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From the 2012 ADA Mtg: Early Detection of Peripheral Neuropathy Using Virtual Obstacle Crossing
BIJAN NAJAFI, GURTEJ GREWAL, RASHAD SAYEED, STEVE YASCHECK, YASER KHAN, ROBERT A. MENZIES, TALAL K. TALAL,
This is a pilot study observing the effect of virtual reality technique on the early detection of diabetic peripheral neuropathy (DPN). We predicted that DPN patients would show a misjudgment of foot position during obstacle crossing, an altered reaction time, and an impaired balance.
An innovative virtual obstacle crossing (VOC) paradigm using wearable sensors was developed in attempts to detect lower extremity nerve damage due to DPN. Sixty-eight participants including diabetes with no, moderate and severe neuropathy and aged matched healthy controls were recruited. Severity of neuropathy was quantified using vibratory perception threshold (VPT) values .The ability of perception of lower extremity was quantified by measuring the rate of obstacle crossing success (OCS), reaction time (TR), and foot position while crossing a series of virtual obstacles with heights ranging from 5% to 20% of the subject’s leg length. Additionally, balance was assessed pre, during and post VOC trials.
No significant difference was found between groups for age and BMI (p>0.05). Results suggest VOC test allows separating between groups. The rate of OCS was significantly reduced with increasing neuropathy severity (p<0.05). Results also suggest a significant correlation between TR and VPT values (r=0.5, p<10-5). Finally, results suggest a significant deterioration in balance due to diabetes, irrespective of neuropathy severity (p<0.05).The results proposed the benefit of virtual obstacle crossing as an objective method for detecting peripheral neuropathy at early stage. This is based on the reasoning that lower extremity proprioception decreases with increasing nerve damage. The increased reaction time, decreased OCS, and increased sway of the DPN patients in this study suggests their decreased proprioception, and, therefore, increased peripheral nerve damage. Further studies should be addressed to compare VOC with other standard methods to confirm whether VOC can detect DPN earlier than current methods.