Impaired balance due to sensory loss in their feet is very common among older people and diabetes patients. It often results in falls. Bone fractures in older people often lead to long rehabilitation processes and the fear of falling may result in social isolation. Research by Juha Hijmans, movement scientist at the University Medical Center Groningen, has revealed that vibrating insoles can improve standing balance. Hijmans will be awarded a PhD by the University of Groningen on 13 May 2009.
As a result of their disease, diabetes patients can develop a neuropathy causing a loss of sense. This in turn will lead to a loss of balance, causing patients to fall. Hijmans examined whether improved sensitivity in the foot sole might influence this balance. His results show that vibrating insoles can improve balance. A subtle, imperceptible vibration under the sole of the foot can help people with a neuropathy to maintain their balance.
In addition, Hijmans has determined the required characteristics of such vibrations: it turns out that a vibration with a continuously changing frequency up to a maximum of 200Hz is most effective. In this research project thin insoles were used that would fit right into a shoe. However, the operating system for the insoles is currently so large and heavy that it cannot yet be applied. The next step will thus be to make the research results applicable in actual practice.
In addition to the vibrating insoles, Hijmans also examined whether balance can also be improved by means of compression, for example by wearing a support stocking. This had previously only been studied for ankle instability in athletes, but the expectation based on this study was that support stockings would be effective because they provide additional compressive and tractive forces on the ankle skin, which forwards proprioceptive information to the brain. Proprioceptive information involves the reception and processing of stimuli that originate from the nervous system itself. Hijmans examined older people (with an average age of 80) with somatosensory problems, i.e. impaired sense in the ankles and feet. As expected, proprioception improved until values equivalent to those of young adults were reached, but at the same time, unexpectedly, the balance decreased somewhat.
This may be explained, Hijmans thinks, by the decreasing levels of information processing in older people. The brain is not able to quickly process the additional proprioceptive input and integrate it with visual input and input from the vestibular system. On the other hand, it is also possible that a support stocking forwards less sensory information from the foot sole, resulting in decreasing balance. Hijmans concludes that, in order to improve balance in people with somatosensory problems, the focus should primarily be on aids that improve feeling in the foot sole and less on aids that improve the ankle’s proprioception. Vibrating insoles are an example of an aid that improves the sense of touch in the foot sole.
Juha Hijmans (Enschede, 1978) studied movement sciences at the University of Groningen. He conducted his PhD research at the Department of Rehabilitation Medicine at the University Medical Center Groningen. His supervisors at the Faculty of Medical Sciences are Prof. K. Postema and Prof. J.H.B. Geertzen. His thesis is entitled: ‘Orthotic Interventions to Improve Standing Balance in Somatosensory Loss’. The research was partly sponsored by the Annafonds and the Stichting Beatrixoord Noord-Nederland.
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