Assessing Postural Control and Postural Control Strategy in Diabetes Patients Using Innovative and Wearable Technology

Abstract

Introduction: Currently, diagnosis of patients with postural instability relies on a rudimentary clinical examination. This article suggests an innovative, portable, and cost-effective prototype to evaluate balance control objectively. Methods: The proposed system uses low-cost, microelectromechanical sensor, body-worn sensors (BalanSens™) to measure the motion of ankle and hip joints in three dimensions. We also integrated resulting data into a two-link biomechanical model of the human body for estimating the two-dimensional sway of the center of mass (COM) in anterior-posterior (AP) and medial-lateral (ML) directions. A new reciprocal compensatory index (RCI) was defined to quantify postural compensatory strategy (PCS) performance. To validate the accuracy of our algorithms in assessing balance, we investigated the two-dimensional sway of COM and RCI in 21 healthy subjects and 17 patients with diabetic peripheral neuropathic (DPN) complications using the system just explained. Two different conditions were examined: eyes open (EO) and eyes closed (EC) for duration of at least 30 seconds. Results were compared with center of pressure sway (COP) as measured by a pressure platform (Emed-x system, Novel Inc., Germany). To further investigate the contribution of the somatosensory (SOM) feedback to balance control, healthy subjects performed EO and EC trials while standing on both a rigid and a foam surface. Results: A relatively high correlation was observed between COM measured using BalanSens and COP measured using the pressure platform ( r = 0.92). Results demonstrated that DPN patients exhibit significantly greater COM sway than healthy subjects for both EO and EC conditions ( p < 0.005). The difference becomes highly pronounced while eyes are closed (197 ± 44 cm2 vs 68 ± 56 cm2). Furthermore, results showed that PCS assessed using RCI is significantly better in healthy subjects compared to DPN subjects for both EO and EC conditions, as well as in both ML and AP directions ( p < 0.05). Alteration in SOM feedback in healthy subjects resulted in diminished RCI values that were similar to those seen in DPN subjects ( p > 0.05). Discussion/Conclusion: This study suggested an innovative system that enables the investigation of COM as well as postural control compensatory strategy in humans. Results suggest that neuropathy significantly impacts PCS.

Equilíbrio estático em pacientes com diabetes melito tipo 2 com ou sem polineuropatia diabética

“…This finding is similar to what was discovered by other authors, who stated that patients presenting peripheral neuropathy or DPN show balance alterations when contrasted with healthy subjects (15)(16)(17)(18)(21)(22)(23)(24)(25) and with subjects presenting DM without DPN (17,18,21,23,25). This statement is based on the fact that the tactile sensorial system is the main mechanism for balance (26); hence, when influenced by DPN, balance control is affected.…”

“…A number of investigations has been carried out on the influence of DPN in the balance of subjects with DM. Higher CoP displacements have been observed in patients presenting DPN, in contrast with those presenting DM without DPN and healthy individuals (15)(16)(17). Furthermore, Ghanavati and cols.…”

A Novel Shear Reduction Insole Effect on the Thermal Response to Walking Stress, Balance, and Gait

“…15 Strengths of our study include good measurement properties for the instrumentation used. [8][9][10][11][12]17,19,21,22 We also allowed for a thermal wash-out period 15 between testing and randomized the insole testing sequence. We assessed for gait and balance changes under single and dual task conditions.…”

“…There was a 5-minute acclimatization period without weight-bearing, shoes, or socks prior to baseline thermal imaging and standardized walking stress test. 15 In random sequence, each insole condition was tested for gait during habitual speed, 16 balance in tandem stance with eyes open and closed, 17 and a thermal image was taken after 200 steps of walking stress. To explore whether reducing shear force may impact risk of falling, gait was also examined during dual task (walking while counting backward), which is a more sensitive paradigm than single task (walking alone) to evaluate risk of falling.…”

“…Balance measures were center of mass sway (COM) in anteriorposterior (COM AP ), mediolateral (COM ML ), and area (COM APxML ). 17 Thermal imaging was conducted with a Fluke® Ti25 thermal imager (Fluke Corporation, Everett, WA, USA). A purpose-designed image processing toolbox 15 was used to isolate each foot from the thermal image and to extract plantar temperature in 3 anatomical regions (eg, hind-, mid-, and forefoot).…”