Fatores preditivos da marcha em pacientes diabéticos neuropático e não neuropáticos

Saura, Vinicius; Santos, Alexandre Leme Godoy dos; Ortiz, Rafael Trevisan; Parisi, Maria Cândida Ribeiro; Fernandes, Túlio Diniz; Nery, Márcia

doi:10.1590/s1413-78522010000300006

Cited by 14 publications

(6 citation statements)

References 34 publications

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“…While stroke survivors without DPN and healthy controls followed similar paths, vertical forces peak of the paretic side tended to be lower in magnitude than on the nonparetic side. In contrast, the first and second peaks of vertical forces were higher in the DPN when compared with the control and diabetic groups [14, 30]. This overload might be associated with changes of the intrinsic musculature of the foot in DPN that undergo higher compressive and prolonged longitudinal stresses during walking [14, 27].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the first and second peaks of vertical forces were higher in the DPN when compared with the control and diabetic groups [14, 30]. This overload might be associated with changes of the intrinsic musculature of the foot in DPN that undergo higher compressive and prolonged longitudinal stresses during walking [14, 27]. This discrepancy in our findings might be related to the manifestations of adopting slower walking speed in stroke survivors with DPN which then leads to lower vertical forces production.…”

Section: Discussionmentioning

confidence: 99%

“…It is already well known that DPN patients presented with alterations of GRFs during gait performance including reduce anterior-posterior forces production [12], lack of medial-lateral forces production, and lower peak of vertical forces [13]. These GRFs alterations are believed to develop as a result of progressive loss of somatosensory sensitivity, proprioception, and distal muscle function in DPN which cause decline of the GRFs production [13, 14] which might increase the instability of gait performance [14, 15]. …”

Section: Introductionmentioning

confidence: 99%

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The Effect of Diabetic Peripheral Neuropathy on Ground Reaction Forces during Straight Walking in Stroke Survivors

Mustapa

Justine

Mustafah

et al. 2017

Rehabilitation Research and Practice

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Purpose. The aim of this present study was to investigate the ground reaction forces (GRFs) alterations in stroke survivors with diabetic peripheral neuropathy (DPN). Methods. Ten stroke survivors with DPN, 10 stroke survivors without DPN, and 10 healthy controls with matched body weight between groups participated in this case-control cross-sectional study. Three-dimensional GRFs (anterior-posterior, medial-lateral, and vertical) were collected at a comfortable walking speed using the Nexus Vicon motion analysis system and force plate. The Kruskal–Wallis test was used to analyze GRFs parameters. Results. We found significant alterations of medial-lateral forces of the nonparetic side and vertical forces of the paretic side in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. In addition, there were smaller braking and lower propulsion peak in anterior-posterior forces, smaller magnitude of medial-lateral forces, and lower first and second peak of vertical forces in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. Conclusion. The study findings identified that GRFs were affected in stroke survivors with DPN on both the paretic and the nonparetic sides. Further investigations are warranted to explore the impact of DPN on the kinematics and muscle activity related to the gait performance in stroke survivors with DPN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Diabetic Peripheral Neuropathy on Ground Reaction Forces during Straight Walking in Stroke Survivors

Mustapa

Justine

Mustafah

et al. 2017

Rehabilitation Research and Practice

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“…This is easy to apply in a clinical setting and could be important to aid the understanding of the clinical condition of diabetic patients. Accordingly, early studies suggest possible relationships between the degree of incapacity in the diabetic population and the disability in gait variables 10,12 ; however, without considering the presence of diabetic peripheral vascular disease (PVD), creating a gap in the scientific knowledge since the population with this level of impairment presents a challenge due to the limited ability to walk without the need for auxiliary gait devices. In this sense, the present study aimed to analyze the influence of peripheral neurovascular impairment on gait variables, believing that the confirmation or dismissal of this relationship could contribute to awareness of the risks of the chronic complications of diabetes, as well as highlight the importance of early intervention.…”

Section: Introductionmentioning

confidence: 99%

Vasculopathy associated with peripheral neuropathy in gait parameters of diabetic people

Mantovani

Savian

Palma

et al. 2016

Motriz: rev. educ. fis.

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-Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus when glycemic levels are poorly controlled. Sometimes DPN is accompanied by vasculopathy (DPV), which can worsen the clinical prognosis. The aim of this study was to analyze the gait parameters of nondiabetic individuals and diabetic individuals with DPN with or without DPV. Method: The study included 68 individuals (50 to 65 years old) divided into three groups: people without diabetes mellitus (n = 33), diabetic patients with DPN (n = 18), and diabetic patients with both DPN and DVP (n = 17). The participants underwent a gait evaluation using electronic baropodometry to obtain the single and double support, velocity, and pressure-time integral. Results: The pressure-time integral, velocity, and single support variables were lower, and the double support and double support/single support ratio were higher in the diabetic neuropathy and vasculopathy group. The velocity was lower the greater the degree of impairment of the diabetic foot. Some correlations were identified with velocity. Conclusion: In diabetic individuals, there was a significant worsening of the gait parameters analyzed according to increasing degree of clinical impairment.

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“…1,2 The manifestations are more evident in the lower limbs, with tissue and structural damage to the feet, 1 which diminishes the sensory information necessary for proper motor control. 3,4 When there is damage to the peripheral nervous system, a significant loss of muscle strength, 3,5 restricted joint mobility, 6 reduction of tactile sensitivity as well as proprioceptive loss may be evident, which can lead to losses in the strategies necessary for maintaining gait stability. [7][8][9][10] Studies have been investigating the postural instability in neuropathic diabetic individuals, especially in stationary posture 11,12 when there are important losses of peripheral somatosensory information.…”

Section: Introductionmentioning

confidence: 99%

Changes of the gait parameters and sensory-motor deficit associated with peripheral diabetic neuropathy

Martinelli¹,

Mantovani²,

Nozabieli³

et al. 2014

Acta Fisiátrica

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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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Fatores preditivos da marcha em pacientes diabéticos neuropático e não neuropáticos

Cited by 14 publications

References 34 publications

The Effect of Diabetic Peripheral Neuropathy on Ground Reaction Forces during Straight Walking in Stroke Survivors

The Effect of Diabetic Peripheral Neuropathy on Ground Reaction Forces during Straight Walking in Stroke Survivors

Vasculopathy associated with peripheral neuropathy in gait parameters of diabetic people

Changes of the gait parameters and sensory-motor deficit associated with peripheral diabetic neuropathy

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