Nathalia Cristina de Souza Borges

• Document type: Master's Dissertation
• Press: Ribeirão Preto.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina de Ribeirão Preto (PCARP/BC)
• Defense date: 2016-09-30

Examining board members

Rinaldo Roberto de Jesus Guirro; Denise Hollanda Iunes; Luis Mochizuki; Renato de Moraes

• Advisor: Rinaldo Roberto de Jesus Guirro

Abstract

The individual\'s capacity to maintain an upright position, while adjusting efficiently the body movements and responding to external stimuli, represents essential postural control strategies for the daily-life activities. Type- 2 diabetes mellitus (DM-2) is considered an important public health care problem because of complications, such as functional performance deficit of the lower limbs and consequent falls, which can interfere with maintenance of the balance in addition to being a strong predictor of self-reported functional limitations. The objective of the present study is to assess the postural balance in type-2 diabetic patients after supervised and non-supervised sensory-motor training considering the orthostatic position, gait and functional tests. Eighty type-2 diabetic male and female volunteers aged 45 to 64 years old were distributed into three groups: GC - control group (n=27); GTD - At-home training group (n=27); and GTS - Supervised training group (n=26). Data on postural balance were obtained with the volunteers training on the platform (Neurocom Balance Master System®) and by using BESTest for clinical evaluation. The intervention was performed twice a week during 45 minutes for 12 weeks, divided into three phases: warm-up, sensory-motor training and cool-down, including monitoring of blood pressure and glycemia. After analysis of data distribution, Wilcoxon\'s test was applied to compare the times before and after the intervention, whereas Kruskal-Wallis\' test, followed by Dunn\'s post-hoc test, were used for inter-group comparisons, both whit significance level of 5%. The initial results regarding tactile and vibratory sensitivity showed an absence of peripheral neuropathy in the diabetic patients. In the comparisons between times, there was a significant increase in the asymptomatic classification of diabetic distal polyneuropathy in the Groups GTD and GTS (P<0,05). Type-2 diabetic patients in the Group GTS (P<0,05) had better performance for reactive postural response, gait stability and total BESTest score, also achieving a significant reduction in the oscillation speed of the centre of gravity on stable surface with open eyes (P<0,05) and better directional control of the body during right-lateral displacement, whereas those in the Group GTD (P<0,05) showed increased gait speed and better directional control of the body during left-lateral displacement (P<0,05). In the inter-group comparisons, there was found no substantial change after the intervention. Therefore, one can conclude that sensory-motor training improves the dynamic postural balance performance only for intra-group evaluations of type-2 diabetic patients. (AU)

• FAPESP's process: 14/19083-6 - Analysis of postural balance in type 2 diabetic after sensory-motor training: a randomized controlled blind clinical trial
• Grantee: Nathalia Cristina de Souza Borges
• Support Opportunities: Scholarships in Brazil - Master