Effect of Square Stepping Exercise on balance and risk of fall in subjects with Diabetic Neuropathy.

Diabetic Neuropathy (DN) is one of the commonest causes of peripheral neuropathy and is defined as signs and symptoms of peripheral nerve dysfunction in a patient with diabetes mellitus in whom other causes of peripheral nerve dysfunction have been excluded. When compared to people with T1DM, the incidence is greater in T2DM. Individuals with diabetes are susceptible to developing neuropathy at any point, with an increased risk correlating with advancing age and a duration of diabetes exceeding five years. Diabetic neuropathy is a major cause of falls in elderly patients and people with peripheral neuropathy caused by diabetes often experience balance disorders. Patients with this condition experience more postural sway, particularly when their eyes are closed. Exercise has been shown to enhance various metabolic factors that can influence nerve health and micro-vascular function, potentially providing indirect protection against peripheral nerve damage. Patients with diabetic neuropathy benefit from exercise therapy, including balance exercises, since it increases oxygen pressure in the skin, lower limbs, and chest, hence improving skin blood flow. Alterations in shear stress and pressure on the plantar surfaces during standing tasks can activate mechanoreceptors, transmitting signals to higher nervous centres and thereby, enhancing balance in patients with diabetic neuropathy. Research suggests that Square Stepping Exercise is an apparently most effective alternative to walking for improvement of balance. Its effectiveness has been shown to be beneficial for subjects with stroke, Parkinson’s Disease, Multiple Sclerosis and elderly population. But there is a dearth of literature concerning Diabetic Neuropathy. Hence, the present study is developed with the aim to investigate the effect of SSE on balance and risk of falls in subjects with Diabetic Neuropathy. This study will include 62 participants, who will be divided equally into two groups: Group A & Group B. Participants in Group A will receive Square Stepping Exercise and Group B will receive Conventional Therapy. Both groups will receive intervention for 50 minutes with 10 minutes of warm-up and cool-down period, 3 times a week for 8 weeks. Data will be collected from both the groups pre and post intervention by using Berg Balance Scale and Timed Up and Go test. Statistical analysis will be done by Statistician to compare the results.