How Does Self-Perceived Unsteadiness Influence Balance and Gait in People With Diabetes? Preliminary Observations

Reeves, Neil D.; Petrović, Miloš; Boulton, Andrew J.M.; Vileikyte, Loretta

doi:10.2337/dc16-2183

Cited by 14 publications

(13 citation statements)

References 6 publications

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“…Previous studies of older adults with diabetes found that individuals with greater fear of falling also walk at slower velocities (30,31). In specifically investigating the influence of self-perceived unsteadiness during gait, Reeves et al (32) found gait velocity to be strongly correlated with self-perceived unsteadiness (r = 20.57; P = 0.0001). That finding fits well with the premise put forth by Dingwell et al (33) that reductions in walking speed by individuals with diabetic neuropathy are a compensatory strategy used to maintain dynamic stability of the upper body.…”

Section: Discussionmentioning

confidence: 99%

Decreasing an Offloading Device’s Size and Offsetting Its Imposed Limb-Length Discrepancy Lead to Improved Comfort and Gait

Crews

Candela

2018

Diabetes Care

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Section: Discussionmentioning

confidence: 99%

Decreasing an Offloading Device’s Size and Offsetting Its Imposed Limb-Length Discrepancy Lead to Improved Comfort and Gait

Crews

Candela

2018

Diabetes Care

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“…We have recently refined the posture first hypothesis indicting that it was evident only among older adults with known locomotive limitations (Holtzer, Verghese, et al, 2016). A recent report found that the presence of peripheral diabetic neuropathy was associated with worse perception of steadiness and poorer walking performance (Reeves, Brown, Petrovic, Boulton, & Vileikyte, 2017). Hence, due to their already slower gait and possible concerns about stability and safety older adults with diabetes may have prioritized gait over the cognitive interference task, which resulted in reduced dual-task costs compared to participants without diabetes.…”

Section: Discussionmentioning

confidence: 99%

The effect of diabetes on prefrontal cortex activation patterns during active walking in older adults

Holtzer

George

İzzetoğlu

et al. 2018

Brain and Cognition

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Background Gait alterations were documented in diabetic patients. However, the effect of diabetes on cortical control of gait has not been reported. We evaluated the effect of diabetes on prefrontal cortex (PFC) Oxygenated Hemoglobin (HbO2) levels during active walking in older adults. Methods Of the total sample (n=315; mean age=76.84±6.71ys; %female=56.5) 43 participants (13.7%) had diabetes. The experimental paradigm consisted of two single tasks: Normal-Walk (NW); and Cognitive Interference (Alpha); and one dual-task condition consisting of the two single tasks, Walk-While-Talk (WWT). Functional Near-Infrared-Spectroscopy (fNIRS) was used to quantify PFC HbO2 levels. Results Older adults without diabetes showed higher PFC HbO2 levels in WWT compared to both NW and Alpha. HbO2 levels during NW were not different between the two groups. Consistent with Neural Inefficiency, older adults with diabetes exhibited higher HbO2 levels during Alpha while performing significantly worse than those without diabetes. Moreover, the presence of diabetes was associated with attenuated HbO2 levels during WWT. This pattern is consistent with Capacity Limitations suggesting a failure to recruit brain resources vis-à-vis the more cognitively challenging WWT condition. Conclusions A distinct functional neural signature of diabetes was established during active and attention demanding walking among older adults without overt neurological disease.

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“…As off-loading is the best validated of all current interventions, it is important that further work is undertaken to increase understanding of how the patient's agenda can be best incorporated into the process of considering, adopting, and assessing both offloading devices and other interventions in routine clinical practice. While this may be partly the result of the constraints imposed by off-loading devices, as well as their appearance, there is also evidence that poor adherence may reflect unrecognized unsteadiness caused by neuropathy (67).…”

Section: Ulcer Healing Adherence and The Patient Agendamentioning

confidence: 99%

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

et al. 2018

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Diabetic foot ulcers remain a major health care problem. They are common, result in considerable suffering, frequently recur, and are associated with high mortality, as well as considerable health care costs. While national and international guidance exists, the evidence base for much of routine clinical care is thin. It follows that many aspects of the structure and delivery of care are susceptible to the beliefs and opinion of individuals. It is probable that this contributes to the geographic variation in outcome that has been documented in a number of countries. This article considers these issues in depth and emphasizes the urgent need to improve the design and conduct of clinical trials in this field, as well as to undertake systematic comparison of the results of routine care in different health economies. There is strong suggestive evidence to indicate that appropriate changes in the relevant care pathways can result in a prompt improvement in clinical outcomes.Despite considerable advances made over the last 25 years, diabetic foot ulcers (DFUs) continue to present a very considerable health care burdendone that is widely unappreciated. DFUs are common, the median time to healing without surgery is of the order of 12 weeks, and they are associated with a high risk of limb loss through amputation (1-4). The 5-year survival following presentation with a new DFU is of the order of only 50-60% and hence worse than that of many common cancers (4,5). While there is evidence that mortality is improving with more widespread use of cardiovascular risk reduction (6), the most recent datadderived from a Veterans Health Adminstration populationdreported that 1-, 2-, and 5-year survival was only 81, 69, and 29%, respectively, and the association between mortality and DFU was stronger than that of any macrovascular disease (7). Iversen et al. (8) have also shown that the occurrence of a DFU was an independent predictor of mortality even at 10 years.The cost to health care services is also enormous. The estimated global cost of diabetes in 2015 was $1.3 trillion (9), and it has been reported that up to one-third of diabetes expenditure is on lower-limb-related problems in the U.S. (10). The latest data from the U.K. estimate that the total annual cost of management of DFUs exceeds £1 billion ($1.32 billion) and represents almost 1% of the total National Health Service budget (11). The equivalent figure from the U.S. has been estimated to be $9-13 billion (12). GEOGRAPHIC DIFFERENCES IN CLINICAL OUTCOMEThere is also wide variation in clinical outcome within the same country (13-15), suggesting that some people are being managed considerably less well than others.

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How Does Self-Perceived Unsteadiness Influence Balance and Gait in People With Diabetes? Preliminary Observations

Cited by 14 publications

References 6 publications

Decreasing an Offloading Device’s Size and Offsetting Its Imposed Limb-Length Discrepancy Lead to Improved Comfort and Gait

Decreasing an Offloading Device’s Size and Offsetting Its Imposed Limb-Length Discrepancy Lead to Improved Comfort and Gait

The effect of diabetes on prefrontal cortex activation patterns during active walking in older adults

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

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