Influence of visuo-motor integration on cortisol levels and gait performance in diabetic polyneuropathy patients: A randomized controlled trial

High morning cortisol levels are associated with cognitive decline in diabetic polyneuropathy (DPN) patients. Cognitive decline is the fourth diabetic microvascular complication which has an effect on gait parameters in DPN patients. Objective. Our aim was to investigate influence of cognitive therapy (CT) on the cortisol levels and the spatiotemporal gait parameters during three different gait conditions (walking without cognitive task, walking with verbal fluency & walking with arithmetic task) in DPN patients. Materials and methods. Forty patients with type II diabetes mellitus (DM) with moderate polyneuropathy participated in this study. The patients group were assigned into two equal groups; study group (G1) treated by visuo-motor integration program via Rehacom system in addition to a selected physical therapy program for DPN patients, control group (G2) treated by the same selected physical therapy program. Rehacom procedure was used to assess cognitive function for all the patients and make CT for the study group (G1). Treatment was conducted three times per week for eight weeks. The cortisol level test was used to measure cortisol levels. The glycated hemoglobin (Hb1AC) test was used to detect the glycated Hb level. Different variables of spatiotemporal gait parameters (cadence, velocity & stride length) for all the patients were assessed using two dimension (2D) video-based motion analysis during the three different gait conditions. Results. The results showed significant reduction in cortisol levels post-treatment in (G1) compared to (G2) (P < 0.05). There was a significant improvement in all cognitive domains in (G1) compared to (G2) post-treatment (P < 0.05). Significant increase in all spatiotemporal gait parameters post-treatment in (G1) compared to (G2) during the three different gait conditions (P < 0.05). Conclusion. Visuo-motor integration activities have a positive effect on reducing serum cortisol levels and consequently improving cognitive function and gait parameters especially during dual task conditions while walking with verbal fluency task and walking with arithmetic task in DPN patients.