Comparing the effects of cerebellar and prefrontal anodal transcranial direct current stimulation concurrent with postural training on balance and fatigue in patients with multiple sclerosis: a double-blind, randomized, sham-controlled trial.

Fatigue and balance disorders are common challenges experienced by Multiple Sclerosis (MS) individuals. The purpose of this study was to compare the concurrent effects of cerebellar and prefrontal anodal trans-cranial direct current stimulation (a-tDCS) with postural training on balance and fatigue in MS patients. 51 patients were evaluated to randomly allocation to a-tDCS over cerebellum, a-tDCS over dorsolateral prefrontal cortex (DLPFC) and sham group. 46 individuals (n = 16 in experimental groups and n = 14 in control group) followed treatment. All the groups received 10 sessions of postural training. The experimental groups underwent a-tDCS with a current of 1.5 mA for a period of 20 min. While, in the sham group, tDCS was only activated for 30 s and then turned off. The treatment included 10 sessions for four weeks. Before and after intervention, fatigue and balance were assessed using Fatigue Severity Scale (FSS), Timed Up and Go (TUG) test and Berg Balance Score (BBS), respectively. There was found a significant reduction in fatigue in the group receiving a-tDCS over the prefrontal cortex with postural training compared to the other two groups (P < 0.001). Additionally, a significant improvement was found in balance in the group receiving a-tDCS over the cerebellum concurrent with postural training in comparison to the other two groups (P < 0.001). Besides, in the sham group, the significant results were not reported in the variables. (P > 0.001). The results demonstrated that a-tDCS enhances the effects of postural training on balance and fatigue in MS patients.

The effect of exercise therapy on balance in patients with diabetic peripheral neuropathy: a systematic review.

Background: Peripheral sensory and motor nerves are often affected in people with diabetes mellitus (DM), and balance problems are widespread. Diabetic peripheral neuropathy is common. This study investigated the impact of exercise treatment on balance parameters in diabetic peripheral neuropathy patients. Method: Electronic databases, such as PubMed, Web of Science, and Science Direct, were used to perform a search of accessible papers. The search strategy was (exercise therapy OR physical activity) AND (balance OR equilibrium OR postural control OR fall OR fall risk OR static balance OR dynamic balance OR functional balance) AND diabetic peripheral neuropathy. The Physiotherapy Evidence Database (PEDro) scale was used to rate the research in this review for its quality and reliability. Scores ranged from 5 to 9 on the PEDro scale. Result: According to databases, about 9,103 articles were found in August 2021 from March 1984 to February 2020. From 9103 articles, 3872 were deleted for different reasons, including duplicate, non-randomized controlled trial (RCT) articles and after reviewing the title and abstract. About 5,231 articles were found in free full text. In the end, 12 submissions were approved. These studies investigated the effects of exercise treatment on static, dynamic, and functional balance parameters in diabetic peripheral neuropathy patients. Conclusions: This study showed the positive effects of balance and strengthening exercise on static balance indices in patients with diabetic peripheral neuropathy. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01077-1.

The immediate effect of a single whole-body vibration session on balance, skin sensation, and pain in patients with type 2 diabetic neuropathy.

Purpose: Patients with diabetic neuropathy usually suffer from impaired balance, pain, and decreased sole-foot sensation. The present research was designed to appraise the relic of whole-body vibration (WBV) on balance, pain, and sole-foot sensation in diabetic neuropathy patients. Methods: Present study was a single-blind randomized controlled clinical trial. Thirty-four patients with type 2 diabetic neuropathy were randomly divided into intervention groups (n=17) and control (n=17). The therapeutic program in the intervention group included standing on the platform of the WBV device, and in the control group included using the device in off mode. Dynamic balance (including overall, anterior-posterior, and medial-lateral stability indices) was measured using Biodex device, functional balance with timed up and go (TUG) test, pain using the visual analog scale (VAS), and sole-foot sensation of both feet with a monofilament. The outcomes were measured in both groups before and after the interventions. Results: Sixteen people in each group were analyzed. Intra-group comparison showed a significant improvement in the mean pain (P = 0.000), functional balance (P = 0.011), right and left sole-foot sensation (P = 0.001), and overall (P = 0.000), anterior-posterior (P = 0.000) and medial-lateral (P = 0.000) stability indices for the intervention group in post-intervention compared to pre-intervention. However, changes in the control group were not statistically significant. Results of inter-group comparison indicated a significant improvement in all parameters in the intervention group, except for functional balance. Conclusion: WBV can be effective in reducing pain and improving the sole-foot sensation and dynamic balance.