Published: 2021-06-25

Effects of sensory stimulation on balance and postural control in diabetic neuropathy: systematic review

Hetal S. Giri, Pradeep Borkar


Diabetic peripheral neuropathy is a complication of Diabetes Mellitus and is the most common noncommunicable disease. It involves decreases in the sensations and Lower extremity strength leading to reduce dynamic stability in balance and postural control. The purpose of the study is to review the effects of sensory stimulation interventions on Balance and Postural control in Diabetic peripheral neuropathy. A systematic review was conducted following the centers for Goggle scholar, PUBMED and science direct database using the keywords Sensory Stimulation, Balance, Postural control, Diabetic neuropathy. The time frame of the search was from 2006 to 2021. The review resulted in search of 18 articles with duration from 1 day to 26 weeks with a total population of 1,422 diabetes Mellitus type I and type II patients from the year 2006 to 2021. There were strong evidences of effects of sensory stimulation on postural control and Balance with noticeable difference in DPN. Based on our analysis results, most of the study stated that Vibration, Plantar Massages, Kinesiotaping, Rocker shoe, Vibromedical insole, Conventional exercises with proprioception stimulation, Mechanical noise have shown significant difference on balance and postural control. Whereas, offloading devices did not show any remarkable variance. The currently existing studies require a clear recommendation on whether which intervention is more effective. Thus, longer duration studies are required to improve balance and postural control in Diabetic Neuropathy.


Diabetic neuropathy, Sensory stimulation, Balance, Postural control

Full Text:



Abdissa D, Hamba N, Kene K, Bedane DA, Etana G, Muleta D et al. Prevalence and Determinants of peripheral neuropathy among type 2 adult diabetes patients attending Jimma university medical center, southwest Ethiopia, 2019, an institutional-based cross-sectional study. Journal of Diabetes Research. 2020;2020.

Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843.

Mellitus D. Diagnosis and classification of diabetes mellitus. Diabetes care. 2005;28(S37):S5-10.

Brown MJ, Asbury AK. Diabetic neuropathy. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 1984;15(1):2-12.

Boulton AJ, Gries FA, Jervell JA. Guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy. Diabet Med. 1998;15(6):508-14.

Papatheodorou K, Banach M, Edmonds M, Papanas N, Papazoglou D. Complications of Diabetes. J Diabetes Res. 2015;2015:189525.

Podwall D, Gooch C. Diabetic neuropathy: clinical features, etiology, and therapy. Curr Neurol Neurosci Rep. 2004;4(1):55-61.

Magrinelli F, Briani C, Romano M, Ruggero S, Toffanin E, Triolo G, Peter GC, Praitano M, Lauriola MF, Zanette G, Tamburin S. The association between serum cytokines and damage to large and small nerve fibers in diabetic peripheral neuropathy. Journal of diabetes research. 2015;2015.

Jáuregui-Renaud K. Postural balance and peripheral neuropathy. Peripheral neuropathy-a new insight into the mechanism, evaluation and management of a complex disorder. Rijeka: Intech. 2013;125-46.

Viseux F, Lemaire A, Barbier F, Charpentier P, Leteneur S, Villeneuve P. How can the stimulation of plantar cutaneous receptors improve postural control? Review and clinical commentary. Neurophysiol Clin. 2019;49(3):263-8.

Trivedi S, Pandit A, Ganguly G, Das SK. Epidemiology of Peripheral Neuropathy: An Indian Perspective. Ann Indian Acad Neurol. 2017;20(3):173-84.

Bark K, Wheeler JW, Premakumar S, Cutkosky MR. Comparison of skin stretch and vibrotactile stimulation for feedback of proprioceptive information. In2008 Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems 2008;71-8.

Paré M, Carnahan H, Smith AM. Magnitude estimation of tangential force applied to the fingerpad. Exp Brain Res. 2002;142(3):342-8.

Paton J, Glasser S, Collings R, Marsden J. Getting the right balance: insole design alters the static balance of people with diabetes and neuropathy. J Foot Ankle Res. 2016;9:40.

Ghomian B, Kamyab M, Jafari H, Khamseh M, Healy A. Rocker outsole shoe is not a threat to postural stability in patients with diabetic neuropathy. Prosthet Orthot Int. 2016;40(2):224-30.

Bagherzadeh Cham M, Mohseni-Bandpei MA, Bahramizadeh M, Kalbasi S, Biglarian A. The effects of vibro-medical insole on sensation and plantar pressure distribution in diabetic patients with mild-to-moderate peripheral neuropathy. Clin Biomech (Bristol, Avon). 2018;59:34-9.

Hijmans JM, Geertzen JH, Zijlstra W, Hof AL, Postema K. Effects of vibrating insoles on standing balance in diabetic neuropathy. J Rehabil Res Dev. 2008;45(9):1441-9.

Najafi B, Talal TK, Grewal GS, Menzies R, Armstrong DG, Lavery LA. Using Plantar Electrical Stimulation to Improve Postural Balance and Plantar Sensation Among Patients with Diabetic Peripheral Neuropathy: A Randomized Double Blinded Study. J Diabetes Sci Technol. 2017;11(4):693-701.

Thakral G, Kim PJ, LaFontaine J, Menzies R, Najafi B, Lavery LA. Electrical stimulation as an adjunctive treatment of painful and sensory diabetic neuropathy. J Diabetes Sci Technol. 2013;7(5):1202-9.

Priplata AA, Patritti BL, Niemi JB, Hughes R, Gravelle DC, Lipsitz LA et al. Noise-enhanced balance control in patients with diabetes and patients with stroke. Ann Neurol. 2006 Jan;59(1):4-12. doi: 10.1002/ana.20670. PMID: 16287079.

Ahmad I, Noohu MM, Verma S, Singla D, Hussain ME. Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy. Gait Posture. 2019;74:114-20.

Bagherzadeh Cham M, Mohseni-Bandpei MA, Bahramizadeh M, Forogh B, Kalbasi S, Biglarian A. Effects of vibro-medical insoles with and without vibrations on balance control in diabetic patients with mild-to-moderate peripheral neuropathy. J Biomech. 2020;103:109656.

Cloutier R, Horr S, Niemi JB, D'Andrea S, Lima C, Harry JD, Veves A. Prolonged mechanical noise restores tactile sense in diabetic neuropathic patients. The international journal of lower extremity wounds. 2009;8(1):6-10.

Kumar S. Significance of Sensory Specific Intervention on Balance in Type 2 Peripheral Diabetic Neuropathy Individuals.

El-Wishy A, Elsayed E. Effect of proprioceptive training program on balance in patients with diabetic neuropathy: a controlled randomized study. Bulletin of Faculty of Physical Therapy. 2012;17(2).

Ahmed AE, Mohamed NI, Mariam EM, Ahmed M. Effect of Kinesiotape versus Resistive Exercise on Dorsiflexors Functional Performance in Diabetic Peripheral Neuropathy. The Medical Journal of Cairo University. 2020;88:1777-82.

Akbari M, Dadgoo M, Ebrahimi I, Moradi S. Effects of Skin Stretch Sensory Stimuli on Balance in Patients with Diabetic Neuropathy. J Nov Physiother. 2011;1(105):2.

Bagherzadeh Cham M, Mohseni-Bandpei MA, Bahramizadeh M, Kalbasi S, Biglarian A. The clinical and biomechanical effects of subthreshold random noise on the plantar surface of the foot in diabetic patients and elder people: a systematic review. Prosthetics and orthotics international. 2016;40(6):658-67.

Tütün Yümin E, Şimşek TT, Sertel M, Ankaralı H, Yumin M. The effect of foot plantar massage on balance and functional reach in patients with type II diabetes. Physiotherapy theory and practice. 2017;33(2):115-23.

Horstink KA, van der Woude LH, Hijmans JM. Effects of offloading devices on static and dynamic balance in patients with diabetic peripheral neuropathy: A systematic review. Reviews in Endocrine and Metabolic Disorders. 2021;1-1.

Bernard-Demanze L, Vuillerme N, Ferry M, Berger L. Can tactile plantar stimulation improve postural control of persons with superficial plantar sensory deficit? Aging clinical and experimental research. 2009;21(1):62-8.