Diabetes mellitus (DM) is a common disorder affecting individuals in the United States and in the world. The prevalence of DM has increased noticeably over the last three decades with an estimated 380 million people currently diagnosed with this disease. DM is associated with numerous systemic complications that affect the retina, heart, brain, kidneys, and nerves. The most common complication of DM is diabetic peripheral neuropathy. Diabetic peripheral neuropathy causes reduced sensation, reflexes, proprioception, and strength in lower limbs that leads to balance problems. Various manual therapy techniques have not approached a pilot study for the efficacy of a manual therapy technique to evaluate symptom alleviation in patients with diabetic peripheral neuropathy in order to improve balance.

The purpose of this study is to look at the impact of a novel intervention called Intraneual facilitation (INF) on objective static, objective dynamic, subjective balance measures, and a peripheral neuropathy scale in patients with Diabetic Peripheral Neuropathy (DPN).

Balance will be assessed using VSR Computerized Dynamic Posturography Sensory Organization Test (SOT, objective static balance measure), VSR Computerized Dynamic Posturography Limits of Stability (LOS, objective dynamic balance measure), and Activities-Specific Confidence in Balance Scale (ABC, subjective balance measure) and neuropathy will be assessed using modified total neuropathy scale (mTNS). Evaluation will be conducted at baseline (pre intervention) and (post intervention). The results of this study showed hat subjects showed significant improvement in the SOT, one component in the LOS (movement velocity, MVL), and mTNS (P < .05).

In conclusion, intraneural facilitation improved objective balance measures and neuropathy symptoms in patients with diabetic peripheral neuropathy. Further study is needed to determine long-term benefits of this intervention.

LLU Discipline

Physical Therapy


Physical Therapy


School of Allied Health Professions

First Advisor

Johnson, Eric

Second Advisor

Bussell, Mark

Third Advisor

Tsao, Bryan E.

Fourth Advisor

Bahjri, Khalid

Degree Name

Doctor of Science (DSc)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Diabetic Neuropathies; Peripheral Nervous System; Neuromuscular Manifestations; Postural Balance; Physical Therapy Modalities

Subject - Local

Diabetes Mellitus; Systemic Complications; Peripheral neuropathy; Intraneual Facilitation; Posturography



Page Count


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.


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