Diabetes Technol Ther. 2014 Dec;16(12):822-7.

Tactile intervention as a novel technique in improving body stability in healthy elderly and elderly with diabetes.

Alshammari FS, Petrofsky JS, Daher N, Alzoghbieh ES, Dehom SO, Laymon MS.

Department of Physical Therapy, Loma Linda University , Loma Linda, California.

 

Abstract

BACKGROUND: Body sway increases in the elderly because of normal aging and high incidence of disease such as diabetes. Prevalence of sway is greater in the elderly with diabetes because of damage to the central and peripheral nervous systems. Increase in body sway is associated with an elevated risk of falling. Falling is one of the major causes of morbidity and mortality in the elderly. The purpose of this study was to develop a new technique to improve body stability and decrease body sway in the elderly people with or without diabetes.

SUBJECTS AND METHODS: Twenty-two subjects-12 elderly (mean age, 75.5±7.3 years) and 10 age-matched elderly with diabetes (mean age, 72.5±5.3 years)-were recruited for this study. Subjects received tactile feedback as a tingling sensation resulting from electrical stimulation triggered by body sway.

RESULTS: The results showed a significant reduction in body sway in the elderly while standing on foam with eyes open (1.0±0.31 vs. 1.9±0.8; P=0.006) and eyes closed (1.8±0.7 vs. 3.3±1.5; P=0.001). In the group with diabetes, there was a significant reduction in body sway while standing on foam with eyes closed (1.4±0.5 vs. 2.3±0.8; P=0.045) but not with eyes open.

CONCLUSIONS: In this small study, this technique offers a new tool for training people with diabetes and elderly people to improve body stability and balance.

PMID: 25299792

 

Supplement:

The aging process reduces balance, increased sway during standing and walking and thereby increases the risk of falls in the elderly population.1,2 Such falls are a major cause of morbidity and mortality in the elderly. One third of people who are 65 years or older fall every year.2 About one third of these falls result in fall related injuries.2 This study aimed to find a new way to reduce body sway to improve body stability and reduce the risk of falling in the elderly. We examined the effect of tactile feedback on body sway in elderly people with or without diabetes. Tactile feedback used in this study was defined as providing sensory cues to the lower limb to improve body stability.

Body sway was measured and presented on a screen as a white line. When the subject swayed, there was an upward excursion of the displayed line. A photocell, sensitive to the light emitted by the line, was attached to the screen to sense a critical increase in sway (Figure 1). At this trigger point, the photocell output closed a relay which, in turn, allowed electrical stimulation to be provided to the leg. This was accomplished through two electrodes that were attached to the lateral aspect of the subject’s lower leg (Figure 2). The subject would feel the electrical stimulation as a tingling sensation cuing him or her to stop sway and hold steady. This mechanism resulted in tactile feedback generated by the body sway to improve body stability and balance among the elderly (Figure 3).

Novelty of this technique

According to our best knowledge, there is no existing tactile feedback system used to reduce body sway and improve body stability. This makes the tactile feedback system that we developed and used in this study a novel technique in improving body stability and balance in the elderly.

The importance of this novel technique

Tactile feedback required less time and effort to reduce body sway and improve body balance in the elderly. The current regimen of normal therapeutic balance training requires about 45-60 minutes which could be a reason that the elderly do not participate in such training due to limited fitness and stamina.3 However, tactile feedback training requires only 6 minutes of training and the results showed improvement following the training session.

 FA fig1

Figure 1. Photocell used to detect the light emitted from the sway line

 

 FA fig2Figure 2. Subject standing on platform with electrical stimulation electrodes attached to the leg

 

 

FA fig3

Figure 3. Tactile Feedback System

 

 

References

  1. Dhar HL. Physiology of aging. Indian journal of medical sciences. Nov 1998;52(11):485-497.
  2. Prevention CfDCa. Falls Among Older Adults: An Overview. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html. Accessed 04/15/2014, 2014.
  3. Chang Ho Song JSP, Seung Won Lee, Kyoung Jin Lee, Jong Eun Yim, . Effects of an Exercise Program on Balance and Trunk Proprioception in Older Adults with Diabetic Neuropathies. DIABETES TECHNOLOGY & THERAPEUTICS 2011;13(8).

 

 

 

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