Intralimb Coordination Patterns in Absent, Mild, and Severe Stages of Diabetic Neuropathy: Looking Beyond Kinematic Analysis of Gait Cycle

Abstract

AimDiabetes Mellitus progressively leads to impairments in stability and joint motion and might affect coordination patterns, mainly due to neuropathy. This study aims to describe changes in intralimb joint coordination in healthy individuals and patients with absent, mild and, severe stages of neuropathy.MethodsForty-seven diabetic patients were classified into three groups of neuropathic severity by a fuzzy model: 18 without neuropathy (DIAB), 7 with mild neuropathy (MILD), and 22 with moderate to severe neuropathy (SVRE). Thirteen healthy subjects were included as controls (CTRL). Continuous relative phase (CRP) was calculated at each instant of the gait cycle for each pair of lower limb joints. Analysis of Variance compared each frame of the CRP time series and its standard deviation among groups (α = 5%).ResultsFor the ankle-hip CRP, the SVRE group presented increased variability at the propulsion phase and a distinct pattern at the propulsion and initial swing phases compared to the DIAB and CTRL groups. For the ankle-knee CRP, the 3 diabetic groups presented more anti-phase ratios than the CTRL group at the midstance, propulsion, and terminal swing phases, with decreased variability at the early stance phase. For the knee-hip CRP, the MILD group showed more in-phase ratio at the early stance and terminal swing phases and lower variability compared to all other groups. All diabetic groups were more in-phase at early the midstance phase (with lower variability) than the control group.ConclusionThe low variability and coordination differences of the MILD group showed that gait coordination might be altered not only when frank evidence of neuropathy is present, but also when neuropathy is still incipient. The ankle-knee CRP at the initial swing phase showed distinct patterns for groups from all degrees of neuropathic severity and CTRLs. The ankle-hip CRP pattern distinguished the SVRE patients from other diabetic groups, particularly in the transitional phase from stance to swing.

Later stages of diabetic neuropathy affect the complexity of the neuromuscular system at the knee during low‐level isometric contractions

“…The VL muscle has an important function during locomotor activities because it eccentrically controls the knee flexion during the loading phase . Alterations in intralimb joint coordination during gait have been described in DPN participants, and a less variable pattern is observed in DPN participants in comparison with healthy participants . This lower variability is observed in the ankle–knee and knee–hip continuous relative phase during the early stance phase, when the knee contributes eccentrically to the load attenuation, and in the knee–hip relative phase during the terminal swing phase, when the knee assumes the important task of propelling the limb.…”

Peer Review #2 of "Effects of knee sleeves on coordination of lower-limb segments in healthy adults during level walking and one-leg hopping (v0.1)"

“…The continuous relative phase (CRP) is one of the most common parameters used to evaluate multi-joint/segment coordination. Many studies assessed the CRP to evaluate pathological and/or abnormal gait (Barela et al 2000;Chiu et al 2015;Chiu et al 2010;Hamill et al 2012;Yi et al 2016). The CRP is calculated by monitoring the segment movement and its response velocity and thus it considers temporal and spatial patterns, which are important elements of motor coordination.…”

Padrões dinâmicos de recrutamento muscular por EMG de alta densidade de diabéticos em diferentes níveis de severidade de neuropatia classificados por um modelo linguistico fuzzy

“…Moreover, alterations in the intra-limb joint coordination during gait have been described in DPN subjects, and a less variable movement pattern was observed in these subjects in comparison to healthy subjects (Yi et al, 2016). This lower variability is observed at the ankle-knee and knee-hip continuous relative phase at early stance phase, when the knee contributes eccentrically to the load attenuation, and in the knee-hip relative phase at terminal swing phase, when the knee assumes the important task of propelling the limb.…”