Random vs. blocked perturbation training on reactive balance control in peripheral neuropathy: A protocol study for a randomized controlled trial

Diabetic peripheral neuropathy (DPN) is the leading cause of disturbances in reactive balance control. The repeated, external mechanical perturbations in perturbation-based balance training(PBBT) evoke balance recovery strategies; which subsequently improve reactive balance performance. Using the practice schedule concept of motor learning in the design of PBBT is a relatively new approach related to balance exercises. This study aims to investigate the effects of blocked and random PBBT on reactive balance control and its persistency and transfer to conditions different from those experienced during training. Individuals with DPN will be recruited and randomly allocated to one of the three groups: random, blocked, and control group. Random and blocked PBBT groups will receive single-session balance training, including unexpected perturbations of platform during quiet standing in two directions (anterior and posterior), and three difficulty levels of platform motion (displacement, velocity, and acceleration). Each balance perturbation in blocked group will be repeated over blocks of four trials. For the random group, perturbation sequence will be unpredictable for these four trials in each block. Primary outcomes (i.e., center of pressure variables, reaction time, movement time, and total response time variables) will be assessed at baseline as well as immediately and one day after intervention.