Buerger's Exercises and Proprioceptive Drills on Postural Stability and Foot Perfusion in Elderly Patients With Chemotherapy

Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting side effect of neurotoxic chemotherapy agents, characterized by sensory loss, impaired proprioception, and muscle weakness, predominantly affecting the lower limbs. These impairments significantly contribute to postural instability and increase fall risk in elderly patients. Additionally, CIPN-associated microvascular changes can compromise peripheral circulation, further exacerbating neuromotor dysfunction and balance deficits. While pharmacological options for CIPN are limited and often inadequate, exercise-based interventions have shown promise in mitigating functional impairments. Buerger's exercises, a vascular stimulation technique, are known to enhance peripheral blood flow, whereas proprioceptive drills can improve neuromuscular coordination and postural control. However, their combined effect on both postural stability and foot perfusion in elderly patients with CIPN has not been systematically studied.

Inclusion Criteria: * Aged 65 years or older * Diagnosed with CIPN for at least 3 months * Demonstrating impaired postural stability (BBS ≤ 48 or ≥2 falls in the past year) * Medically cleared for exercise * Cognitively intact (MMSE ≥ 24) * Willing and able to give consent Exclusion Criteria: * Severe peripheral arterial disease (ABI \< 0.5) * Severe postural hypotension or positional syncope * Recent orthopedic procedures or fractures (past 6 months) * Vestibular or cerebellar disorders * Uncontrolled systemic diseases * Cognitive impairment (MMSE \< 24) * Concurrent participation in another structured balance or vascular program * Lower limb ulcers or active infection * Severe visual impairment * Intolerance to positional exercises