Diabetic Peripheral Neuropathy Compromises Balance During Daily Activities

Abstract

OBJECTIVEPatients with diabetes with peripheral neuropathy have a well-recognized increased risk of falls that may result in hospitalization. Therefore this study aimed to assess balance during the dynamic daily activities of walking on level ground and stair negotiation, where falls are most likely to occur. RESEARCH DESIGN AND METHODSGait analysis during level walking and stair negotiation was performed in 22 patients with diabetic neuropathy (DPN), 39 patients with diabetes without neuropathy (D), and 28 nondiabetic control subjects (C) using a motion analysis system and embedded force plates in a staircase and level walkway. Balance was assessed by measuring the separation between the body center of mass and center of pressure during level walking, stair ascent, and stair descent. RESULTSDPN patients demonstrated greater (P < 0.05) maximum and range of separations of their center of mass from their center of pressure in the medial-lateral plane during stair descent, stair ascent, and level walking compared with the C group, as well as increased (P < 0.05) mean separation during level walking and stair ascent. The same group also demonstrated greater (P < 0.05) maximum anterior separations (toward the staircase) during stair ascent. No differences were observed in D patients. CONCLUSIONSGreater separations of the center of mass from the center of pressure present a greater challenge to balance. Therefore, the higher medial-lateral separations found in patients with DPN will require greater muscular demands to control upright posture. This may contribute to explaining why patients with DPN are more likely to fall, with the higher separations placing them at a higher risk of experiencing a sideways fall than nondiabetic control subjects.Patients with diabetic peripheral neuropathy (DPN) have an altered gait strategy (1-3) and a fivefold increased risk of falling (4-6). Falling is a major health risk in many developed countries; for example, in the general U.K. population, over a quarter of accidents that required hospital treatment were the result of a fall (7). A fall is preceded by loss of balance, which may be recoverable in some individuals, but requires rapid responses and a high level of strength from the lower-limb muscles (8,9). Nevertheless, the more likely an individual is to lose balance, the more likely they will at some point experience a fall. Therefore, quantifying balance control

Avaliação Clínica Do Risco De Quedas Com E Sem Fraturas Em Pacientes Com Neuropatia Diabética

“…A maior propensão a quedas nos pacientes diabéticos afeta enormemente a sua qualidade de vida, pois pode resultar em fraturas, diminuição da autonomia, declínio da mobilidade, evitação de atividades, hospitalização e maior morbimortalidade (7,10).…”

“…Os mecanismos envolvidos nessa instabilidade incluem: comprometimento de fibras motoras que afetam os músculos da marcha, anormalidades nos centros de pressão plantares, deformidades osteoarticulares, déficit sensitivo nos pés e redução dos reflexos posturais (7)(8)(9). Tudo isso leva a um risco aumentado de quedas nesses indivíduos, que pode ainda ser agravado por outras complicações da doença como retinopatia, afecção vestibular, alterações ósseas e presença de úlceras plantares (8).…”

Benefits, Challenges, and Potential Utility of a Gait Database for Diabetes Patients

“…24 However, gait alterations are also observed in diabetes patients without DPN, 25 which result from deterioration of skeletal muscle 26,27 and visual factors. 27 These sensory and muscular detriments result in patients with diabetes utilizing a more conservative gait strategy: walking at a slower speed, [28][29][30][31] with lower muscular demands, 30,32 and a larger base of support. 28,33 However, this slower walking speed is directly associated with a reduced quality of life.…”

Study of Nursing Countermeasure of Senile Oblique Inguinal Hernia Complication

“…gait disturbance, therefore increasing risk of fall with diabetes patients [3,4]. Studies have pointed out thatfor people with diabetes who have complication with peripheral neuropathy, the prevalance of fall was five times more than healthy people of the same age, and more than half of the patients at least fall once a year due to the weakened balance function [3].…”

“…Studies have pointed out thatfor people with diabetes who have complication with peripheral neuropathy, the prevalance of fall was five times more than healthy people of the same age, and more than half of the patients at least fall once a year due to the weakened balance function [3]. According to Health Ministry survey statistics, the elderlys' injury medical costs due to falling presents an increasing trend year by year in our country [5].…”