P-031 - The importance of gait preservation in the elderly with diabetes

Abstract Title: The importance of gait preservation in the elderly with diabetes

Background: A 86-year-old male with a past medical history of diabetes mellitus, chronic kidney disease, atrial fibrillation, and benign prostatic hyperplasia presents with a lumbar L1 fracture treated non-surgically after a ground level fall. Patient’s prior level of function was independent with all ADLs and modified independently with a FWW. After the fracture, the patient required moderate assistance with all ADLs and ambulation.

Purpose/Objectives: Diabetic neuropathy affects about half of diabetic patients with complications that limit their limb use due to pain and sensory loss. Usually, affecting and impairing gait function. Physical therapy, through multiple methods, has been found to be beneficial in increasing range of motion in patients with diabetic neuropathy. Therapies focused on strength, balance, flexibility, and stretch have been found to improve gait function. In this report we showcase the added utility of physical therapy to improve gait function in a diabetic patient to improve overall long term health beyond the primary diagnosis.

Methods: A chart review of a patient’s past medical history and assessment and plan.

Results: At initial physical therapy evaluation, patients noted to have uneven step length, decreased stride length, excessive trunk flexion, and muscle instability. Initial physical exam also noted for tight hip flexors bilaterally and decreased sensation to pinprick in the L5/S1 dermatomes.

Conclusions/Implications for future research and/or clinical care: Physical therapy has been found to be beneficial in the management and improvement of gait in patients with diabetic neuropathy. It has been found that training focused on sensorimotor and gait improved the patient’s proprioception and nerve function. Patients with diabetic neuropathy were found to have improved gait function when training focused on strength, range of motion, balance, stretch, flexibility, and circuit exercise This approach will not only improve functional status presently but also reduce potential fall in the future and future fractures. This highlights the need for a comprehensive rehabilitation strategy that targets the whole body, one of the tenants of the osteopathic profession .

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