Problems with Gait and Posture in Neuropathic Patients with Insulin‐Dependent Diabetes Mellitus

Cavanagh, Peter R.; Derr, Janice; Ulbrecht, Jan S.; Maser, Raelene E.; Orchard, Trevor J.

doi:10.1111/j.1464-5491.1992.tb01819.x

Cited by 276 publications

(185 citation statements)

References 15 publications

Supporting

Mentioning

172

Contrasting

Unclassified

Order By: Relevance

“…Subjects with diabetic peripheral neuropathy are 23 times more likely to fall (7) and are 15 times more likely to report an injury compared to matched non-neuropathic subjects (1).…”

Section: Introductionmentioning

confidence: 99%

“…Lower limb diabetic sensory neuropathy has an adverse effect on postural stability and walking (1) and ultimately increases the risk of falling in people with diabetes. Subjects with diabetic peripheral neuropathy are 23 times more likely to fall (7) and are 15 times more likely to report an injury compared to matched non-neuropathic subjects (1).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy

et al. 2009

View full text Add to dashboard Cite

with diabetes and no neuropathy (70 ± 2.9years). The temporal and spatial parameters of gait were evaluated using the GAITRite walkway. Subjects undertook four walks under normal walking conditions (single task); four times while simultaneously undertaking an additional motor task, carrying a tray with cups of water (dual task); and four times whilst undertaking a cognitive dual task, counting backwards in sevens. This arithmetic task was also completed in sitting.Results: For all gait variables there was a statistically significant difference between the groups. Subjects with DPN walked slower and with smaller steps compared to those with diabetes. In general the secondary task had a significant and adverse effect on the gait parameters and this effect was greater for those with DPN in both absolute and relative terms. Both groups had poorer arithmetic ability when walking compared to sitting. Discussion:Patients with DPN have different gait parameters to diabetic patients without neuropathy. Problems with divided attention when walking were more evident in the DPN group and may increase their risk of falls.

show abstract

“…Subjects with diabetic peripheral neuropathy are 23 times more likely to fall (7) and are 15 times more likely to report an injury compared to matched non-neuropathic subjects (1).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy

et al. 2009

View full text Add to dashboard Cite

show abstract

“…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.…”

mentioning

confidence: 99%

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

et al. 2008

View full text Add to dashboard Cite

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...

show abstract

“…Future studies should include patients with conditions that can affect their gait such as diabetes [39], Parkinson's [40] or patients with Multiple Sclerosis (MS) disease [41]. Several studies have also confirmed a relationship between gait variability and age progression [42][43][44].…”

Section: Future Workmentioning

confidence: 99%

Instrumented Wireless SmartInsole System for Mobile Gait Analysis: A Validation Pilot Study with Tekscan Strideway

Arafsha¹,

Hanna²,

Aboualmagd³

et al. 2018

JSAN

View full text Add to dashboard Cite

A SmartInsoles Cyber-Physical System (CPS) is designed and implemented for the purpose of measuring gait parameters of multiple users in a restriction-free environment. This CPS comprises a master software installed on a computer and numerous multi-sensory health devices in the form of smart insoles. Each of these insoles contains 12 Force-Sensitive Resistor (FSR) sensors, an Inertial Measurement Unit (IMU), a WiFi-enabled microcontroller and a battery to power all components. A validation pilot study was completed in collaboration with the Interdisciplinary School of Health Sciences at the University of Ottawa by performing 150 trials on 15 healthy subjects. Each subject performed 10 walks on the Tekscan Strideway gait mat system, while simultaneously wearing the designed SmartInsoles CPS. Spatiotemporal data for over 450 unique steps were collected by both systems. These data were analyzed carefully, and a thorough comparison was performed between the results from the two systems. Seven parameters were analyzed in this study: stride time, stance time, swing time, double support time, step time, cadence and gait time. Detailed results in the form of tables, scatterplots, histograms and Bland-Altman graphs were generated. Analysis of the results shows high agreement between the values of the two systems and suggests high accuracy of the implemented CPS as a multi-device, multi-sensory system for gait measurement and analysis.

show abstract

Problems with Gait and Posture in Neuropathic Patients with Insulin‐Dependent Diabetes Mellitus

Cited by 276 publications

References 15 publications

The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy

The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy

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

Instrumented Wireless SmartInsole System for Mobile Gait Analysis: A Validation Pilot Study with Tekscan Strideway

Contact Info

Product

Resources

About