Thesis (Ph.D.) - Cairo University - Faculty of Physical Therapy - Department of Physical Therapy for Neuromuscular and Neurosurgery

Background: Cognitive decline is the fourth diabetic microvascular complication which has an effect on gait parameters in DPN patients. The purpose of this study was to investigate influence of visuo-motor integration (VMI) on both cortisol & glycated hemoglobin (HbA1c) levels, cognitive functions and spatiotemporal gait parameters during three different gait conditions (walking without cognitive task, walking with verbal fluency & walking with arithmetic task). Also, to investigate the effect of physical therapy program on peripheral nerves functions in DPN patients. Methods: Forty patients with type II diabetes mellitus (DM) with moderate polyneuropathy were randomly assigned into two equal groups [study (G1) &control (G2)]. Group 1 treated with physical therapy program consisted of visuo-motor integration via RehaCom system in addition to therapeutic exercises for diabetic polyneuropathy. Group 2 treated only with the same selected therapeutic exercises as in (G1).Treatment was conducted three sessions per week for two months. Amplitude, latency and conduction velocity of sural, peroneal, Tibial and ulnar nerves (motor &sensory branches) were assessed. Cortisol & HbA1c levels tests were done for each patient. Rehacom was used to assess cognitive functions including (attention/ concentration (A/C), reaction behavior and figural memory). Different variables of gait parameters including (cadence, velocity& stride length) were assessed during three different gait conditions using two dimension (2D) video-based motion analysis. Pre and post assessment for all variables were done. Results showed significant improvement in all cognitive domains & significant reduction in both cortisol& HbA1c levels in (G1). Significant increase in all spatiotemporal gait parameters in (G1) during the three different gait conditions (P <0.05). In G1, Tibial & ulnar nerves showed significant improvement of amplitudes, velocities &latency while sural &peroneal nerves showed only significant improvement of velocity& latency

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