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Can Hand Tactile Stimulation Improve Body Balance in the Elderly?

Dr. Faris S Alshammari

Two patients, one male with age of 82 and one female with age of 77 years. Both were diagnosed with Diabetes and peripheral neuropathy. According to recent blood analysis, A1C for the first patient was 6.9 and 5.7 for the second patient. Patients were complaining of poor body balance. Romberg test on noncompliant and compliant surfaces, and single leg stance test were conducted on both patients. Two small spongy balls, each of them weighing 50 grams, were used to provide tactile stimulation to hands. Tactile sensation of both hands and feet was evaluated using Semmes Weinstein monofilament from 1g to 10 g. Joint Position Sense was examined in both feet. Upon examining the tactile sensation of the sole of the foot, the first patient was able to feel 6 g monofilament in the mid left foot and 10 g monofilament on the mid right foot, and bilateral toes, forefoot, and heel areas. However, the second patient was able to feel 6 g monofilament on the whole planter aspect of the foot bilaterally. Joint position test was positive for the first patient and negative for the second patient. Upon conducting Romberg test on noncompliant surface, the first patient was able to maintain balance for 5 seconds, whereas, the second patient was able to maintain body balance for 7 seconds. Upon holding balls in hands, the first patient was able to maintain body balance in Romberg for 11 seconds and 12 seconds for the second patient. Patients were able to maintain balance for shorter time while conducting a Romberg test on a compliant surface. The first patient maintained body balance for 3 seconds and second patient for 4 seconds. With hand tactile stimulation, the ability of the first patients improved to 7 seconds whereas the second patient improved to 8 seconds. The ability of first patient on maintaining single leg stance improved from 2 seconds to 5and from 3 seconds to 5seconds for the second patient while holding the balls. Nerve damage in theperipheral neuropathy starts first in the feet then in the hands following a pattern.While the sensory impairment starts in the feet first, it could still intact in the hands. Therefore, stimulation of the hands can provide more sensory information regarding body orientation to the brain which can improve body stability.