This study aimed to perform a clinical evaluation of low cost and easily applied to detect the presence of peripheral diabetic neuropathy (DPN) in individuals with DM and to correlate the score of the esthesiometry’s test and MNSI. We evaluated 44 participants with a diagnosis of DM.The NDP was diagnosed by the Michigan Neuropathy Screening Instrument (MNSI) and by esthesiometry with Semmes-Weinstein monofilaments. Eighteen (40.9%) subjects were diagnosed with neuropathy by MNSI and 30 (68.2%) by esthesiometry, the two tests showed a significant correlation, then, is possible to conclude that these two tests are effective when used together for such a diagnosis
RESUMOObjetivo deste estudo foi analisar o equilíbrio postural de indivíduos neuropatas diabéticos, por meio de baropodometria, relacionando com prejuízos no sistema sensoriomotor. Vinte e oito pessoas saudáveis e 25 com diagnóstico de neuropatia diabética foram submetidas à avaliação estática (mensuração do deslocamento do centro de pressão corporal) e dinâmica (análise temporal da fase de apoio do ciclo da marcha). A sensibilidade tátil dos pés foi avaliada por meio de monofilamentos Semmes Weinstein e a força muscular isométrica do tornozelo por dinamometria. As análises de multivariânvia (MANOVAs) e de variância (ANOVAs) indicaram desempenho inferior na sensibilidade tátil, na força muscular e no equilíbrio dinâmico, porém não apontou diferença para o equilíbrio estático de neuropatas diabéticos. Com esse estudo por meio da análise de regressão, pode-se inferir que as diferenças do equilíbrio na marcha dos neuropatas podem ser resultantes da insensibilidade tátil e da força muscular. Palavras-chave: diabetes mellitus, neuropatia diabética, equilíbrio postural, força muscular ABSTRACT Objective of this study was to analyze the postural balance of neuropathic diabetic individuals through baropodometry, related to losses in the sensorimotor system. Twenty-eight healthy and 25 diagnosed with diabetic neuropathy were subjected to static evaluation (measurement of displacement of body center of pressure) and dynamic (temporal analysis of the stance phase of gait cycle). The tactile sensitivity of the feet was assessed by Semmes Weinstein monofilaments and isometric muscle strength of ankle dynamometry. Analyses of multivariânvia (MANOVAs) and variance (ANOVAs) indicated lower performance in tactile sensitivity, muscle strength and dynamic balance, but showed no difference for static equilibrium of diabetic neuropathy. With this study by regression analysis, one can infer that the equilibrium differences in gait of neuropathic insensitivity may result from tactile and muscle strength.
Peripheral nervous system impairment, with sensory and motor loss, as observed in diabetic neuropathy, can induce serious effects on balance control and gait in this population. Objective: To evaluate the performance of the gait and the sensory-motor changes, stemming from peripheral diabetic neuropathy (PDN). Method: Twenty-four individuals with PDN participated along with twenty-eight healthy individuals with no glycemic alterations indicative of diabetes. Participants were first subjected to clinical evaluations to confirm the clinical diagnosis of diabetic neuropathy by testing the tactile sensitivity of the soles of the feet with a monofilament test. Subsequently, ankle angle variations in static posture and during the gait were investigated through kinematics. The ankle muscle strength was investigated using a digital dynamometer. Results: The diabetic neuropathy group showed longer duration in double support and full support periods of gait than the control group, confirming greater difficulty in dynamic balance for these individuals. The group with neuropathy demonstrated reduced muscle strength, as much in the dorsiflexors as in the plantar flexors of the ankle. Conclusion: The sensory-motor losses stemming from PDN may cause impairment in gait performance, with consequent loss of balance.Keywords: Gait, Muscle Strength, Postural Balance, Diabetic Neuropathies RESUMOQuando há dano no sistema nervoso periférico, com prejuízos sensoriais e motores, como observado em neuropatas diabéticos, podem ocorrer graves repercussões sobre o equilíbrio e a locomoção nesta população. Objetivo: Avaliar o desempenho da marcha e alterações sensório-motoras, decorrentes da neuropatia diabética periférica. Método: Participaram 24 indivíduos neuropatas diabéticos e 28 indivíduos saudáveis sem alterações glicêmicas indicativas de diabete. Os participantes foram submetidos inicialmente a avaliações clínicas para confirmação de diagnóstico de neuropatia diabética por meio de teste de sensibilidade tátil da sola dos pés com monofilamentos. Posteriormente, foram submetidos à avaliação da variação angular do tornozelo, em condição estática e durante a marcha, por meio de cinemetria. A força muscular do tornozelo foi investigada por meio de dinamometria digital. Resultados: Foi demonstrado maior duração nos períodos de duplo apoio e apoio total da marcha em indivíduos com neuropatia diabética quando comparados com o grupo controle, confirmando uma maior dificuldade no equilíbrio dinâmico destes indivíduos. Para o grupo experimental de indivíduos neuropatas foi evidenciado redução da força muscular, tanto para os músculos dorsiflexores, quanto para os plantiflexores de tornozelo. Conclusão: As perdas sensório-motoras decorrentes da NDP podem implicar em prejuízo no desempenho da marcha, com consequente perda de equilíbrio.
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