Pawan Suraj Prakash Arora IJSRE Volume 05 Issue 05 May 2017 Page 6455 Volume||5||Issue||05||May-2017||Pages-6456-6460||ISSN(e):2321-7545 Website: http://ijsae.in
Index Copernicus Value- 56.65 DOI: http://dx.doi.org/10.18535/ijsre/v5i05.14
Effect of Tai Chi Exercises on Balance of Type 2 Diabetic Peripheral Neuropathy
Patients
Authors
Preeti Gazbare1, Pawan Suraj Prakash Arora2, Tushar Palekar3 1
Assistant professor, Dr. D Y Patil College of physiotherapy, Dr. D Y Patil Vidyapeeth, Pune, India. 2
Dr. D Y Patil College of physiotherapy, Dr. D Y Patil Vidyapeeth, Pune, India. 3
Principal, Dr. D Y Patil College of physiotherapy, Dr. D Y Patil Vidyapeeth, Pune, India.
ABSTRACT
Background: Diabetes Mellitus is a clinical syndrome characterized by hypoglycemia which is caused by absolute or relative deficiency of insulin. The chronic hyperglycemia of diabetes mellitus is associated with long term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. Tai Chi exercises are form of traditional martial art that shows improvement in many conditions.
Method: 50 patients with age group 40-59 years were selected by purposive sampling. 2 Groups were made as A and B. In Group A patients were treated by Tai Chi exercises and conventional physiotherapy while patients in Group B were treated by only conventional physiotherapy. Intervention was given Nerve Conduction Velocity, Balance and Quality of life for group A and B respectively. Duration was thrice a week for 4 weeks. Pre and Post assessment was done on day 1 and at the end of 12th session by using NCV machine, BBS and SF 36 Questionnaire. Statistical analysis was done by using Paired and Unpaired t Test.
Result: Significant improvement in pre and post scores of NCV (p<.05), BBS (p<.05) and SF 36 Questionnaire (p<.05) was observed in both the groups. There was statistical significant difference found when group A and group B compared with each other (p>.05).
Conclusion:- This study concludes that Tai Chi exercises shows significant difference on Nerve conduction velocity of Median, Ulnar, Tibial and Peroneal nerves, Balance and Quality of life.
Key Words: Diabetic peripheral neuropathy, Balance, Quality of Life, Tai Chi exercises,
INTRODUCTION
Diabetes Mellitus is a clinical syndrome characterized by hypoglycemia which is caused by absolute or relative deficiency of insulin. The chronic hyperglycemia of diabetes mellitus is associated with long term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. Retinopathy with potential loss of vision, nephropathy leading to renal failure, peripheral neuropathy with risk of foot ulcers, amputation and charcots joints and autonomic neuropathy causing gastrointestinal, genitourinary and cardiovascular symptoms and sexual dysfunction are the long term complications of diabetes mellitus. In type 2 diabetes, the body senses that there is a low level glucose inside the cells (despite having high levels in the blood) and the insulin level is increased and the hunger center in brain is activated, driving the person to eat more. These all combination of events causes person with type 2 diabetes to over eat, which leads to obesity.
Pawan Suraj Prakash Arora IJSRE Volume 05 Issue 05 May 2017 Page 6456 person to eat more. These all combination of events causes person with type 2 diabetes to over eat, which leads to obesity. If a person’s fasting glucose level is between 110 to 126 mg/dl then we consider this person to have prediabetes, or what is often referred to as glucose tolerance. Fasting glucose levels above 126 mg/dl on two separate occasions are indicative of diabetes mellitus. If u have a blood sugar level test after you have already eaten is described as a non fasting to be above 200 mg/dl, then this is enough to make the diagnosis of diabetes mellitus. The glucose tolerance test is done for the diagnosis of diabetes mellitus. The test is normal if the fasting glucose is less than 110 mg/dl and the 2 hours glucose levels is less than 140 mg/dl. If the 2 hour result shows a level between 140 to 200 mg/dl, then it is indicative that glucose will develop diabetes. A two hour glucose level greater than 200 mg/dl is the indication of diabetes. We can also choose to do another test, the hemoglobin A1C (HbA1C). If your initial test shows 2 fasting glucose levels of 130 mg/dl, which is above the diagnostic threshold of 126 mg/dl, that confirms the diagnosis of type 2 diabetes. If HbA1C is significantly elevated, your doctor will decide to monitor you more closely. This may include starting a medication regimen earlier in addition to make changes in diet and exercise habit, other test can differentiate between type 1 and type 2 diabetes. When insulin is formed in the pancreas, the C- peptide separates from the insulin portion of the molecule and can be measured in the blood of those with type 2 diabetes, whereas it is not present in those with type 1 diabetes, because they don’t produce insulin. Diabetic patients should always protect their feet from the heat and cold. Allowing the feet to become cold will leads to decrease the sensation in them. In cold climates patients should wear thicker socks, shoes and boot with the soft insulation. Wearing tight shoes or socks and crossing your legs or standing in one place for extended periods of time should be avoided. Avoid smoking tobacco because it decreases blood flow, which further results into cold feet.
Diabetic Neuropathy (DN) is a common disorder and is defined as signs and symptoms of peripheral nerve dysfunction in patients with diabetes mellitus (DM) in those patients where other causes of peripheral nerve dysfunction have been excluded. Diabetic neuropathy is one of the commonest cause of peripheral neuropathy. It accounts for hospitalization more frequently than other complications of the diabetes and also is the most frequent cause of non traumatic amputation. Prevalence of the neuropathy increases with the duration of diabetes mellitus. Neuropathy is associated with pain, burning and impairment of pain and temperature sensation, which are often associated with autonomic neuropathy. Diabetic neuropathy pain is typically worsened at the night and can be described as burning, pins and needles, shooting, aching, jabbing, sharp, cramping, tingling, cold and allodynia. Diabetic Neuropathy is a common problem for the patients suffering from diabetes, leading to pain and impaired sensation and movement in the limbs, which in turn can cause leg ulcers or foot ulcer.
Pawan Suraj Prakash Arora IJSRE Volume 05 Issue 05 May 2017 Page 6457 METHOD
Patients were screened according to the inclusion and exclusion criteria. The aim of the study and procedure was explained to the patient. The baseline measurement of berg balance score was taken before the intervention.
Patients were divided randomly with chit method into 2 groups A and B. Group A patients had received Tai Chi exercise program along with conventional physiotherapy program and Group B received conventional physiotherapy exercises only. Tai Chi treatment program includes silk reeling form. It contains of 14 different types of movement, given for 3 repetitions and 3 sets of each move given along with conventional physiotherapy duration of treatment for both group was thrice a week for 4 weeks.
At the end of 4 weeks of treatment session berg balance score was taken. Thus the data obtained is considered for statistical analysis.
DATA ANALYSIS AND INTERPRETATION:-
Data analyzed by using Primer and Winpepi software. For pre-post comparison of values of BBS score measurement Paired t test was used to compare within the groups. And Unpaired t test was used to compare pre-pre and post-post scores between the groups.
Graph 1:- Demographic data of Age.
Interpretation:- The mean age of patients in group A is 51.65 and the mean age of patients in group B is 52.2608.
Graph 2:- Demographic data of Gender.
Interpretation: In a study out of total 50 patients 27 male and 23 female patients participated. 51.65
52.2608
51.2 51.4 51.6 51.8 52 52.2 52.4
EXPT. CONTROL
Demographic data of Age
AGE
27 23
Demographic data of Gender
MALE
Pawan Suraj Prakash Arora IJSRE Volume 05 Issue 05 May 2017 Page 6458 Table 3:- Pre and post mean values of BBS of Group A & B
N PRE POST DIFFERENCE p Value
Group A 20 36.3±3.21 38.55±3.50 2.25±0.85 <0.001 Group B 23 35.74±3.59 36.74±3.73 1±0.60 <0.001 t Value of Mean Difference = 5.613
p Value of Mean Difference = <0.001
Graph 3:- Comparison of mean difference on bbs of both groups
Interpretation:- It shows that there is a more significant difference of berg balance score in group A than compared to group B. It suggests that Tai Chi exercise is effective in improving balance as compared to conventional physiotherapy treatment.
RESULT
In this study, 50 Type 2 Diabetic Peripheral Neuropathy patients were included based on the inclusion criteria. Patients were treated by Tai Chi exercises along with conventional physiotherapy treatment in Group A and Conventional physiotherapy in Group B. Outcome measure was Berg Balance scale measurement.
By applying Paired t Test for Berg Balance Score for both Group shown in Table 3:- The Pre & Post treatment mean value of BBS in group A was 36.3±3.2 and 38.55±3.5 respectively. It shows significant improvement after intervention.. Significant improvement in the BBS was observed after intervention which was p<0.001. Similarly for group B, Pre & Post treatment mean value of BBS was 35.74±3.5 and 36.74±3.7 suggesting significant improvement with p <0.001.
By applying Unpaired t Test for pre score and mean difference of BBS in both groups:- The mean value of Berg Balance Score of Group A & B pre treatment was 36.3±3.2 and 35.74±3.5. There is no significant difference observed between the two which was p< 0.595. The difference between pre post values of mean of BBS in Group A Group B is 2.25±085 and 1±0.6. There is a significant difference seen in differences in BBS mean of both groups which was <0.001.
DISCUSSION
The purpose of this study was to investigate the effectiveness of Tai Chi exercises program in Diabetic Peripheral Neuropathy Patients. There were 50 patients of type 2 diabetic peripheral neuropathy taken. And were divided into 2 groups. Group A in which supervised Tai Chi exercise program along with conventional physiotherapy was given and Group B received only conventional physiotherapy exercises. There were 7
2.25
1
0 0.5 1 1.5 2 2.5
EXPT. CONTROL
Pawan Suraj Prakash Arora IJSRE Volume 05 Issue 05 May 2017 Page 6459 dropout patients who in between left the treatment due to other health issues. Out of them 2 patients were from very far place which were not able to maintain follow up. Out of 7 dropouts 5 were from group A (i.e. experimental group) and 2 were from group B (i.e. control group). Thus 43 patients were considered for the statistical analysis. The result of this study showed that there was a significant improvement in balance of both the groups.
Balance combines many systems within the body that work in concert to move the center of mass (COM) in relation to the base of support (BOS) in a controlled manner when engaged in dynamic task. There are three primary systems involved for the balancing process: (1) The sensory system (visual, cutaneous and proprioceptive and vestibular senses), which gives feedback to alter the balance action during a voluntary motor task, (2) the motor system, which creates the coordination movement to maintain balance, and (3) the biomechanical system or the musculoskeletal system, which includes the muscles that create the movement torques and the bony and joint frame on which movements are made. All these three systems may be associated with the improvement of balance by Tai Chi exercises. During the Tai Chi exercises, the visual cues provide visual information necessary to anticipant ground condition, and motor pattern are unconventional.
A study by Tesfaye et al. investigating sensory conduction velocity of sural nerves (SSCV) showed that SSCV increased significantly after less than 10 min of strenuous exercise in normal participants and participants with non-neuropathic diabetes, but not in participants with neuropathic diabetes. Balducci et al. reported that patients with DM who participate in long-term aerobic exercise had less progression of diabetic neuropathy. Richerson & Rosendale showed that elderly patients who had plantar sensory loss due to diabetic peripheral neuropathy and other diseases attained significant improvement in sensory ability after 6 months of Tai Chi exercise training. It showed that motor NCV of tibial and median nerves and distal sensory latency of ulnar nerves significantly improved after 4 weeks of Tai Chi exercise in patients with DM. The progression of diabetic neuropathy is related to diabetic duration and severity. Based on the above findings, we postulated that early Tai Chi exercise intervention may be able to prevent or rescue patients with DM from progression of diabetic neuropathy.
CONCLUSION
This study concludes that Tai Chi exercises has shown a more significant difference on Balance (measure by Berg Balance Scale).
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