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Iso-kinetic measurement of ankle proprioception of strength,
Transcript of Iso-kinetic measurement of ankle proprioception of strength,
Berg Balance Test (BBT)
Diabetic Polyneuropathy Check Device
Diabetes is a group of metabolic disease associated with hyperglycemia because of defects in insulin action, insulin secretion, or both.
Sidelying with the leg to be tested on top.
The patient should be in
a comfortable position that
allows for relaxation of the
leg and foot.
Biodex system Isokinetic dynamometer
Diabetic neuropathy are disorders of the nerves caused by diabetes .
Berg Balance Test
Duaa Babaier Najlaa Al Ghamdi
Classification of Neuropathy
Peripheral Neuropathy (polyneuropathy)
Focal Neuropathy (mononeuropathies)
The proprioception is very important for promoting dynamic joint and stability, and it play a major role during balance and functional activities.
Difficulty interpreting sensations about the position and movement of his head and limbs.
Instability while to standing with eyes closed, disturbed balance, delayed in nerve velocity and responses .
15 Neuropathic patients their age ranged between 40-60 years
( Group I )
15 Healthy subjects their age ranged between 40-60 years
( Group II )
The inclusive criteria
The subjects has diagnosis of diabetic polyneuropathy not less than 5 years.
The subjects are complaining from neuropathic symptoms in the foot (burning, tingling, numbness, aching pain sensations).
The exclusive criteria
Gross deformity of lower limbs.
Current foot ulcers.
Any neurological diseases affecting the balance.
Sever visual impairment.
Cardiopulmonary diseases .
Iso-kinetic Measurement of Ankle Proprioception and Strength, and
Nerve Conduction Examination in Diabetic Polyneuropathic
To evaluate muscular performance
and proprioception at the ankle in diabetic neuropathic patients and determine the severity with quantitative and standardized tools .
of the Study
Biodex system Isokinetic dynamometer
Mean values of planter flexors and dorsifexors
peak torque in both groups
Mean values of reposition accuracy in both groups
It is a fast, accurate and quantitative test for sural nerve ,that can be used to evaluate neuropathies .
Entering Personal data
, and Body Mass Index .
Repositioning accuracy for dominant ankle
Active repositioning test with speed 60/second, with three repetitions for each test.
The subject was asked to move his limb to the target angle (15°) actively, when the subject felt that he reached the target angle actively he would stop the apparatus using the Hold/Release button.
Maximal isokinetic strength of planterflexor and
dorsiflexor at the Dominant ankle
The subjects were instructed to push and pull as hard and fast as possible through the full available range of motion
The peak torques was at an angular velocity of 60 degrees/s
at the ankle joint .
Skin cleaning and preparation
Insert the biosensor into the port
and remove the cover .
Apply a small amount of conductive gel to each probe.
Locate the probe just behind the lateral malleulas and maintain constant force .
Mean values of Berg balance score in both groups
Frequency distribution according to severity
Recommendations for the further studies :
- Involving larger sample to allow generalization of findings.
- Compare the balance responses in neuropathic patient with normal by using instrumental measurement of balance.
- Evaluate the effect of isokinetic training on the functional capability of neuropathic patient
- Correlate the findings of DPN check
with the of electrophysiological findings of
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First and foremost, thanks to ALLAH
and deep thanks to Dr. Ashraf Darwesh for his generous supervision .
Deep appreciation and thanks to Dr. Amer Alsaif chairman of physical therapy department.
Special appreciation to DR. Amir Alfiky Assistant professor in physical therapy department Umm Al - Qura University and for DR. Kalid Edrees Consultant Podiatric Foot & Ankle surgeon for his unlimited help .
At last but not least, we can’t forget to thank our family, friends and all subjects who participated in this study
It is an objective method for testing and rehabilitation for joints of the upper limb,
lower limb and trunk.
It can be operated in different modes, isokinetic, passive, isometric and isotonic .
Biodex system Isokinetic
56 : Max score
> 45 : Less likely to fall
< 45 : More likely to fall
The Isokinetic system is an objective and standardized and sensitive tool to detect the motor and propreoceptaion changes of the diabetic neuropathic patients .
Examination of nerve conduction velocity and amplitude by DPN check help in determination of the severity and confirmation of the diagnosis.
The results of our study showed significant difference between the diabetic neuropathic patients and normal subjects in muscle strength.
Neuropathic processes might be a possible mechanism for the poor muscle function in diabetes and this may explain the torque differences
This is consistent with
(Haris et al., 2001 )
who found that muscle strength was reduced in the group of diabetic neuropathy than control subjects.
The results revealed significant decrease in proprioceptive accuracy in diabetic neuropathy group. This is consistent with
(Guney et al. 2013)
who found that diabetic patients displayed decreased ankle joint position sense.
There is significant decrease in the berg balance scores in diabetic neuropathy might be attributed to decreased proprioceptive input.
This come in agreement with
(Turcot et al., 2009)
who suggested that individuals with peripheral neuropathy show postural instability .
Regarding the examination of sural nerve conduction velocity and amplitude, the results revealed decrease in the mean values of the nerve conduction velocity and amplitude compared to the normal limits.
(Perkins et al., 2008)
stated that DPN Check is a sural nerve conduction test which is a standard, quantitative biomarker of DPN.