Today's post from podiatrytoday.com (see link below) talks about using technology to monitor balance issues for people with neuropathic foot problems. It involves a sort of physiotherapy that involves interactive balance training, using information gleaned from sensors. Unfortunately, the article doesn't go into detail about the sensors themselves, which I'm sure most readers are interested in. However, there's no doubt that more emphasis on training to avoid loss of balance due to numbness and wrong signals would be very helpful to all people living with neuropathy - it's a somewhat neglected area of neuropathy treatment. Don't worry about the title reference to diabetes - it applies to all forms of neuropathy.
Thursday, 02/26/15 David G. Armstrong DPM MD PhD
Diabetic peripheral neuropathy can be a risk factor for falls due to deficits in sensory and motor skills that can lead to proprioceptive difficulties. In a new study in Gerontology, my coauthors and I investigate the use of interactive balance training to increase postural stability.1
The randomized study performed at our unit focused on 39 patients with diabetic peripheral neuropathy (with an average age of 63.7 years) with one group performing sensor-based interactive exercise twice a week for four weeks and the other group being a control group.1 The exercises included shifting weight and crossing virtual obstacles. Participants wore sensors to acquire kinematic data and provide real-time joint visual feedback during the training.
Patients in the intervention group showed a significantly reduced center of motion sway, ankle sway and hip joint sway during the balance test with open eyes, according to the study.1 Ankle sway in our study was also significantly lower in the intervention group during measurements while the eyes were closed. These promising data certainly provide early evidence to potentially promote the use of wearable technology in exercise training but we need future studies to compare this technology with commercially available systems to evaluate the benefit of interactive visual joint movement feedback.
There are some really extraordinary technologies available to us in the sensor world. Trends are moving to smaller, cheaper and more flexible sensors. Some of the newest flexible sensors we have available are actually more like medical tattoos. These sensors would normally have taken up an entire backpack just a few years ago. The sensors are becoming so inexpensive and so ubiquitous that we are not only going to be able to measure aspects of instability but we are also going to be able to intervene right away by trying to measure and steadily improve people’s postural stability. By doing this, I believe we can reduce the completely unnecessary number of falls and unnecessary morbidity and death that occurs every day in homes and hospitals not only in the United States but around the world.
This problem of falls is getting more and more common not only in people with diabetes but also in the aging population overall. This fall risk is preventing people from being independent, productive members of society, keeping them at home and putting them forever on this cycle of dependence. We think these sort of sensors can really help us measure what we manage as doctors and patients.
Reference
1. Grewal GS, Schwenk M, Lee-Eng J, et al. Sensor-based interactive balance training with visual joint movement feedback for improving postural stability in diabetics with peripheral neuropathy: a randomized controlled trial. Gerontology. 2015; epub ahead of print.
http://www.podiatrytoday.com/blogged/can-sensors-and-balance-exercises-improve-balance-and-reduce-fall-risk-people-diabetic
Today's post from knoxnews.com (see link below) makes a sensible suggestion regarding cannabis as a pain reliever. With all the hoo-ha about opioid-distribution at the moment, neuropathy patients face the real possibility that their vital medications may be curtailed or even stopped in the future (and that may not be confined to just opioids!). For that reason, it's vitally important that we get any viable alternatives right...at the beginning...so that they will stand up to any future media hype that brands them as an evil in society. Although most experts have finally recognised the value of cannabis as an analgesic, there's still a long way to go before it is accepted as a workable alternative to pharmaceutical drugs as pain killers. Unfortunately, most law-makers and enforcers have little to no knowledge of the science behind the herb and react instinctively to the fact that it is also a recreational drug. Sound familiar? The current 'ban everything' approach to opioids, is very much in the same vain. This article calls for a cannabis programme, based on current science and common sense. It's only aimed locally in this case but there's no doubt that a national/international cannabis program would overrule any gut-instinct reactions from unknowing authorities.
Saying that medical marijuana will "do more harm than good'' during a legislative hearing earlier this month, state Health Commissioner John Dreyzehner did actual harm to the hopes of thousands of hurting Tennesseans who need real help right now.
And right now is the time for state lawmakers to put Tennessee citizens first and take up the issue of legalization of medical cannabis in the upcoming session and not cause their neighbors additional suffering.
Amazingly, Dreyzehner said: "Currently, the weight of evidence is that when marijuana is used as medicine, it will do more harm than good to the overall population of our state."
Dreyzehner's opinion is a bit out of date — by about 25 years — and out of step with medical professionals and citizens of our state.
As Dr. Sanjay Gupta of CNN fame has said: "I am here to apologize. We have been terribly and systematically misled for nearly 70 years in the United States (regarding cannabis), and I apologize for my own role in that."
Physician support for medicinal cannabis mirrors the same 75-80 percent support as the general public holds. Safe Access Tennessee, a non-profit group devoted solely to medicinal cannabis (not recreational legalization), would like citizens and our state legislators to examine certain significant and material facts with respect to medicinal cannabis.
The key rationale for having a Tennessee medicinal cannabis program is to protect our state's citizens from out-of-touch and distant federal bureaucracies, particularly the Drug Enforcement Agency and its related entities, which have fought a 45-year losing battle against the cannabis plant. This campaign of "systematically misleading" started with the proposition there is no medicinal value in cannabis.
The falsehood that there is no medicinal value in cannabis is written into U.S. federal law and has been a consistent theme to justify large governmental budgets for law enforcement. Every medical advance related to cannabis has been opposed, slowed, delayed and harassed by DEA officials more dedicated to their bureaucratic power than the advancement of medicine. That is what Gupta means by "systematically misleading."
The federal stranglehold on cannabis continued even after the discovery of the Endocabannioid System (ECS) in 1989. This unique system of the human body controls the immune system, appetite and pain (separately from the central nervous system), and is one of the most important scientific discoveries of the 20th century. It seems God designed our bodies to use cannabinoids (inherent in cannabis and other plants) to maintain health — the exact opposite of the DEA propaganda.
The ECS was discovered over 25 years ago, and only two FDA medicines have been approved when a free market could have generated hundreds, if not thousands, of viable medical alternatives. State medical cannabis programs are essential to the advancement of medicine for mankind.
The large medicinal potential of the ECS is being squandered by highly paid federal bureaucrats. The DEA stopped research authorized by the 2014 state legislative session by not allowing cannabis to be grown at Tennessee Tech University for academic research purposes. Our state Legislature cannot let these restrictions on medical and scientific advancement stand.
Tennessee needs a medicinal cannabis program just to maintain our economic competitiveness in the area of advanced ECS health solutions. Nashville is the leading health care investment location in the country, and our state laws need to support this critical industry.
http://www.knoxnews.com/opinion/columnists/david-c-hairston-medicinal-cannabis-program-is-needed-276c18d5-a2c7-58e8-e053-0100007fc881-363418961.html
Today's post from care.diabetesjournals.org (see link below) is all over the internet in various forms at the moment but to my mind is pretty much another 'duh!' moment as far as neuropathy news is concerned. Almost every experienced neuropathy patient will be able to tell you that their neuropathy has compromised their balance in some way and it doesn't take a great deal of imagination to understand why (given the other symptoms we experience). However, these things all have to be proved in one way or another via studies and research and this article does go into the science behind balance issues. Worth a read but you knew it didn't you?
Published online before print March 12, 2015, doi: 10.2337/dc14-1982 Diabetes Care March 12, 2015
Steven J. Brown1⇑,
Joseph C. Handsaker1,
Frank L. Bowling2,
Andrew J.M. Boulton2 and
Neil D. Reeves1
+ Author Affiliations
1School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, U.K.
2Faculty of Medical and Human Sciences, University of Manchester, U.K.
Corresponding author: Steven J. Brown, s.brown@mmu.ac.uk.
Abstract
OBJECTIVE Patients with diabetes with peripheral neuropathy have a well-recognized increased risk of falls that may result in hospitalization. Therefore this study aimed to assess balance during the dynamic daily activities of walking on level ground and stair negotiation, where falls are most likely to occur.
RESEARCH DESIGN AND METHODS Gait analysis during level walking and stair negotiation was performed in 22 patients with diabetic neuropathy (DPN), 39 patients with diabetes without neuropathy (D), and 28 nondiabetic control subjects (C) using a motion analysis system and embedded force plates in a staircase and level walkway. Balance was assessed by measuring the separation between the body center of mass and center of pressure during level walking, stair ascent, and stair descent.
RESULTS DPN patients demonstrated greater (P < 0.05) maximum and range of separations of their center of mass from their center of pressure in the medial-lateral plane during stair descent, stair ascent, and level walking compared with the C group, as well as increased (P < 0.05) mean separation during level walking and stair ascent. The same group also demonstrated greater (P < 0.05) maximum anterior separations (toward the staircase) during stair ascent. No differences were observed in D patients.
CONCLUSIONS Greater separations of the center of mass from the center of pressure present a greater challenge to balance. Therefore, the higher medial-lateral separations found in patients with DPN will require greater muscular demands to control upright posture. This may contribute to explaining why patients with DPN are more likely to fall, with the higher separations placing them at a higher risk of experiencing a sideways fall than nondiabetic control subjects.
Received August 18, 2014.
Accepted February 17, 2015.
© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
http://care.diabetesjournals.org/content/early/2015/03/11/dc14-1982.abstract
