APPENDIX D

LETTER SEEKING PERMISSION FROM THE PARTICIPANTS

Dear participants,

I am M.Mahalakshmi M.Sc, Nursing, IInd Year Mother Theresa College of Nursing

conducting a study to evaluate the effectiveness of Buerger Allen exercise in improving

peripheral circulation among diabetes mellides patients. I request your valuable participation

in this study by performing the exercise as guided. The information collected will be kept

strictly confidential and used only for research purposes. Your participation is voluntary and

you may withdraw at any time without affecting your treatment. Kindly give your consent by

signing below and state your willing ness to take part in this study.

Thanking you,

Name :

Signature:
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 APPENDIX G

DESCRIPTION OF INTERVENTION

BUERGER ALLEN EXERCISE:

The Buerger-Allen Exercise is a set of physical therapy exercises designed to

improve circulation, particularly in individuals with peripheral artery disease (PAD), often

caused by conditions like diabetes. This exercise regimen is particularly beneficial for

individuals who suffer from poor blood flow to the extremities, leading to symptoms such as

leg pain, numbness, and coldness in the feet. It aims to promote blood flow to the lower limbs

by using the force of gravity and muscle contractions to enhance circulation. Despite being a

low-cost, non-invasive intervention, the use of Buerger-Allen Exercises in improving

peripheral circulation remains underutilized and under-researched.

The exercise involves a series of positions that encourage the flow of oxygen-rich

blood into the legs and feet. Here's a basic outline of how the Buerger-Allen Exercise works:

1. Leg Elevation:

The individual lies on their back and elevates their legs to a 45-90 degree angle,

using a footboard or pillows for support. This position is maintained until the skin on the

feet and toes becomes pale (usually 1-3 minutes).

2. Dependency:

The individual then sits at the edge of the bed or chair with their legs hanging down,

allowing the feet and legs to dangle freely. This phase can also include ankle and toe
exercises (dorsiflexion, plantarflexion, etc.). The dependent position is held for a few

minutes, until the skin turns pink or reddish.

Dorsiflexion: Slowly pull your toes upward toward your shin, flexing your foot. This is

the dorsiflexion motion. Hold for 2-3 seconds, then relax.

Plantarflexion: Slowly point your toes downward, away from your body. This is the

plantarflexion motion. Hold for 2-3 seconds, then relax.

Inversion: While keeping your feet flat, rotate the soles of your feet inward (toward each

other), so that the toes point slightly inward. Hold for 2-3 seconds, then return to neutral.

Eversion: Now, rotate the soles of your feet outward (away from each other), so that your

toes point slightly outward. Hold for 2-3 seconds, then return to neutral.

3. Horizontal Rest:

Finally, the individual lies flat with their legs resting horizontally on the bed. A warm

blanket can be used to keep the legs warm and comfortable for about 5-10 minutes.

These three phases constitute one cycle of the Buerger-Allen Exercise.

DESCRIPTION OF THE TOOL

ASSESSEMENT OF ABI

Procedure Steps

1. Preparation

• Explain the procedure to the patient and obtain consent.

• Ensure the patient rests in a supine position (lying flat) for at least 5–10 minutes.

• Remove tight clothing, socks, and shoes to allow proper cuff placement.
2. Equipment Needed

• Blood pressure cuff (appropriate size for arm and ankle)

• Handheld Doppler ultrasound with conducting gel

3. Brachial Pressure Measurement

• Wrap the cuff around the upper arm, 2–3 cm above the antecubital fossa.

• Apply gel and place the Doppler probe over the brachial artery pulse.

• Inflate the cuff until the signal disappears, then deflate slowly.

• Note the systolic pressure when the signal reappears.

• Repeat on the other arm and record the higher systolic value.

4. Ankle Pressure Measurement

• Wrap the cuff just above the ankle.

• Locate the posterior tibial artery (behind the medial malleolus) or dorsalis pedis artery

(on top of the foot).

• Apply gel and place the Doppler probe on the artery.

• Inflate the cuff until the signal disappears, then deflate slowly.

• Record the systolic pressure when the signal reappears.

• Repeat on both ankles.

5. Calculation

Highest ankle systolic pressure (either dorsalis pedis or posterior tibial)