Article
Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy1,

https://doi.org/10.1016/j.apmr.2003.06.015Get rights and content

Abstract

Menz HB, Lord SR, St George R, Fitzpatrick RC. Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Arch Phys Med Rehabil 2004;85:245–52.

Objective

To evaluate, in older people with diabetic peripheral neuropathy (DPN) and in age-matched controls, acceleration patterns of the head and pelvis when walking to determine the effect of lower-limb sensory loss on walking stability.

Design

Case-control study.

Setting

Falls and balance laboratory in Australia.

Participants

Thirty persons with diabetes mellitus (age range, 55–91y) and 30 age-matched controls.

Interventions

Acceleration patterns of the head and pelvis were measured while participants walked on a level surface and an irregular walkway. Participants also underwent tests of vision, sensation, strength, reaction time, and balance.

Main outcome measures

Temporospatial gait parameters and variables derived from acceleration signals.

Results

Participants with DPN had reduced walking speed, cadence, and step length, and less rhythmic acceleration patterns at the head and pelvis compared with controls. These differences were particularly evident when participants walked on the irregular surface. Participants with DPN also had impaired peripheral sensation, reaction time, and balance.

Conclusions

Older people with DPN have an impaired ability to stabilize their body when walking on irregular surfaces, even if they adopt a more conservative gait pattern. These results provide further insights into the role of peripheral sensory input in the control of gait stability, and suggest possible mechanisms underlying the increased risk of falling in older people with diabetic neuropathy.

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.

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