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Iso-kinetic measurement of ankle proprioception of strength,

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do3aa moh

on 3 February 2015

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Transcript of Iso-kinetic measurement of ankle proprioception of strength,

Subjects, Materials
and Methods

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.
DPN- Check
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
Diabetic neuropathy are disorders of the nerves caused by diabetes .
Berg Balance Test
Duaa Babaier Najlaa Al Ghamdi
Dr.Ashraf Darwesh

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 .
Proprioceptors Disorders
15 Neuropathic patients their age ranged between 40-60 years

Control group
( Group I )
15 Healthy subjects their age ranged between 40-60 years

Study group
( 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.
Charcot foot.
Any neurological diseases affecting the balance.
Sever visual impairment.
Cardiopulmonary diseases .

Assessment tools
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 .

Patients Positioning
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
the EMG.

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Andersen H, Nielsen, Carl E, Mogensen, and Johannes Jakobsen :Muscle Strength in Type 2 Diabetes Diabetes 53:1543–1548, 2004.
Andersen H, Jakobsen J: A comparative study of isokinetic dynamometry and manual muscle testing of ankle dorsal and plantar flexors and knee extensors and flexors. Eur Neurol 37:239–242, 1997.

Aring A M, Jones D E and Falko A M,: Evaluation and Prevention of Diabetic Neuropathy American family physician 2005; 71(11):124- 130.
Asakawa K, Ishikawa H, Kawamorita T, Fujiyama Y, Shoji N, Uozato H (2007). Effects of Ocular Dominance and Visual Input on Body Sway. J Ophthalmol; 51: 375–378.
Berg KO, Maki BE, Williams JI, Holliday PJ and Wood-Dauphinee SL (1992). Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil, 73: 1073-180.

Beynnon BD, Riemann Bryan L and Fu Freddie H: Validation of Techniques to Measure Knee Proprioception and Neuromuscular Control in Joint Stability Edited by: Lephart smaf, Freddie H. Human Kinetics, Inc; 2000.

Björklund M, Radovanovic S, Ljubisavljevic M, Windhorst U,Johansson H. Neurosci Res, Muscle stretch-induced modulation of noxiously activated dorsal horn neurons of feline spinal cord; 2004, 48:175-184.
Boerboom LA, Huizinga RM, Kaan AW, Stewart ER, Hof LA, Bulstra KS and Diercks LR: Validation of a method to measure the proprioception of the knee. Gait & Posture 28 (2008) 610–614.

Bogle Thorbahn LD, Newton RA (1996). Use of the Berg balance test to predict falls in elderly persons. Phys Ther;; 76: 576-585.

Browne J E & O'Hare N J (2005). Review of the Different Methods for Assessing Standing Balance Physiotherapy; 87: (9) 489-495. Cappa P, Patane F, Rossi S, Petrarca M, Castelli E, Berthoz A (2008). Effect of changing visual condition and frequency of horizontal oscillations on postural balance of standing healthy subjects. Gait & Posture; 28:(4): 615-626.

Cimbiz A, Cakir O Evaluation of balance and physical fitness in diabetic neuropathic patients Journal of Diabetes and Its Complications;2005 (19)160– 164.

Cook A and Woollacott M: physiology in motor control,Motor control theory&practical application,Lippincott,Williams and Wilkins,2001:50-90.

Daubney ME, Culham EG (1999). Lower-Extremity Muscle Force and Balance Performance in Adults Aged 65 Years and Older. Physical Therapy; 79: (12), 1177-85.

Duzgun I, Kanbur N, Baltaci G and Aydin T: Effect of Tanner Stage on Proprioception Accuracy. The Journal of Foot & Ankle Surgery (2011); 50:11–15

Dyck PJ, Karnes JL, O’Brien PC, Litchy WJ, Low PA and Melton LJ III (1992):The Rochester Diabetic Neuropathy study: reassessment of tests and criteria fordiagnosis and staged severity. Neurology 42:1164–1170.

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
Thank You
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.
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