Balance and ankle muscle strength predict spatiotemporal gait parameters in individuals with diabetic peripheral neuropathy

The association of cardiometabolic multimorbidity and fear of falling among older adults: Data from the national health and aging trends study

OBJECTIVES

Cardiometabolic diseases (CMDs) have been individually associated with fall-related outcomes, but their combined effect on fear of falling (FOF) has not been investigated. This study aims to examine the association between cardiometabolic multimorbidity and FOF in older adults.

METHODS

Data from the National Health and Aging Trends Study, 4,295 community-dwelling older adults ≥ 65 years were analyzed in this longitudinal study. CMDs were assessed at baseline, including heart disease, diabetes, stroke, and hypertension. FOF was evaluated by asking participants if they worried about falling in the past month. Data were analyzed using multi-adjusted logistic regression.

RESULTS

Cardiometabolic multimorbidity was associated with a higher risk of FOF. The combination of heart disease and diabetes showed the highest risk of FOF (OR = 3.47, 95 % CI: 1.63-7.40).

CONCLUSIONS

These findings underscore the need for targeted interventions to mitigate the combined impact of cardiometabolic multimorbidity on FOF in older adults.

Digital gait markers to potentially distinguish fragile X-associated tremor/ataxia syndrome, Parkinson's disease, and essential tremor

Background

Fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disease that affects carriers of a 55-200 CGG repeat expansion in the fragile X messenger ribonucleoprotein 1 (FMR1) gene, may be given an incorrect initial diagnosis of Parkinson's disease (PD) or essential tremor (ET) due to overlapping motor symptoms. It is critical to characterize distinct phenotypes in FXTAS compared to PD and ET to improve diagnostic accuracy. Fast as possible (FP) speed and dual-task (DT) paradigms have the potential to distinguish differences in gait performance between the three movement disorders. Therefore, we sought to compare FXTAS, PD, and ET patients using quantitative measures of functional mobility and gait under self-selected (SS) speed, FP, and DT conditions.

Methods

Participants with FXTAS (n = 22), PD (n = 23), ET (n = 20), and controls (n = 20) underwent gait testing with an inertial sensor system (APDM™). An instrumented Timed Up and Go test (i-TUG) was used to measure movement transitions, and a 2-min walk test (2MWT) was used to measure gait and turn variables under SS, FP, and DT conditions, and dual-task costs (DTC) were calculated. ANOVA and multinomial logistic regression analyses were performed.

Results

PD participants had reduced stride lengths compared to FXTAS and ET participants under SS and DT conditions, longer turn duration than ET participants during the FP task, and less arm symmetry than ET participants in SS gait. They also had greater DTC for stride length and velocity compared to FXTAS participants. On the i-TUG, PD participants had reduced sit-to-stand peak velocity compared to FXTAS and ET participants. Stride length and arm symmetry index during the DT 2MWT was able to distinguish FXTAS and ET from PD, such that participants with shorter stride lengths were more likely to have a diagnosis of PD and those with greater arm asymmetry were more likely to be diagnosed with PD. No gait or i-TUG parameters distinguished FXTAS from ET participants in the regression model.

Conclusion

This is the first quantitative study demonstrating distinct gait and functional mobility profiles in FXTAS, PD, and ET which may assist in more accurate and timely diagnosis.

Effects of Tai Chi on Postural Control in People with Peripheral Neuropathy: A Systematic Review with Meta-Analysis

BACKGROUND

Effects of Tai Chi on people with peripheral neuropathy (PN) are not yet apparent. This systematic review was conducted to evaluate the effects of Tai Chi on postural control in people with PN.

METHODS

Literature was screened in seven databases for relevant randomized controlled trials. The reports and methodological quality were evaluated. A meta-analysis was performed using RevMan5.4 software.

RESULTS

Ten reports were included, involving a total of 344 subjects. The meta-analysis found that Tai Chi therapy for people with PN resulted in a smaller sway area, in the double-leg stance with eyes closed test (SMD = -2.43, I² = 0%), than that observed in the control group, greater distance covered in the six-minute walking test (SMD = -0.46, I² = 49%) and faster performance in the timed-up-and-go test (SMD = 0.68, I² = 50%), than the baseline.

CONCLUSIONS

Tai chi effectively enhanced dynamic postural control in people with PN. However, no better effects on postural control from Tai Chi than from other rehabilitation approaches were observed in this study. Further high-quality trials are needed to better understand Tai Chi's effects on individuals with PN.

Determinants of improvement in functional abilities in peripheral neuropathy patients undergoing rehabilitation: the role of Berg Balance Scale items

PURPOSE

This prospective observational cohort study aimed to verify whether single Berg Balance Scale (BBS) items were important determinants of improvement in functional abilities in patients with peripheral neuropathy (PN).

METHODS

Data were collected in 75 older patients with PN performing a standard motor rehabilitation program. Backward stepwise multiple regression analyses were performed to identify determinants of outcome measures. Gain in total and motor Functional Independence Measure (FIM) and gain in motor-FIM areas were the outcome measures.

RESULTS

Among BBS items, at the end of rehabilitation, the score was higher in "sitting unsupported" (3.94 ± 0.22) and lower in "standing on one foot" (1.18 ± 1.06). The gain was higher in "standing to sitting" (1.02 ± 0.67) and "standing unsupported" (1.00 ± 1.00), and lower in "sitting unsupported" (0.22 ± 0.60) and "standing on one foot" (0.65 ± 0.77). "Standing unsupported" was the only determinant of gain in motor-FIM (beta - 0.36, p = 0.002) and gain in self-care (beta - 0.37, p = 0.002). The R2 value of the models was 0.13 and 0.14, respectively. No independent variable was a determinant of gain in total-FIM.

CONCLUSIONS

The study shows that "unsupported standing" is an important determinant of results of ADL rehabilitation in PN patients and indicates that ability to stand without support for a fairly long time is an essential requirement to achieve with rehabilitation higher gain levels in functional abilities in PN patients.

The effect of loss of foot sole sensitivity on H-reflex of triceps surae muscles and functional gait

Objective: To investigate the effects of foot sole insensitivity on the outcomes of the triceps surae muscle H-reflex and functional gait. Material and Methods: People with peripheral neuropathy were recruited and divided into two groups: people with more (n = 13, 73.3 ± 4.3 years old) or less (n = 10, 73.5 ± 5.3) sensitive tactile sensation. Their monofilament testing scores were 9.0 ± 1.5 (range: 7-10) and 2.3 ± 2.4 (range: 0-6) out of 10, respectively. H-reflex of the triceps surae muscles during quiet standing and their relationship with functional gait, 6 min walking distance (6MWD), and timed-up-and-go duration (TUG), were compared between groups. Results: No significant difference was detected for H-reflex parameters between the groups. The less sensitive group showed reduced (p < .05) functional gait capacity compared to the other group, 38.4 ± 52.7 vs. 463.5 ± 47.6 m for 6MWD, and 9.0 ± 1.5 vs. 7.2 ± 1.1s for TUG, respectively. A significant correlation (p < .05), worse functional gait related to greater H/M ratio, was observed in the less sensitive group, not the other group. Conclusion: Although there was no significant H-reflex difference between the groups, more pronounced tactile sensation degeneration affected functional gaits and their relationship with H-reflex.

The Impact of Diabetic Neuropathy on Activities of Daily Living, Postural Balance and Risk of Falls - A Systematic Review

OBJECTIVE

The objective of this review is to discuss a compilation of the currently available literature regarding the impact of diabetic neuropathy (DN) on activities of daily living (ADL), postural stability, and risk of falls.

METHODS

A systematic electronic search strategy was conducted on PubMed/MEDLINE database, Cochrane Library, and Embase in March 2020. This narrative review included clinical cross-sectional studies assessing ADL, postural balance, and falls in adults with DN. All studies underwent a quality assessment based on the Newcastle Ottawa scale developed to assess cross-sectional studies.

RESULTS

Forty-two studies were identified. A total of 37 studies evaluated postural stability in DN, 10 studies assessed fall accidents, and three studies assessed ADL in individuals with DN. Seven studies assessed both postural stability and fall accidents, and one study assessed postural stability and ADL. Each of the studied outcome variables was assessed separately. Based on a quality assessment, eight studies were excluded resulting in an evaluation of 34 studies.

CONCLUSIONS

Diabetic neuropathy has a negative impact on postural balance and gait kinematics combined with an increased fall risk. Because of the few number of studies available, we were unable to evaluate the impact of DN on ADL. Our findings are in concordance with previous reviews, supporting the evidence for DN as a critical measure negatively impacting postural stability and fall risk in individuals with diabetes. Further clinical investigative studies are needed.

Association between quadriceps function, joint kinetics, and spatiotemporal gait parameters in young adults with and without obesity

BACKGROUND

Individuals with obesity have impaired gait and muscle function that may contribute to reduced mobility and increased fall risk.

RESEARCH QUESTIONS

(1) what is the difference in spatiotemporal gait parameters and joint kinetics between individuals with and without obesity; (2) what is the association between spatiotemporal gait parameters, joint kinetics, and quadriceps function?

METHODS

Forty-eight young adults with obesity (BMI = 33.0 ± 4.1 kg/m²) and 48 without obesity (BMI = 21.6 ± 1.7 kg/m²) completed assessments of quadriceps function (peak torque and early/late rate of torque development (RTD)) and walking biomechanics at self-selected speed. Spatiotemporal gait parameters (stance time, double support time, double support to stance ratio, step width, step length, cadence, and gait stability ratio (GSR)) and joint kinetics (total support moment, and relative contribution from extensor moments) were compared using one-way MANOVAs. Partial correlation examined the association between the total support moment and quadriceps function, and spatiotemporal gait parameters controlling for sex and speed.

RESULTS

Individuals with obesity walked with longer stance (p = 0.01), longer double-limb support (p < 0.001), wider steps (p < 0.001), lower cadence (p = 0.03), and a greater absolute (p < 0.001) but lesser normalized total support moment (p = 0.03) compared with adults without obesity. In those with obesity, greater PT was associated with less double limb support (p = 0.011) and smaller double support to stance ratio (p = 0.006); greater early RTD was associated with less double limb support (r = -0.455, p = 0.0021), less stance time (r = -0.384, p = 0.008), and a smaller double support to stance ratio (r = -0.371, p = 0.011). In those without obesity, a larger total support moment was associated with longer step length (r = 0.512, p < 0.001), lesser cadence (r = -0.497, p < 0.001), and smaller GSR (-0.460, p = 0.001).

SIGNIFICANCE

Individuals with obesity walk with altered spatiotemporal gait parameters and joint kinetics that may compromise stability. Extended periods of support may be a strategy used by individuals with obesity to increase stability during gait and accomodate insufficient quadriceps function.

Abnormal vibration perception threshold alters the gait features in type 2 diabetes mellitus patients

OBJECTIVE

It is generally believed that gait characteristics of diabetic neuropathic patients differ from those of non-diabetic ones. However, it is still unclear how the abnormal foot sensation influences the gait during walking in type 2 diabetes mellitus (T2DM). For the purpose of gaining a better insight into the alterations of detailed gait parameters and figuring out important aspects in the gait indexes by peripheral neuropathy in elder T2DM patients, we compared the gait features in participants with normal glucose tolerance (NGT) controls and diabetic individuals complicated by peripheral neuropathy or not.

SUBJECTS AND METHODS

Gait parameters were observed during the 10-m walk on flat land among different conditions of diabetes in 1,741 participants from three clinical centers. Subjects were divided into four groups: persons with NGT were taken as the control group; patients with T2DM included three subgroups: DM control (no chronic complications), DM-DPN (DM complicated by only peripheral neuropathy), and DM-DPN+LEAD (DM complicated by both neuropathy and artery disease). The clinical characteristics and gait parameters were assessed and compared among these four groups. Analyses of variance were employed to verify possible differences of gait parameters between groups and conditions. Stepwise multivariate regression analysis was performed to reveal possible predictors of gait deficits. Receiver operating characteristic (ROC) curve analysis was employed to find any discriminatory power of diabetic peripheral neuropathy (DPN) for the step time.

RESULTS

In participants burdened with DPN, whether complicated by lower extremity arterial disease (LEAD) or not, step time increased sharply (p < 0.05). Stepwise multivariate regression models showed that independent variables of gait abnormality were sex, age, leg length, vibration perception threshold (VPT), and ankle-brachial index (ABI) (p < 0.01). Meanwhile, VPT was a significant independent predictor of step time, spatiotemporal variability (SD_A), and temporal variability (SD_B) (p < 0.05). ROC curve analysis was explored to find the discriminatory power of DPN for the occurrence of increased step time. The area under the curve (AUC) value was 0.608 (95% CI: 0.562-0.654, p < 0.01), and the cutoff point was 538.41 ms accompanied by a higher VPT. A significant positive association was observed between increased step time and the highest VPT group [odds ratio (OR) = 1.83, 95% CI: 1.32-2.55, p< 0.01]. In female patients, this OR value elevated to 2.16 (95% CI: 1.25-3.73, p< 0.01).

CONCLUSIONS

In addition to sex, age, and leg length, VPT was a distinct factor that associated with altered gait parameters. DPN is associated with increased step time, and the step time increases with worsening VPT in type 2 diabetes.

Influence of Physically Active or Sedentary Lifestyle on Postural Control of Community-dwelling Old Adults

Objectives: The maintenance of the postural balance is fundamental for the daily living activities, as well as for the practice of physical exercise. However, the aging process and sedentary behavior (i.e., large sitting time) lead to changes biological systems, impairing postural balance with consequent increased falls risk. On the other hand, physical activity practice is a protective factor against these trends. The aim of this study is to investigate the influence of physical activity profile and sedentary behavior on postural control in community-dwelling old adults.Methods: This is a cross-sectional study including 208 community-dwelling old adults, which were stratified as sufficiently or insufficiently physically active and with or without sedentary behavior. Then, they were grouped as follow: G1 (sufficiently physically active and without sedentary behavior), G2 (insufficiently physically active, but without sedentary behavior), G3 (sufficiently physically active, but with sedentary behavior), and G4 (insufficiently physically active and with sedentary behavior).Results: Stabilometric parameters (sway area, total length of center of pressure [CoP] trajectory, and the mean velocity of CP displacement) were obtained to evaluate the postural control. There was significant difference between G1 and G4 on mean velocity of CoP displacement (p < 0.05).Conclusions: The coexistence of sedentary behavior and insufficient physically active profile seem to impact negatively on postural control.

Long-Term Use of a Sensory Prosthesis Improves Function in a Patient With Peripheral Neuropathy: A Case Report

Background: Peripheral neuropathy (PN) can result in either partial or complete loss of distal sensation resulting in an increased fall risk. Walkasins® uses a shoe insert to detect the magnitude and direction of sway and sends signals to a leg unit that provides sensory balance cues. The objective of this case report is to describe the long-term influence of the Walkasins® lower limb sensory neuroprosthesis on balance and gait for an individual with diabetic PN. Case Description: A 51-year-old male with a 3-year history of PN and a 10-year history of type II diabetes mellitus was fitted bilaterally with Walkasins® and utilized them 8-10 hours/day for more than 2 years. Although, vibration and tactile sensation thresholds were severely impaired at his 1st metatarsophalangeal joint and the lateral malleolus bilaterally he could perceive tactile stimuli from the Walkasins® above the ankles. Outcomes: Following Walkasins® use, his Activities-specific Balance Confidence Scale (ABC) scores improved from 33 to 80%. His mean Vestibular Activities of Daily Living (VADL) scores decreased from 3.54 to 1. His Functional Gait Assessment (FGA) scores increased from 13/30 to 28/30 and his miniBESTest scores improved from 15/28 to 26/28. Gait speed increased from 0.23 to 1.5 m/s. The patient described a decrease in pain and cramping throughout his lower extremities and an increase in function. Discussion: Gait and balance improved with the use of the Walkasins® and participation in a wellness program. This improvement suggests that the use of sensory substitution devices, such as the Walkasins®, may replace sensory deficits related to gait and balance dysfunction experienced by patients with PN. Further research is needed to determine if other patients will have a similar response and what the necessary threshold of sensory function is to benefit from use of the Walkasins®.

Effect of a HIIT protocol on the lower limb muscle power, ankle dorsiflexion and dynamic balance in a sedentary type 1 diabetes mellitus population: a pilot study

Background

Type 1 diabetes mellitus (T1DM) is commonly associated with premature loss of muscle function, ankle dorsiflexion and dynamic balance. Those impairments, usually, lead to physical functionality deterioration. High-intensity interval training is an efficient and safety methodology since it prevents hypoglycemia and not requires much time, which are the main barriers for this population to practice exercise and increase physical conditioning. We hypothesized that a 6-week HIIT program performed on a cycle ergometer would increase lower limb muscle power, ankle dorsiflexion range of motion and dynamic balance without hypoglycemic situations.

Methods

A total of 19 diagnosed T1DM subjects were randomly assigned to HIIT group (n = 11; 6-week HIIT protocol) or Control group (n = 8; no treatment). Lower limb strength was evaluated through velocity execution in squat with three different overloads. Weight bearing lunge test (WBLT) was performed to test ankle dorsiflexion range of motion and Y-Balance test (YBT) was the test conducted to analyze dynamic balance performance.

Results

Velocity in squat improved a 11.3%, 9.4% and 10.1% (p < 0.05) with the 50%, 60% and 70% of their own body mass overload respectively, WBLT performance increased a 10.43% in the right limb and 15.45% in the left limb. YBT showed improvements in all directions (right limb-left limb): Anterior (4.3–6.1%), Posteromedial (1.8–5.2%) and Posterolateral (3.4–4.5%) in HIIT group (p < 0.05), unlike control group that did not experience any significant change in any of the variables (p > 0.05).

Conclusion

A 6-week HIIT program is safe and effective to improve execution velocity in squat movement, a fundamental skill in daily living activities, as well as ankle dorsiflexion range of motion and dynamic balance to reduce foot ulcers, risk falls and functional impairments. HIIT seems an efficient and safety training methodology not only for overcome T1DM barriers for exercising but also for improving functional capacities in T1DM people.

IMPACT OF DIABETIC NEUROPATHY ON QUALITY OF LIFE AND POSTURAL BALANCE IN BRAZILIAN OLDER ADULTS

OBJECTIVE

To analyze the impact of the Peripheral Diabetic Neuropathy (PDN) on the postural and functional balance and quality of life of Brazilian older adults.

METHODS

A cross-sectional study. Sixty older men and women (60-79 years) were divided into three groups: control, DM without and with PDN. The following parameters were evaluated: anthropometry; quality of life; postural balance (BESTest); functional balance in force plate (NeuroCom Balance).

RESULTS

PDN group presented significant differences compared with the other groups, with the worst performance in quality of life than DM2 without PDN in: sensory functioning (p = 0.030); past and future (p = 0.036); death and dying (p = 0.035). Postural balance deficit in the total score (p = 0.025) and biomedical constraints section (p = 0.043) of the BESTest, compared with DM2 without PDN (p = 0.007). In the functional balance (Neurocom), PDN group presented a worse performance in the time spent on the left side (p = 0.030) than the control group. During step up over test, the control group performed the task faster than the group with PDN (p = 0.004).

CONCLUSION

This study showed that neuropaths presented worse physical performance and postural balance deficits, sensorial limitations, affecting the daily tasks and, as a consequence, decreasing the quality of life in Brazilian older adults. Level of Evidence II, Cross-sectional observational study.

The impact of sensory and/or sensorimotor neuropathy on lower limb muscle endurance, explosive and maximal muscle strength in patients with type 2 diabetes mellitus

AIMS

The purpose of this study was to investigate the impact of diabetic neuropathy (dNP) on lower limb endurance, explosive and maximal muscle strength in patients with Type 2 Diabetes Mellitus (T2DM).

METHODS

Fifty-four participants, aged between 55 and 85, were enrolled in this observational comparative study. The patients with T2DM had an average HbA1c of 7.4% (±1.03) and diabetes duration of 13 years. Participants were classified by means of electroneuromyography as T2DM without dNP (dNP-; n = 8), T2DM with sensory dNP (dNPs; n = 13), T2DM with sensorimotor dNP (dNPsm; n = 14), and healthy controls without neuropathy (C; n = 19). Maximal muscle strength and muscle endurance of the dominant knee and ankle were measured by dynamometry, while explosive muscle strength was evaluated by mechanography.

RESULTS

Muscle endurance "total work" in knee extension and ankle plantar flexion was higher in the healthy controls compared to dNP-, dNPs and dNPsm, in knee flexion compared to dNPs and dNPsm, and in ankle dorsiflexion compared to dNPsm only (p<0.05). Furthermore, relative explosive muscle strength "total power/body weight" and relative maximal muscle strength "peak torque/lean body mass of the dominant leg" considering knee flexion, ankle plantar flexion and dorsiflexion, were higher in healthy controls compared to the dNPsm group, and for maximal muscle strength ankle dorsiflexion even between dNP- and dNPsm (p < 0.05).

CONCLUSIONS

Muscle endurance is impaired in patients with T2DM, independent of the presence of dNP. Explosive and maximal muscle strength are more likely affected by the presence and severity of dNP.

Assessment of Balance Control Subsystems by Artificial Intelligence

Recent studies have shown that balance performance assessment based on artificial intelligence (AI) is feasible. However, balance control is very complex and requires different subsystems to participate, which have not been evaluated individually yet. Furthermore, these studies only classified individual's balance performance across limited grades. Therefore, in this study we attempted to implement AI to precisely evaluate different types of balance control subsystems (BCSes). First, a total of 224 commonly used and newly developed features were extracted from the center of pressure (CoP) data for each participant, respectively. Then, regressors were employed in order to map these features to the evaluation scores given by physical therapists, which include the total score in Mini-Balance-Evaluation-Systems-Tests (Mini-BESTest) and its sub-scores on BCSes, namely anticipatory postural adjustments (APA), reactive postural control (RPC), sensory orientation (SO), and dynamic gait (DG). Their scoring ranges should be 0-28, 0-6, 0-6, 0-6, and 0-10, respectively. The results show that their minimum mean absolute errors from AI estimation reach up to 2.658, 0.827, 0.970, 0.642, and 0.98, respectively. In sum, our study is a preliminary study for assessing BCSes based on AI, which shows its possibility to be used in the clinics in the future.

Gait Biomarkers Classification by Combining Assembled Algorithms and Deep Learning: Results of a Local Study

Machine learning, one of the core disciplines of artificial intelligence, is an approach whose main emphasis is analytical model building. In other words, machine learning enables an automaton to make its own decisions based on a previous training process. Machine learning has revolutionized every research sector, including health care, by providing precise and accurate decisions involving minimal human interventions through pattern recognition. This is emphasized in this research, which addresses the issue of “support for diabetic neuropathy (DN) recognition.” DN is a disease that affects a large proportion of the global population. In this research, we have used gait biomarkers of subjects representing a particular sector of population located in southern Mexico to identify persons suffering from DN. To do this, we used a home-made body sensor network to capture raw data of the walking pattern of individuals with and without DN. The information was then processed using three sampling criteria and 23 assembled classifiers, in combination with a deep learning algorithm. The architecture of the best combination was chosen and reconfigured for better performance. The results revealed a highly acceptable classification with greater than 85% accuracy when using these combined approaches.

Influence of Diabetic Distal Symmetric Polyneuropathy on the Performance of the Musculoskeletal System of Lower Leg and Foot

Introduction:

Complications on the lower extremities are a major cause of morbidity, disability, emotional and physical suffering in people with diabetes. Diabetic neuropathy (DN) is the most frequent complication of both types of diabetes. Lack of performance of the musculoskeletal system of lower leg and foot can results in high focal plantar pressures with increased ulceration risk in patients with neuropathy.

Aim:

To determine the impact of the severity of distal symmetric polyneuropathy (DSPN) on the foot and ankle muscle strength and the range of motion (ROM) at ankle joint (AJ), subtalar joint (SJ) and first metatarsophalangeal joint (I MTP).

Methods:

A cross-sectional study was conducted among 100 diabetic patients. The level of DSPN was assessed using the Neuropathy Disability Score. Function of ten foot and ankle muscles has been evaluated by manual muscle testing. Muscle strength was scored by semiquantitative grading system used in the Michigan Diabetic Neuropathy Score. ROM at the AJ, SJ and I MTP was measured with goniometer.

Results:

The average patients age was 61.91±10.74 and diabetes duration 12.25±8.60 years. DSPN was present in 45% of patients. The average strength of foot and ankle muscles expressed by muscle score was 11.56±5.08. The average ROM at AJ was 47.85°, at SJ 35.10° and at I MTP 72.70°. Correlations between the severity of the DSPN and muscle function, ROM at AJ, SJ and I MTP were statistically significant. ROM at SJ and I MTP declines significantly with progression of neuropathy but not significant at AJ.

Conclusion:

The severity of DSPN is significantly associated with foot and ankle muscle weakness and ROM at the SJ and the I MTP, but not significantly with the ROM at the AJ.

Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy

PURPOSE

The aim of the study was to evaluate the effect of sensorimotor training on balance measures, and proprioception, among middle-aged and older adults with diabetic peripheral neuropathy (DPN).

METHODS

A randomized controlled study with four parallel arms (two intervention groups and two control groups) was conducted at CPRS, Jamia Millia Islamia. Thirty-seven individuals were selected on the basis of inclusion and exclusion criteria. Of these, 16 middle-aged and 21 older adults were randomly allocated to intervention and control groups, respectively. Subjects in the intervention group were administered eight weeks (3days/week) of sensorimotor training, involving 10 different types of exercises, progressed from easy to hard every two weeks, along with diabetes and foot care education; subjects in control group received diabetes and foot care education only. Outcomes measures involved static and dynamic balance measures, centre of pressure (COP) range, COP sway, and proprioception, measured before and after eight weeks.

RESULTS

Baseline measures showed significant age effect for timed up and go test (TUG) (p =  0.002), one leg stance (OLS) in eyes open (EO) and eyes closed (EC) (p ≤ 0.041), COP range in front (p =  0.007), back (p =  0.009) and right direction (p =  0.013), COP sway with visual feedback in front-back direction (p =  0.027), COP sway without visual feedback in left-right direction (p =  0.028), and proprioception in right direction (p =  0.026). After intervention, OLS EO and EC on both legs showed significant time effect (p ≤  0.003), group effect as well as time×group interaction (p <  0.05), and age effect and time×age interaction (p ≤  0.04). Functional reach test, TUG, COP range, COP sway, and proprioception were found with significant time effect (p <  0.03), group effect, and time×group interaction (p ≤  0.035). Age effect and time×age interaction were found to be non-significant for all COP ranges and COP sway.

CONCLUSION

Sensorimotor training improved static and dynamic balance as well as proprioception measures after eight weeks of exercise intervention. Static balance showed greater improvement in the middle-aged than older aged adults, while dynamic balance and proprioception showed similar results for both.

Translation and Psychometric Properties of the Arabic Version of Michigan Neuropathy Screening Instrument in Type 2 Diabetes

OBJECTIVE

To translate the patient questionnaire section of the Michigan Neuropathy Screening Instrument (MNSI) into Arabic, examine the reliability of the translated version, and provide descriptive data on a sample of patients with type 2 diabetes.

METHODS

Researchers used the translation-back translation method to obtain MNSI Arabic. The test was then applied on 76 patients with type 2 diabetes. A subgroup of 25 patients answered MNSI Arabic twice to examine reliability.

RESULTS

The intraclass correlation coefficient was 0.87, revealing good reliability of MNSI Arabic. The most common symptoms patients complained of were numbness (62%), prickling feelings (57%), burning pain (47%), and pain with walking (46%).

CONCLUSION

Similar to the original MNSI version, our study demonstrates that the Arabic version of the MNSI questionnaire is a reliable tool for screening the symptomatic neuropathy status in patients with type 2 diabetes. Availability of this tool in Arabic will provide valuable and easy-to-obtain screening information regarding diabetic peripheral neuropathy that may help delay its complications by promoting early management.

Lower cerebral vasoreactivity as a predictor of gait speed decline in type 2 diabetes mellitus

Gait speed is an indicator of overall functional health and is correlated with survival in older adults. We prospectively evaluated the long-term association between cerebral vasoreactivity and gait speed during normal walking (NW) and dual-task walking (DTW) in older adults with and without type 2 diabetes mellitus (T2DM). 40 participants (aged 67.3 ± 8.8 years, 20 with T2DM) completed a 2-year prospective study consisting of MRI, blood sampling, and gait assessments. The whole brain vasoreactivity was quantified using continuous arterial spin labeling MRI. Gait speed during DTW was assessed by subtracting serial sevens. Dual-task cost was calculated as the percent change in gait speed from NW to DTW. In the entire cohort, higher glycemic profiles were associated with a slower gait speed. In the diabetic group, lower vasoreactivity was associated with a slower gait speed during NW ([Formula: see text] = 0.30, p = 0.019) and DTW ([Formula: see text] = 0.35, p = 0.01) and a higher dual-task cost ([Formula: see text] = 0.69, p = 0.009) at 2-year follow-up. The participants with T2DM and lower cerebral vasoreactivity had a greater decrease in gait speed during NW and DTW after the 2-year follow-up ([Formula: see text] = 0.17, p = 0.04 and [Formula: see text] = 0.28, p = 0.03, respectively). Longer diabetes duration was associated with a higher dual-task cost ([Formula: see text] = 0.19, p = 0.04) and a greater decrease in gait speed during NW ([Formula: see text] = 0.17, p = 0.02). These findings indicate that in older adults with type 2 diabetes, gait performance is highly dependent on the integrity of cerebrovascular regulation.

Influence of Exergaming on the Perception of Cancer-Related Fatigue

OBJECTIVE

Exercise is recommended for cancer patients to reduce fatigue and improve quality of life. This study's aim is to evaluate the influence of an exergaming protocol on cancer-related fatigue, muscle fatigue, and muscle strength in cancer patients.

MATERIALS AND METHODS

We conducted a quasi-experimental control study using exergaming in all groups through an Xbox360 Kinect™ console, two to three times per week, for 20 sessions. Three groups were created: cancer patients in chemotherapy and/or radiotherapy group (CRG; n:15), cancer patients after chemotherapy and/or radiotherapy (CAG; n:15), and a control group (CG; n:15). They were assessed for cancer-related fatigue using the fatigue subscale of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. To assess dorsiflexor and plantar flexor muscle functioning, we used median frequency (MDF) of the surface electromyography and muscle strength using a dynamometer. The assessments were performed preintervention (EV0), after 10 sessions (EV1), and after 20 sessions (EV2).

RESULTS

With an exergaming protocol, CRG and CAG showed a reduction in related fatigue compared with CG (P < 0.01). The CRG group saw an increase in maximal voluntary isometric contraction in right plantar flexor muscles and dorsiflexor muscles, as well as an increase in the MDF of both medial gastrocnemius muscles and the left tibialis anterior muscle of the CAG. For other analyses done, the differences were observed during exergaming.

CONCLUSIONS

Exergaming demonstrated efficacy in reducing cancer patients' fatigue, including muscle fatigue, and increasing muscle strength in patients' legs.

Effects of whole-body vibration therapy on perception thresholds of type 2 diabetic patients with peripheral neuropathy: a randomized controlled trial

[Purpose] The aim of this study was to investigate the effect of whole-body vibration training on perception thresholds in type 2 diabetic patients with peripheral neuropathy. [Subjects and Methods] Fifty-nine patients with diabetic neuropathy participated in the study. They were randomly divided into the experimental group (n=29) and the control group (n=30). The experimental group performed whole-body vibration training, whereas the control group performed only lower body training in the same posture without using whole-body vibrator for 6 weeks. Perception threshold variables were measured to examine the effect of training. [Results] Warm and cold pain thresholds did not show significant changes in both groups before and after training. Vibration perception threshold showed significant improvement in the experimental group. [Conclusion] Our findings suggest that whole-body vibration training can improve vibration perception threshold of type 2 diabetic patients with peripheral neuropathy.

Gait and Functional Mobility Deficits in Fragile X-Associated Tremor/Ataxia Syndrome

Fragile X-associated tremor/ataxia syndrome (FXTAS) results from a "premutation" (PM) size CGG repeat expansion in the fragile X mental retardation 1 (FMR1) gene. Cerebellar gait ataxia is the primary feature in some FXTAS patients causing progressive disability. However, no studies have quantitatively characterized gait and mobility deficits in FXTAS. We performed quantitative gait and mobility analysis in seven FMR1 PM carriers with FXTAS and ataxia, six PM carriers without FXTAS, and 18 age-matched controls. We studied four independent gait domains, trunk range of motion (ROM), and movement transitions using an instrumented Timed Up and Go (i-TUG). We correlated these outcome measures with FMR1 molecular variables and clinical severity scales. PM carriers with FXTAS were globally impaired in every gait performance domain except trunk ROM compared to controls. These included total i-TUG duration, stride velocity, gait cycle time, cadence, double-limb support and swing phase times, turn duration, step time before turn, and turn-to-sit duration, and increased gait variability on several measures. Carriers without FXTAS did not differ from controls on any parameters, but double-limb support time was close to significance. Balance and disability scales correlated with multiple gait and movement transition parameters, while the FXTAS Rating Scale did not. This is the first study to quantitatively examine gait and movement transitions in FXTAS patients. Gait characteristics were consistent with those from previous cohorts with cerebellar ataxia. Sensitive measures like the i-TUG may help determine efficacy of interventions, characterize disease progression, and provide early markers of disease in FXTAS.

Postural Control and Gait Performance in the Diabetic Peripheral Neuropathy: A Systematic Review

Purpose. The aim of this paper is to review the published studies on the characteristics of impairments in the postural control and gait performance in diabetic peripheral neuropathy (DPN). Methods. A review was performed by obtaining publication of all papers reporting on the postural control and gait performance in DPN from Google Scholar, Ovid, SAGE, Springerlink, Science Direct (SD), EBSCO Discovery Service, and Web of Science databases. The keywords used for searching were “postural control,” “balance,” “gait performance,” “diabetes mellitus,” and “diabetic peripheral neuropathy.” Results. Total of 4,337 studies were hit in the search. 1,524 studies were screened on their titles and citations. Then, 79 studies were screened on their abstract. Only 38 studies were eligible to be selected: 17 studies on postural control and 21 studies on the gait performance. Most previous researches were found to have strong evidence of postural control impairments and noticeable gait deficits in DPN. Deterioration of somatosensory, visual, and vestibular systems with the pathologic condition of diabetes on cognitive impairment causes further instability of postural and gait performance in DPN. Conclusions. Postural instability and gait imbalance in DPN may contribute to high risk of fall incidence, especially in the geriatric population. Thus, further works are crucial to highlight this fact in the hospital based and community adults.