Lower limb electromygraphy and kinematics of neuropathic diabetic patients during real‐life activities: Stair negotiation

Onodera, Andrea Naomi; Gomes, Aline A.; Pripas, Denise; Mezzarane, Rinaldo A.; Sacco, Isabel de Camargo Neves

doi:10.1002/mus.22072

Cited by 22 publications

(22 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This finding is consistent with the EMG results of the triceps surae, which presents a deficit in its activation in locomotor activities 2,[14][15][16] , and it is expected that in a more difficult task that requires more eccentric activity and control, such as descending stairs, the ankle muscles could not respond adequately.…”

Section: Effect Size Classificationsupporting

confidence: 79%

“…The vastus lateralis delay found in the EMG results in the heel strike phase of level gait in diabetic neuropathic patients 1,2,16 indicates impaired knee extensor muscle function. The diabetic patients' response must be adapted to a higher mechanical demand during stair decent, particularly at the initial contact.…”

Section: Effect Size Classificationmentioning

confidence: 99%

“…Maluf et al 18 observed higher peak pressures in diabetic patients during level walking, ramp climbing, stair climbing, and changing direction compared to level walking. Onodera et al 16 observed a mechanical disadvantage of the vastus lateralis and gastrocnemius medialis muscles in stair negotiation by diabetic individuals.…”

Section: Introductionmentioning

confidence: 99%

“…The ankle plays an important role 12,13 , as its full range of motion allows a suitable distribution of the mechanical energy absorption at the initial foot contact with the step and a proper propulsion at the end of the stance 5 . Ankle function is dramatically affected in diabetic patients since they present a limited range of motion (ROM), lower and delayed triceps surae activity 2,[14][15][16] combined with progressive loss of foot sensitivity. During stair descent, normal ankle ROM and proper muscle eccentric control are even more necessary, and if ankle function is impaired, compensations and adaptations in the kinetics and kinematics of the knee and hip would be expected, as Mueller et al 17 suggested in level gait.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Diabetic patients with and without peripheral neuropathy reveal different hip and ankle biomechanical strategies during stair descent

Picon

Sartor

Roveri

et al. 2012

Rev. bras. fisioter.

View full text Add to dashboard Cite

show abstract

Section: Effect Size Classificationsupporting

confidence: 79%

Section: Effect Size Classificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Diabetic patients with and without peripheral neuropathy reveal different hip and ankle biomechanical strategies during stair descent

Picon

Sartor

Roveri

et al. 2012

Rev. bras. fisioter.

View full text Add to dashboard Cite

show abstract

“…Onodera et al(Onodera et al 2011) examined foot kinematics in individuals with DMPN during a more challenging foot-specific task: stair ascent and descent. Using a single foot segment model, foot on shank dorsiflexion and plantarflexion were limited during ascent and plantarflexion was limited on stair descent.…”

Section: Introductionmentioning

confidence: 99%

Kinematics and kinetics of single-limb heel rise in diabetes related medial column foot deformity

Hastings

Woodburn

Mueller

et al. 2014

Clinical Biomechanics

View full text Add to dashboard Cite

Background Diabetes-related medial column foot deformities contribute to high plantar pressure, joint instability, ulceration and amputation. Impaired foot function may be an early indicator of foot structural incompetence and contribute to deformity progression. This study examines the ability of single-limb heel rise multi-segmental kinematics and kinetics to identify midfoot and hindfoot dysfunction in those with diabetes-related medial column foot deformity. Methods Single-limb heel rise foot kinematics and kinetics were examined in adults with diabetes mellitus and peripheral neuropathy with and without medial column foot deformity and age-, weight-matched controls. Findings Hindfoot relative to shank plantarflexion, peak and excursion, were reduced in bothdiabetes groups compared to controls (P<0.017). Controls' initial forefoot relative to hindfoot position was plantarflexed 31 degrees and plantarflexed an additional 13 degrees during heel rise. The initial forefoot relative to hindfoot position for the diabetes group without deformity was similarly plantarflexed as controls (34 degrees) while the diabetes deformity group was less plantarflexed (lower arch position: 23 degrees, P<0.017). During the heel rise task both diabetes groups demonstrated less ability to plantarflex the forefoot relative to the hindfoot compared to controls (2 and 5 degrees respectively, P<0.017). Ankle plantarflexion power was reduced in the diabetes deformity group compared to controls (P<0.017). Interpretation The single-limb heel rise task identified movement dysfunction in those with diabetes mellitus and peripheral neuropathy. Failure to plantarflex the forefoot relative to hindfoot may compromise midfoot joint stability and increase the risk of injury and arch collapse.

show abstract

Later stages of diabetic neuropathy affect the complexity of the neuromuscular system at the knee during low‐level isometric contractions

et al. 2017

Self Cite

View full text Add to dashboard Cite

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...

show abstract

Lower limb electromygraphy and kinematics of neuropathic diabetic patients during real‐life activities: Stair negotiation

Abstract: Our results reveal an adaptive motor strategy in DN patients to overcome the challenge of stair ascent, which promoted more biomechanical deficits.

Cited by 22 publications

References 33 publications

Diabetic patients with and without peripheral neuropathy reveal different hip and ankle biomechanical strategies during stair descent

Diabetic patients with and without peripheral neuropathy reveal different hip and ankle biomechanical strategies during stair descent

Kinematics and kinetics of single-limb heel rise in diabetes related medial column foot deformity

Later stages of diabetic neuropathy affect the complexity of the neuromuscular system at the knee during low‐level isometric contractions

Contact Info

Product

Resources

About