Body Sway in Diabetic Neuropathy

Uccioli, Luigi; Pg, Giacomini; Monticone, Giovanna; Magrini, A; Durola, Laura; Bruno, Ernesto; Parisi, Luca; Girolamo, Stefano Di; Menzinger, G.

doi:10.2337/diacare.18.3.339

Cited by 129 publications

(103 citation statements)

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“…This increased risk is presumably due to the well-documented balance problems attributed to neuropathy [1] and sensory ataxia, which is the lack of accurate proprioceptive feedback [2]. Sources of instability in patients with type 2 DN include the loss or reduction of peripheral sensory information in the feet [3][4], the inability of the central nervous system (CNS) to appropriately integrate available postural control information [2,[4][5], and a switch from an ankle-based to a hip-based balance strategy [6][7][8][9][10]. In addition, an increase in the use of vestibular information and dependence on visual information [11] alter the style of postural control in patients with DN.…”

Section: Introductionmentioning

confidence: 99%

“…The effects of these natural fluctuations were examined for evaluating different measures of postural sway [13]. Reported studies on patients with diabetes with neuropathic postural sway suggest relative deficits in their ability to maintain posture and indicate greater instability than that observed in patients without diabetes [7] and positive relation between postural sway and falling [14]. Also, studies of postural instability in patients with DN have indicated higher scores for postural stability indexes [15], speed, and area of sway [2,16]; higher center of pressure (COP) ranges [2]; higher root-mean-square values of the COP-center of mass (COM) variable [17] (time domain); and greater increase of sway power within medium-high frequencies (0.5-1.0 Hz) [18] in postural sway variables that indicate lower stability control.…”

Section: Introductionmentioning

confidence: 99%

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Dynamic stability training improves standing balance control in neuropathic patients with type 2 diabetes

Salsabili

Bahrpeyma²,

Forogh³

et al. 2011

JRRD

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Abstract-Patients with type 2 diabetic neuropathy (DN) are at an increased risk of falls due to the decreased accurate proprioceptive feedbacks. Effective balance training should treat context-specific instabilities of postural control of patients with DN. For this purpose, evaluations and balance training were designed with a 3-week baseline with evaluation after 3 weeks, followed by training over 3 weeks with reevaluation. We acquired control scores for standing balance from the Biodex stability system and fluctuations of the center of pressure. We performed repeated measure analysis of variance to test mean differences in three sessions of assessments. In addition, we compared mean differences of each pair of sessions with the least significant difference test. We used the paired t-test to compare the pure effects of trainings. Our investigation showed that the results of Biodex stability scores and force platform medial-lateral sway measurements improved statistically. Significant higher open-eyes median and mean frequency values of postural sway in the medial-lateral direction indicated that balance training allowed patients to develop control over the degree of freedom at the hip joint. In conclusion, training that compensates for disordered balance indicated by subclinical constraints with respect to the guidance effect of external visual feedback improves standing postural control in patients with type 2 DN.Clinical Trial Registration: Clinical Trial Registration: UMIN-CTR Search Clinical Trials, UMIN000004485, "Dynamic stability training can promote quiet standing control in neuropathic patients with type 2 diabetes"; http:// www.umin.ac.jp/ctr/index.htm.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dynamic stability training improves standing balance control in neuropathic patients with type 2 diabetes

Salsabili

Bahrpeyma²,

Forogh³

et al. 2011

JRRD

View full text Add to dashboard Cite

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“…Diabetic neuropathy plays a significant role in falling among elderly patients [4]; people with peripheral neuropathy caused by diabetes often experience balance disorder [5]. Postural sway in these patients is increased, especially with the eyes closed [6].…”

Section: Introductionmentioning

confidence: 99%

Do diabetic neuropathy patients benefit from balance training?

Akbari¹,

Jafari²,

Moshashaee³

et al. 2012

JRRD

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Abstract-Peripheral neuropathy is a common complaint of diabetes. Peripheral neural damage in turn will cause balance impairments in diabetic patients. The purpose of this study was to investigate the effects of balance exercises on sway indices in diabetic patients with neuropathy. In this clinical trial study, 10 diabetic patients with peripheral neuropathy were recruited through simple nonprobability sampling along with 10 nondisabled aged-matched subjects. Participants in both groups were examined for balance abilities with the Biodex Balance System before intervention. The experimental group was tested again after intervention. Intervention consisted of progressive Biodex stability and rocker and wobble-board training for 10 sessions. All tests were done in eyes open and closed conditions with bilateral standing. After intervention, the experimental group was re-examined in the same way. Student and paired t-tests were used for data analysis. The overall stability index and anterior-posterior stability index were significantly decreased after treatment in the experimental group during different conditions. Balance indices in the experimental group were significantly higher than the control group before treatment. There was no significant difference in indices between the two groups after treatment. The results show that balance training can improve stability indices in diabetic patients with neuropathy.

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“…Numerous human studies report that patients with DPN are at increased risk for falls due to decreased postural control, altered gait and balance, and increased body sway (7)(8)(9). The underlying neurologic mechanisms involved in large-fiber DPN remain poorly understood.…”

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confidence: 99%

Abnormal Muscle Spindle Innervation and Large-Fiber Neuropathy in Diabetic Mice

et al. 2008

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OBJECTIVE-Large-fiber diabetic polyneuropathy (DPN) leads to balance and gait abnormalities, placing patients at risk for falls. Large sensory axons innervating muscle spindles provide feedback for balance and gait and, when damaged, can cause altered sensorimotor function. This study aimed to determine whether symptoms of large-fiber DPN in type 1 and type 2 diabetic mouse models are related to alterations in muscle spindle innervation. In addition, diabetic mice were treated with insulin to assess whether sensorimotor and spindle deficits were reversible.RESEARCH DESIGN AND METHODS-Behavioral assessments were performed in untreated and treated streptozotocin (STZ)-injected C57BL/6 mice to quantitate diabetes-induced deficits in balance and gait. Quantification of Ia axon innervation of spindles was carried out using immunohistochemistry and confocal microscopy on STZ-injected C57BL/6 and db/db mice.RESULTS-STZ-injected C57BL/6 mice displayed significant and progressive sensorimotor dysfunction. Analysis of Ia innervation patterns of diabetic C57BL/6 spindles revealed a range of abnormalities suggestive of Ia axon degeneration and/or regeneration. The multiple abnormal Ia fiber morphologies resulted in substantial variability in axonal width and inter-rotational distance (IRD). Likewise, db/db mice displayed significant variability in their IRDs compared with db ϩ mice, suggesting that damage to Ia axons occurs in both type 1 and type 2 diabetes models. Insulin treatment improved behavioral deficits and restored Ia fiber innervation in comparison with nondiabetic mice.CONCLUSIONS-Similar to small fibers, Ia axons are vulnerable to diabetes, and their damage may contribute to balance and gait deficits. In addition, these studies provide a novel method to assay therapeutic interventions designed for diabetes-induced large-fiber dysfunction. Diabetes 57:1693-1701, 2008 E stimates from the Centers for Disease Control and Prevention suggest that 60 -70% of diabetic patients develop neuropathy. In addition, diabetes is the leading cause of neuropathy in the U.S. and Western countries (1). Sensorimotor diabetic polyneuropathy (DPN) affects both large and small sensory afferent nerve fibers. The majority of research focuses on small-fiber neuropathy leading to increased or decreased pain and temperature sensations (2-5). Consequently, there is a shortage of animal model research exploring large-fiber DPN, which can cause deficits in lower-limb proprioception, decreased tactile sensitivity and vibration sense, and incoordination due to balance abnormalities (1,6).The sensorimotor deficits resulting from large-fiber DPN, while sometimes subtle in nature, can lead to significant impairment. Numerous human studies report that patients with DPN are at increased risk for falls due to decreased postural control, altered gait and balance, and increased body sway (7-9). The underlying neurologic mechanisms involved in large-fiber DPN remain poorly understood. It has been hypothesized that large-fiber DPN instability could be ca...

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Body Sway in Diabetic Neuropathy

Abstract: Diabetic patients with peripheral neuropathy demonstrate a relative deficit in their ability to maintain posture. Posturography allows an early disclosure of the failure of postural control.

Cited by 129 publications

References 0 publications

Dynamic stability training improves standing balance control in neuropathic patients with type 2 diabetes

Dynamic stability training improves standing balance control in neuropathic patients with type 2 diabetes

Do diabetic neuropathy patients benefit from balance training?

Abnormal Muscle Spindle Innervation and Large-Fiber Neuropathy in Diabetic Mice

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