Abstract
Common complications of diabetes, such as peripheral neuropathy and retinopathy, can severely affect postural control. 1 This often leads to loss of mobility and increased fall risk. There are several different ways of assessing postural control, but very few are both practical to implement and provide precise quantifiable data.
The BTrackS Balance Plate is a portable force platform that is able to quantify Center of Pressure (COP) during a variety of balance protocols, for example, the Modified Clinical Test of Sensory Integration in Balance (mCTSIB). While this device has a large database of healthy participants, along with published normative percentiles based on sex and age, there are currently only limited data on populations with chronic diseases, including diabetes. Despite this, we believe this technology can be a useful tool for assessing and monitoring postural control as a patient’s diabetes progresses, but its feasibility in a clinical setting with this population must first be assessed.
To test the feasibility of this device in a clinical setting, we conducted a pilot study at a general physician’s office where a researcher administered the mCTSIB on ten type 2 diabetes (T2D) patients (average age of 53.55 [±10.58] years) during their regularly scheduled doctor’s appointment. Patients were excluded from the study if they were outside the age range of 18-64 years, outside the blood glucose range of 80-250 mg/dL, could not stand unassisted, or had any nondiabetes-related neurological diseases. Participants completed four 20-second static trials using the built-in mCTSIB protocol, each evaluating a different sensory condition: standard, proprioception, vision, and vestibular. The total COP path length was calculated for each condition to quantify postural control. The average values, for separate male and female groups, were compared with existing normative data 2 on healthy individuals in the same age range (50-59 years) to evaluate how T2D patients compare with a healthy population.
Our results (Table 1) showed that, overall, these T2D patients had more sway (ie, increased path lengths) and lower percentiles than their healthy counterparts, with females performing better than males on all conditions except proprioception. The trends from our pilot study coincide with previous literature showing persons with diabetes produce a greater amount of postural sway, 1 leading us to believe that this version of the mCTSIB protocol was able to accurately assess these patients’ postural control. It should be mentioned that the exclusion criteria of blood glucose below 250 mg/dL, based on American Diabetes Association’s guidelines for exercise testing, 3 resulted in several possible participants being excluded. This criterion may be too conservative; this type of testing should not pose an adverse risk for those individuals with higher glucose levels.
Average Path Length of Males and Females During the Four mCTSIB Conditions With Their Percentile Rankings (Age 50-59) According to Previously Published Normative Data. 2
In conclusion, convenient and accessible balance testing affords easy-to-use postural control assessments in T2D clinical settings. It is also recommended that the blood glucose exclusion criteria be raised. Such advancements in quantified posture analysis may better inform physicians and patients, allowing for more precise patient-centered therapy.
Footnotes
Abbreviations
BTrackS, the balance tracking system; COP, center of pressure; mCTSIB, modified clinical test of sensory integration in balance; T2D, type 2 diabetes.
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Daniel Goble receives royalties paid to San Diego State University from a patent (US Patent 10660558) related to balance technology in this study. In addition, he has an equity stake (ie, stock options) and performs contract work for Balance Tracking Systems Inc., the parent company of the BTrackS Balance Plate and BTrackS Assess Balance Advance software. This conflict is mitigated by a management plan put in place by his academic institution (Oakland University) to ensure the integrity of his research. Mr Lopatin, Mr Ko, Dr Brown, and Dr Haworth have nothing to disclose.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
