Effects Of Otago Exercise Versus Multisensory Integration Training On Balance And Gait In Elderly With Diabetes

Diabetes one of the most prevalent chronic non-communicable diseases. Diabetic peripheral neuropathy (DPN) is a prevalent complication of diabetes, affecting about 50% of diabetic patients.

DPN characterized by peripheral nerve dysfunction. It initially presents sensory symptoms like numbness and tingling, which may evolve into pain and heightened sensitivity. Subsequently, motor symptoms such as muscle weakness and coordination difficulties appear, potentially leading to muscle atrophy.

Due to all these changes affecting peripheral nerve function, the functions of the lower extremities will be disturbed, which facilitate normal posture and walking, resulting in a loss of somatosensation and proprioception. This decreased sensitivity in the feet leads to balance defects, particularly in elderly and diabetic individuals.

The Otago exercise program is effective in preventing falls in older adults by improving cognitive function, balance, strength, functional fitness, and recovery, while reducing costs. Furthermore, multisensory exercises enhance balance and mobility by targeting sensory systems, thus lowering fall risk compared to traditional methods focused on physical strength or motor skills.

Both interventions positively affect balance and mobility in older adults with type 2 diabetes, but direct comparisons of their effectiveness are limited. This study aims to fill that gap by evaluating two rehabilitation interventions, potentially aiding clinical decision-making by identifying the more effective option for enhancing postural stability and mobility.

Inclusion criteria

• Ninety elderly Patients of both genders.
• Their age will range from 65 to 75th.
• They will be diagnosed with type 2 diabetes for 5 years or more.
• Patients with mild & moderate neuropathy will be included. (Based on the Toronto scale: -mild (6-8); moderate (9-11)
• Berg balance between (21 to <50) patients with mild &moderate risk of fall .
• Time up & go dual task: patient takes longer than 10 sec.
• HBA1C for these patients was ≥ 6.5% .
• BMI will range from (18: 29,9 kg/m2).
• Able to walk independently, with or without assistive devices.

Exclusion criteria

• Any musculoskeletal disorder affecting the lower limb (fracture of the lower limb, tumors, any infection, ligament injuries, foot injuries).
• Any other neurological disorder influences gait such as (stroke, Parkinson's disease, cerebellar dysfunction, ataxia, vestibular disorders)
• Any other cardiovascular disease (arrhythmia, cardiac pacemakers).
• Unstable proliferative retinopathy and visual impairments without correction.
• Non-diabetic neuropathy (inflammatory, autoimmune disease, infections, tumors, vitamin B12 deficiency, hypothyroidism, alcoholism, injury or pressure on the nerve).
• The use of medications significantly impacting postural control (e.g., sedatives).
• Vestibular system and Cognitive disorders.
• Uncontrolled hypertension.
• Common peroneal nerve injury.
• Orthostatic hypotension.