Background: Intraneural facilitation (INF) has shown clinical success, and significant improvements have been found in a recent pilot study. This study aims to investigate further these effects on DMT2 subjects suffering from DPN. Objective: The purpose of this study is to explore the effects of INF on subjects suffering from DPN impacting blood flow, sensation, balance, gait, pain, and quality of life.

Methods: Twenty-eight subjects between 50-75 years old with T2DM and below ankle moderate-severe DPN, were randomly assigned into two groups (N=17 INF, N=11 sham). All blinded subjects went through 9 therapy visits, and blinded assessing physical therapists completed pre/post-testing measurements consisting of; Pain Quality Assessment Scale, Semmes-Weinstein Monofilaments, NeuroCom SMART Balance Master, QOL- DN, Zeno Walkway, and ultrasound.

Results: There were only two significant differences between each group statistically, for unpleasant pain and protective sensation (p < 0.05). There were significant changes within the INF group over time, for 8 PQAS pain qualities, and in 2 pain domains (p < 0.05); sham group showed decreases in 2 pain qualities (p < 0.05). No significant differences seen between groups for gait velocity and stride length. Only the INF group showed within group improvement in static balance composite equilibrium score over time (p < 0.05) in SOT. For LOS, significant differences between groups were seen in forward (FW) direction for movement velocity (MVL) and in right (RT) direction for reaction time (ReT) (p < 0.05). Within the INF group there was improvement for total QOL-DN score, and subcategories; physical functioning/large fiber and symptoms; the sham group showed improvement in subcategory physical functioning/large fiber (p < 0.05). With the sonography assessment, there was no difference between each group statistically, however, there were changes within the experimental group with time Conclusions: Our findings indicate Intraneural Facilitation improved static balance measures within INF group and protective sensation and unpleasant pain quality between groups. Within INF group changes for ultrasound outcomes were encouraging yet further research is needed to elucidate the value of assessing macrovascular regulation using repeated single site sonography assessment. Therefore, applying INF might help benefit those dealing with diabetic peripheral neuropathy.

LLU Discipline

Physical Therapy


Physical Therapy


School of Allied Health Professions

First Advisor

Lee S. Berk

Second Advisor

Mark Bussell

Third Advisor

Lida Gharibvand

Fourth Advisor

Everett Lohman III

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Diabetic Neuropathies* / therapy; Diabetes Mellitus, Type 2* / complications



Page Count

xvi, 108 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives