A new, promising, disease modifying physical approach for the incurable, intractable peripheral diabetic neuropathy.

1. Efficacy of Scanner ultrasound therapy on
nerve conduction studies in peripheral
symmetrical diabetic neuropathy
Dr/ Shimaa A Essa
MSc. Physical Therapy for Neurological
Disorders and its Surgery, Physical Therapy
College, Cairo University

2. Diabetes affects approximately 246 million people
worldwide, it is estimated that 20-30 million people
worldwide are affected by symptomatic diabetic
neuropathy.
Growing rates of obesity and the associated increase
in the prevalence of type 2 diabetes could cause
these figures to double by the year 2030.
((International Diabetes Federation, 2006

3. Distal symmetric polyneuropathy (DSP) is the
most common neuropathic complication of
diabetes; 50% - 80% of patients develop DSP,
and up to 20% have clinical features of
neuropathy at the time of diabetes diagnosis.
And accounts for 80% of diabetic foot
ulceration.

4. It’s a chronic and constantly
progressive micro-vascular
complication of Diabetes mellitus
affecting Type II more than Type I
DM. Why?

5. Type I
Is controlled by
Insulin,
That promotes
NO production
Type II
Is controlled by
hypoglycemic
drugs

6. 50% of Pts. have
either clinical signs
and symptoms or
NCS abnormalities
only
15% of Pts. have
both clinical &
NCS
Abnormalities

7. Positive
signs
Negative
signs
Sensory
Loss
Charcot’s
joints
Foot
Ulcers &
Amputation
Parathesias
Hyperalgesia
Allodynia

9. Distal symmetrical neuropathy is associated
with a progressive distal axonopathy. And
secondary segmental demyelination related
to impairment of the axonal control of
myelination, and remyelination.

10. In symptomatic diabetic
neuropathy, there is a slowing of
nerve conduction velocity owing to
demyelination and loss of large
myelinated fibers, and a decrease
in nerve action potentials owing
to loss of axons

11. 1) Obesity
2) FBS>200 mg/dl
3) HbA1c >9
4) Age >50 years
Treatment of DPN is inform of symptomatic
treatment for pain , Patient education for foot care
and protective treatment for DPN risk factors:
4) Duration of diabetes
>10 years
5) HTN
6) Dyslipidemia

12. How Could Ultrasound
therapy reverse the
underlying
pathophysiology and be
a curative (not just
symptomatic) treatment
for DPN?

15. To provide an alternative,
efficient, safe, and
inexpensive remedy for
patients suffering from distal
symmetrical peripheral
diabetic neuropathy

16. GI (control) GII (study)
15 Pat. (10 M., 5 F.) 15 Pat. (10 M., 5 F.)
 Received medical treatment for
DM & placebo treatment of US.
Subjects
 Received medical treatment
for DM & US therapy.
Both groups were assessed clinically by NAS & NCS
for (motor) Peroneal N. (MCV, MDL & Amplitude)
and (sensory ) Sural N. (SCV, SDL & Amplitude)
30 pat. (20 M. & 10 F.)
Age ranging from 45 to 65 years.
Type II diabetics

17. Ultrasound application
Deep tissue heating Popliteal
Fossa
Popletial arteryViscosity of blood
Blood flow for peripheral circulation
(B.S for Vasa nervosa O2 & Nutrients to
peripheral nerves of feet and lower legs.
That leads to PN regeneration

18. Both groups received a program of 10 minutes
(on each LL) for 7 weeks, 3 times per week, for a
total 20 treatment sessions.
Reevaluation was done after 5 weeks of the end
of treatment program.

20. Variables Groups X±SD MD p-value
Age(years) Group I 55.2±5.18 1.8 0.4
Group II 57±6.51
Duration diabetes mellitus
(years)
Group I 9.53±7.0 0.93 0.69
Group II 10.46±5.8
Duration of neuropathy
(months)
Group I 11.33±0.51 0.67 0.78
Group II 12±0.57
Sex n (%)
(Male/Female)
Group I 10/5 - 0.1
Group II 10/5

22. Sural nerve
GI (control)
present
27%
absent
73%
Pre treatment percentage
present
absent
present
27%
absent
73%
Pre treatment percentage
present
absent

23. Sural nerve
GII (study)
Absent;
80%
Present;
20%
Pre treatment absent response
percentage
Absent
Present
Absent;
0%
Present;
100%
Post-treatment absent response
percentage
Absent
Present

24. Peroneal nerve
0
0.5
1
1.5
2
pretreatment posttreatment
1.57 1.541.45
1.99
LeftMN.Amplitude(mV)
control study
Left Lower Limb

25. Peroneal nerve
0
10
20
30
40
50
60
pretreatment posttreatment
47.03 46.6546.59
51.82
LeftMCV(m.sec)
control study
Left Lower Limb

26. Peroneal nerve
0
1
2
3
4
5
pretreatment posttreatment
4.32 4.36
3.91
3.57
LeftMDL(msec)
control study
Left Lower Limb

27. Pain (NAS)
0
2
4
6
8
10
pretreatment posttreatment
9.20
8.13
9.07
1.87
NAS
Numerical Analogue Scale
control
study

28. Is an Effective treatment for DPN
Safes Time & Money
Prevents development of diabetic foot

29. For more details of
the new approach
visit the book link