Abnormal muscle activation during gait in diabetes patients with and without neuropathy

Sawacha, Z.; Spolaor, Fabiola; Guarneri, G.; Contessa, Paola; Carraro, Elena; Venturin, Andrea; Avogaro, Angelo; Cobelli, Claudio

doi:10.1016/j.gaitpost.2011.08.016

Cited by 105 publications

(96 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9 Complications of diabetes, especially in patients with poorly controlled blood sugar levels, include damage to the eyes, kidneys, nerves and arteries. In the feet, diabetes-related peripheral neuropathy leads to changes to foot architecture (hence increasing pressure on plantar surfaces, including those unaccustomed to load-bearing), 10,11 reduced sweating (hence dry, cracking skin), poor sensation (hence susceptibility to trauma) and accelerated atherosclerotic disease, which leads to reduced circulation, with consequent problems with healing wounds and fighting infection. These peripheral neuropathic and vascular changes, either alone or in combination, predispose the foot to ulceration and its sequalae.…”

Section: Diabetes: Prevalence and Complicationsmentioning

confidence: 99%

Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

Nelson

Wright-Hughes

Brown

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundThere is inadequate evidence to advise clinicians on the relative merits of swabbing versus tissue sampling of infected diabetic foot ulcers (DFUs).ObjectivesTo determine (1) concordance between culture results from wound swabs and tissue samples from the same ulcer; (2) whether or not differences in bacterial profiles from swabs and tissue samples are clinically relevant; (3) concordance between results from conventional culture versus polymerase chain reaction (PCR); and (4) prognosis for patients with an infected DFU at 12 months’ follow-up.MethodsThis was a cross-sectional, multicentre study involving patients with diabetes and a foot ulcer that was deemed to be infected by their clinician. Microbiology specimens for culture were taken contemporaneously by swab and by tissue sampling from the same wound. In a substudy, specimens were also processed by PCR. A virtual ‘blinded’ clinical review compared the appropriateness of patients’ initial antibiotic regimens based on the results of swab and tissue specimens. Patients’ case notes were reviewed at 12 months to assess prognosis.ResultsThe main study recruited 400 patients, with 247 patients in the clinical review. There were 12 patients in the PCR study and 299 patients in the prognosis study. Patients’ median age was 63 years (range 26–99 years), their diabetes duration was 15 years (range 2 weeks–57 years), and their index ulcer duration was 1.8 months (range 3 days–12 years). Half of the ulcers were neuropathic and the remainder were ischaemic/neuroischaemic. Tissue results reported more than one pathogen in significantly more specimens than swabs {86.1% vs. 70.1% of patients, 15.9% difference [95% confidence interval (CI) 11.8% to 20.1%], McNemar’sp-value < 0.0001}. The two sampling techniques reported a difference in the identity of pathogens for 58% of patients. The number of pathogens differed in 50.4% of patients. In the clinical review study, clinicians agreed on the need for a change in therapy for 73.3% of patients (considering swab and tissue results separately), but significantly more tissue than swab samples required a change in therapy. Compared with traditional culture, the PCR technique reported additional pathogens for both swab and tissue samples in six (50%) patients and reported the same pathogens in four (33.3%) patients and different pathogens in two (16.7%) patients. The estimated healing rate was 44.5% (95% CI 38.9% to 50.1%). At 12 months post sampling, 45 (15.1%) patients had died, 52 (17.4%) patients had a lower-extremity ipsilateral amputation and 18 (6.0%) patients had revascularisation surgery.LimitationsWe did not investigate the potential impact of microbiological information on care. We cannot determine if the improved information yield from tissue sampling is attributable to sample collection, sample handling, processing or reporting.ConclusionsTissue sampling reported both more pathogens and more organisms overall than swabbing. Both techniques missed some organisms, with tissue sampling missing fewer than swabbing. Results from tissue sampling more frequently led to a (virtual) recommended change in therapy. Long-term prognosis for patients with an infected foot ulcer was poor.Future workResearch is needed to determine the effect of sampling/processing techniques on clinical outcomes and antibiotic stewardship.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Diabetes: Prevalence and Complicationsmentioning

confidence: 99%

Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

Nelson

Wright-Hughes

Brown

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…A few researchers [11,12] reported variations from the norm in the sEMG example of vastus lateralis and tibialis foremost, soleus, average and sidelong gastrocnemius and, average hamstrings of DPN subjects. Wells (1981) [13] found that the ground response strategy is a decent indicator of net joint moments for moderate step, however expanding the speed of stride results in expanded errors, particularly at the hip. Hence for healthy populaces, the connected portion system is desirable over compute joint moments; the connected section strategy looks into the mass-quickening results of the foot, leg and thigh that the ground response technique dismisses.…”

Section: Literature Surveymentioning

confidence: 99%

A Machine Learning Technique to Analyze Surface EMG Signals in Normal and Diabetic Subjects

Holi²,

Chandrashekar

2016

JBEMi

View full text Add to dashboard Cite

The diabetes mellitus results in many musculoskeletal complications and detection of these problems is important in treatment, prevention of disability and improving the quality of life. Many attempts have been made to effectively acquire and analyze the surface electromyogram (sEMG) signals to understand the musculoskeletal problems in diabetes. The development of methodologies to extract the effective features from sEMG still remains a primary challenge. Previous studies have demonstrated that the sEMG signals have nonlinear characteristics. In this study, by combining the nonlinear time-series analysis and the time-frequency domain methods, we propose the wavelet based method to extract the effective features of sEMG signals. The sEMG signals were first acquired and analyzed by the wavelet transform and the features were obtained. Then, these features were used as the input vectors to artificial neural network (ANN) classifier to discriminate diabetic or non-diabetic subject. The results show that significance of proposed feature extraction method with classification of diabetic and nondiabetic subjects with an accuracy of 97.06%.This indicates that the proposed approach can provide important insight into the nonlinear characteristics and the time-frequency domain features of sEMG signals and is suitable for classifying the normal subjects from diabetic subjects. By comparing with other existing methods, the proposed method exhibited more robustness and higher classification accuracy.

show abstract

“…This, added to deficits in the motor control system, intensifies the imbalances and alterations in posture and gait 3 . Investigations in this population indicate a reduction in gait velocity and step length increasing the duration of the support phase, a decrease in the mobility of the ankle joint, a redistribution of joint moments, and changes in kinematic lower limb and muscle activation, compared with the normal range of subjects without diabetes [7][8][9][10] . According to the International Working Group on Diabetic Foot (IWGDF), based on the aggravation of lower limb complications and thus, the severity of peripheral neurovascular afflictions, the feet of diabetic patients can be classified into categories 11 .…”

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.

View full text Add to dashboard Cite

-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.

show abstract

Abnormal muscle activation during gait in diabetes patients with and without neuropathy

Cited by 105 publications

References 21 publications

Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

A Machine Learning Technique to Analyze Surface EMG Signals in Normal and Diabetic Subjects

Vasculopathy associated with peripheral neuropathy in gait parameters of diabetic people

Contact Info

Product

Resources

About