Introduction: This study evaluates the complexity of force and surface electromyography (sEMG) during knee extension and flexion at low-level isometric contractions in individuals with different degrees of diabetic peripheral neuropathy (DPN). Methods: Ten control and 38 diabetic participants performed isometric contractions at 10%, 20%, and 30% of maximal voluntary contraction. Knee force and multichannel sEMG from vastus lateralis (VL) and biceps femoris were acquired. The SD of force and sample entropy (SaEn) of both force and sEMG were computed. Results: Participants with moderate DPN demonstrated high force-SD and low force-SaEn. Severely affected participants showed low SaEn in VL at all force levels. Discussion: DPN affects the complexity of the neuromuscular system at the knee for the extension task during low-level isometric contractions, with participants in the later stages of the disease (moderate and severe) demonstrating most of the changes. 57: 112-121, 2018 More than 80% of leg amputations in diabetic patients occur after injuries or ulcerations in the foot, making the management of diabetic peripheral neuropathy (DPN) extremely relevant.
Muscle Nerve1 The most commonly reported symptoms of DPN consist of loss of tactile sensitivity, prickling sensations, and pain. As DPN progresses, motor neurons develop loss of neuromuscular junctions and axonal degeneration.2 Loss of axonal function results in the loss of motor units and impaired axonal sprouting.3 Axonal sprouting allows reinnervation of denervated muscle fibers of intact motor units in the neighborhood and re-establishment of neuromuscular activity. However, the compensatory effects of axonal sprouting are often limited because of long-term loss of motor end plates. 3,4 These alterations interfere with muscle strength and endurance while performing tasks of daily living. 5 The literature has described altered activity in the knee muscles in the presence of DPN, especially in the knee extensors.6-14 However, most of these studies demonstrating changes in surface electromyography (sEMG) in relation to DPN are based on single-channel recordings.High density sEMG with a grid of electrodes allows recording of the spatiotemporal muscle activity pattern. 15,16 At low-level contraction forces, the assessment of the spatiotemporal pattern provides information on the variability in the motor unit recruitment pattern.17 Recording high-density sEMG also enables assessment of the level of complexity of the electromyographic activity over a large area. 18 The complexity of a biological system reflects its ability to adapt and function in a constantly changing environment, and this complexity arises from the interaction of structural units and regulatory feedback loops. 19,20 Consequently, structural or functional alterations resulting from DPN would affect the interactions between sensory and motor inputs and reduce the adaptive capacity of the sensory-motor system. Therefore, studying the effects of DPN on motor complexity would form the bas...