ArticleWalking stability and sensorimotor function in older people with diabetic peripheral neuropathy1☆,
Section snippets
Participants with DPN
Thirty community-dwelling people with type 2 diabetes mellitus and DPN were recruited by telephone from a database of eligible patients who attended a diabetes complications clinic at the Prince of Wales Hospital, in Sydney, Australia. Subjects were ineligible if they had Parkinson’s disease, lower-limb amputation (including partial foot amputation), a history of major foot surgery, Charcot’s neuroarthropathy, or were unable to walk unaided. Transportation was provided to maximize participation
Participant Characteristics
The control and DPN groups had equivalent ages (73.9±9.0y vs 73.5±8.3y, t58=.16, P=.87) and heights (168.7±9.2cm vs 170.5±8.8cm, t58=−.78, P=.44). However, the controls weighed less (73.1±13.3kg vs 81.6±16.2kg, t58=−2.2, P=.03) and had a lower body mass index (BMI; 25.6±3.4kg/m2 vs 28.2±6.0kg/m2, t58=−2.0, P=.04). Twelve control subjects and 16 subjects with DPN were classified as overweight (BMI, 25–30kg/m2) and 2 control subjects and 8 subjects with DPN were obese (BMI, >30kg/m2).28 The
Discussion
The tests administered in this study can identify deficits in each of the major physiologic systems that contribute to postural stability.24, 27 Participants with DPN performed similarly to the control group in tests of vision and lower-limb strength. However, they did not perform as well in tests of vibration sense, tactile sensitivity, and proprioception, consistent with previous testing of subjects with diabetes4 and the extensive published data on peripheral neuropathy in long-standing
Conclusions
This study has shown that when walking on an irregular surface, people with DPN exhibit clear differences in stability-related acceleration patterns of the head and pelvis compared with controls, despite adopting a more conservative gait pattern. Specifically, people with DPN walk with less smooth accelerations at the pelvis in the AP plane and less smooth accelerations at the head in the vertical plane, and appear less able to attenuate accelerations at the head. These results provide further
Acknowledgements
We thank Jayne McGreal of the Diabetes Centre, Prince of Wales Hospital, for her assistance with participant recruitment.
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Supported by the National Health and Medical Research Council (grant no. 209799).
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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.