1
|
Rodrigues CB, Soares PNC, Schmitt ACB, Sacco ICN. Implementing a contextually appropriate foot-ankle exercise programme in primary care for the prevention of modifiable risk factors for ulcers in people with diabetes: protocol for a hybrid type 2 study. BMJ Open 2024; 14:e078958. [PMID: 38316587 PMCID: PMC10860075 DOI: 10.1136/bmjopen-2023-078958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Diabetes is a highly prevalent disease that negatively impacts people's health and quality of life. It can result in diabetic peripheral neuropathy (DPN) and foot complications, which in turn lead to ulcers and amputations. The international guidelines on diabetic foot included specific foot-ankle exercises as preventive strategy capable of modifying the risk factors for ulcers. Our aim is to test the effectiveness and to implement a contextually appropriate preventive intervention-a foot-ankle exercises programme alongside educational strategies-in a primary care setting to improve range of motion (ROM), strength, functionality of foot-ankle, and quality of life in people with diabetes. METHODS AND ANALYSIS This is a hybrid type 2 implementation-effectiveness study organised in four phases, being undertaken in Limeira, São Paulo. Phase 1, preimplementation, aims to gather information about the contextual characteristics, barriers, and facilitators and to form the implementation team. In phase 2, the implementation team will structure the foot-ankle programme, adapting it to the context of primary healthcare, and develop the training for health professionals. In phase 3, effectiveness of the 12 week group-based intervention will be tested by a cluster randomised controlled trial. Primary care units (18 clusters) will be randomly allocated to a control or intervention group, with a total sample of 356 people. Primary outcomes will be DPN symptoms and ankle and first metatarsal phalangeal joint ROM. Reach, adoption, and implementation will be evaluated by Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. In phase 4, maintenance and expansion of the programme in the municipality will be assessed. ETHICS AND DISSEMINATION This protocol and the informed consent to be signed by the participants were approved by the Ethics Committee of the School of Medicine of the University of São Paulo (CAAE:63457822.0.0000.0068, 29 November 2022). The project will generate and share data in a public repository. Results will be disseminated through peer-reviewed journals, conference proceedings, and electronic communications for health professionals. TRIAL REGISTRATION NUMBER NCT05639478.
Collapse
Affiliation(s)
- Carla B Rodrigues
- School of Medicine, Physical Therapy, Speech and Occupational Therapy Dept, University of São Paulo, São Paulo, Brazil
| | - Paula N C Soares
- School of Medicine, Physical Therapy, Speech and Occupational Therapy Dept, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina B Schmitt
- School of Medicine, Physical Therapy, Speech and Occupational Therapy Dept, University of São Paulo, São Paulo, Brazil
| | - Isabel C N Sacco
- School of Medicine, Physical Therapy, Speech and Occupational Therapy Dept, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Shahrjerdi S, Bahrpeyma F, Bagherian SA. Acute short term effects of endurance and resistance training on balance control in patients with diabetic peripheral neuropathy. Int J Neurosci 2023; 133:1017-1023. [PMID: 35109765 DOI: 10.1080/00207454.2022.2033739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/08/2020] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Exercise training have numerous beneficial effects on the complications of diabetic peripheral neuropathy. Exercise training may cause immediate effects on balance control in DPN patients. This study aims to assess the Acute Short Term effects of endurance and resistance exercise training on balance control in DPN patients. METHODS In this study, 11 patients with DPN and 11 healthy subjects participated. Patients and healthy subjects did endurance and resistance training in two separate exercise sessions. Dynamic balance and functional balance test were assessed before and after the interventions. Independent t-test was used to compare balance indices before and after training, the intervention effects were examined using ANOVA repeated measure test. The statistical significance level was set at p < 0.05. RESULTS The results showed that dynamic and functional balance in DPN patients were significantly lower than in healthy subjects. Anterior-posterior stability and total stability indices and functional balance test deteriorated significantly after training. CONCLUSION Endurance or resistance training may lead to acute disturbance of dynamic and functional balance in DPN patients. Hence, immediately after exercise, patients with diabetes are at an increased risk of falling, therefore, preventive considerations are necessary.
Collapse
Affiliation(s)
- Samira Shahrjerdi
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Seyed Ahmad Bagherian
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
3
|
Monteiro RL, Ferreira JSSP, Silva ÉQ, Cruvinel-Júnior RH, Veríssimo JL, Bus SA, Sacco ICN. Effects of foot-ankle exercises on foot-ankle kinematics, plantar pressure, and gait kinetics in people with diabetic neuropathy: Secondary outcomes from a randomized controlled trial. Braz J Phys Ther 2023; 27:100517. [PMID: 37348358 DOI: 10.1016/j.bjpt.2023.100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/22/2022] [Accepted: 06/01/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Follow-up report of secondary outcomes of a randomized, single-blinded, parallel controlled trial that investigated the benefits of a foot-ankle therapeutic exercise program on foot-ankle kinematics, plantar pressure, and lower limb kinetics during gait in individuals with diabetic neuropathy (DPN). METHODS Sixty-six participants with DPN were randomly allocated into a control group (CG; n = 31), which received usual care, and an intervention group (IG; n = 35), which received usual care plus a 12-week group-based foot-ankle exercise program. Outcomes were assessed at baseline and 12 weeks by an assessor blinded to group allocation. RESULTS The generalized linear mixed model and intention-to-treat analysis revealed a greater hip extensor moment at push-off and greater hallux contact area in the IG than CG after 12 weeks. A within-group analysis revealed a larger arch height during stance and higher peak pressure and pressure-time integral at the central forefoot region in the IG after 12 weeks compared to baseline. There were no other significant group difference or changes over time in foot-ankle kinematics or in any other joint moment related to overall lower limb biomechanics. CONCLUSION The increases in hip moment at push-off and hallux surface contact area suggest an improvement in the propulsion phase with greater participation of the toes in foot rollover after 12 weeks of a group-based foot-ankle exercises program for people with DPN. Individual face-to-face, longer-term, and more intensive interventions may be needed to positively influence foot-ankle biomechanics and pressure parameters in other plantar areas.
Collapse
Affiliation(s)
- Renan L Monteiro
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Department of Health and Biological Science, Universidade Federal do Amapá, Macapá, AP, Brazil
| | - Jane S S P Ferreira
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Érica Q Silva
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ronaldo H Cruvinel-Júnior
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jady L Veríssimo
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
4
|
Sacco ICN, Trombini-Souza F, Suda EY. Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: A 50-year perspective. J Biomech 2023; 154:111604. [PMID: 37159980 DOI: 10.1016/j.jbiomech.2023.111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
The pivotal role of biomechanics in the past 50 years in consolidating the basic knowledge that underpins prevention and rehabilitation measures has made this area a great spotlight for health practitioners. In clinical practice, biomechanics analysis of spatiotemporal, kinematic, kinetic, and electromyographic data in various chronic conditions serves to directly enhance deeper understanding of locomotion and the consequences of musculoskeletal dysfunctions in terms of motion and motor control. It also serves to propose straightforward and tailored interventions. The importance of this approach is supported by myriad biomechanical outcomes in clinical trials and by the development of new interventions clearly grounded on biomechanical principles. Over the past five decades, therapeutic interventions have been transformed from fundamentally passive in essence, such as orthoses and footwear, to emphasizing active prevention, including exercise approaches, such as bottom-up and top-down strengthening programs for runners and people with osteoarthritis. These approaches may be far more effective inreducing pain, dysfunction, and, ideally, incidence if they are based on the biomechanical status of the affected person. In this review, we demonstrate evidence of the impact of biomechanics and motion analysis as a foundation for physical therapy/rehabilitation and preventive strategies for three chronic conditions of high worldwide prevalence: diabetes and peripheral neuropathy, knee osteoarthritis, and running-related injuries. We conclude with a summary of recommendations for future studies needed to address current research gaps.
Collapse
Affiliation(s)
- Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Francis Trombini-Souza
- Department of Physical Therapy, University of Pernambuco, Petrolina, Pernambuco, Brazil; Master's and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Eneida Yuri Suda
- Postgraduate Program in Physiotherapy, Universidade Ibirapuera, São Paulo, Brazil
| |
Collapse
|
5
|
Chan JS, Mann LM, Doherty CJ, Angus SA, Thompson BP, Devries MC, Hughson RL, Dominelli PB. The effect of inspiratory muscle training and detraining on the respiratory metaboreflex. Exp Physiol 2023; 108:636-649. [PMID: 36754374 PMCID: PMC10103864 DOI: 10.1113/ep090779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/13/2022] [Indexed: 02/10/2023]
Abstract
NEW FINDINGS What is the central question of this study? Is the attenuation of the respiratory muscle metaboreflex preserved after detraining? What is the main finding and its importance? Inspiratory muscle training increased respiratory muscle strength and attenuated the respiratory muscle metaboreflex as evident by lower heart rate and blood pressure. After 5 weeks of no inspiratory muscle training (detraining), respiratory muscle strength was still elevated and the metaboreflex was still attenuated. The benefits of inspiratory muscle training persist after cessation of training, and attenuation of the respiratory metaboreflex follows changes in respiratory muscle strength. ABSTRACT Respiratory muscle training (RMT) improves respiratory muscle (RM) strength and attenuates the RM metaboreflex. However, the time course of muscle function loss after the absence of training or 'detraining' is less known and some evidence suggest the respiratory muscles atrophy faster than other muscles. We sought to determine the RM metaboreflex in response to 5 weeks of RMT and 5 weeks of detraining. An experimental group (2F, 6M; 26 ± 4years) completed 5 weeks of RMT and tibialis anterior (TA) training (each 5 days/week at 50% of maximal inspiratory pressure (MIP) and 50% maximal isometric force, respectively) followed by 5 weeks of no training (detraining) while a control group (1F, 7M; 24 ± 1years) underwent no intervention. Prior to training (PRE), post-training (POST) and post-detraining (DETR), all participants underwent a loaded breathing task (LBT) to failure (60% MIP) while heart rate and mean arterial blood pressure (MAP) were measured. Five weeks of training increased RM (18 ± 9%, P < 0.001) and TA (+34 ± 19%, P < 0.001) strength and both remained elevated after 5 weeks of detraining (MIP-POST vs. MIP-DETR: 154 ± 31 vs. 153 ± 28 cmH2O, respectively, P = 0.853; TA-POST vs. TA-DETR: 86 ± 19 vs. 85 ± 16 N, respectively, P = 0.982). However, the rise in MAP during LBT was attenuated POST (-11 ± 17%, P = 0.003) and DETR (-9 ± 9%, P = 0.007) during the iso-time LBT. The control group had no change in MIP (P = 0.33), TA strength (P = 0.385), or iso-time MAP (P = 0.867) during LBT across all time points. In conclusion, RM and TA have similar temporal strength gains and the attenuation of the respiratory muscle metaboreflex remains after 5 weeks of detraining.
Collapse
Affiliation(s)
- Jason S. Chan
- Department of Kinesiology and Health SciencesFaculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - Leah M. Mann
- Department of Kinesiology and Health SciencesFaculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - Connor J. Doherty
- Department of Kinesiology and Health SciencesFaculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - Sarah A. Angus
- Department of Kinesiology and Health SciencesFaculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - Benjamin P. Thompson
- Department of Kinesiology and Health SciencesFaculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - Michaela C. Devries
- Department of Kinesiology and Health SciencesFaculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - Richard L. Hughson
- Department of Kinesiology and Health SciencesFaculty of HealthUniversity of WaterlooWaterlooOntarioCanada
- Schlegel‐UW Research Institute for AgingWaterlooOntarioCanada
| | - Paolo B. Dominelli
- Department of Kinesiology and Health SciencesFaculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| |
Collapse
|
6
|
Haque F, Reaz MBI, Chowdhury MEH, Ezeddin M, Kiranyaz S, Alhatou M, Ali SHM, Bakar AAA, Srivastava G. Machine Learning-Based Diabetic Neuropathy and Previous Foot Ulceration Patients Detection Using Electromyography and Ground Reaction Forces during Gait. SENSORS (BASEL, SWITZERLAND) 2022; 22:3507. [PMID: 35591196 PMCID: PMC9100406 DOI: 10.3390/s22093507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
Diabetic neuropathy (DN) is one of the prevalent forms of neuropathy that involves alterations in biomechanical changes in the human gait. Diabetic foot ulceration (DFU) is one of the pervasive types of complications that arise due to DN. In the literature, for the last 50 years, researchers have been trying to observe the biomechanical changes due to DN and DFU by studying muscle electromyography (EMG) and ground reaction forces (GRF). However, the literature is contradictory. In such a scenario, we propose using Machine learning techniques to identify DN and DFU patients by using EMG and GRF data. We collected a dataset from the literature which involves three patient groups: Control (n = 6), DN (n = 6), and previous history of DFU (n = 9) and collected three lower limb muscles EMG (tibialis anterior (TA), vastus lateralis (VL), gastrocnemius lateralis (GL)), and three GRF components (GRFx, GRFy, and GRFz). Raw EMG and GRF signals were preprocessed, and different feature extraction techniques were applied to extract the best features from the signals. The extracted feature list was ranked using four different feature ranking techniques, and highly correlated features were removed. In this study, we considered different combinations of muscles and GRF components to find the best performing feature list for the identification of DN and DFU. We trained eight different conventional ML models: Discriminant analysis classifier (DAC), Ensemble classification model (ECM), Kernel classification model (KCM), k-nearest neighbor model (KNN), Linear classification model (LCM), Naive Bayes classifier (NBC), Support vector machine classifier (SVM), and Binary decision classification tree (BDC), to find the best-performing algorithm and optimized that model. We trained the optimized the ML algorithm for different combinations of muscles and GRF component features, and the performance matrix was evaluated. Our study found the KNN algorithm performed well in identifying DN and DFU, and we optimized it before training. We found the best accuracy of 96.18% for EMG analysis using the top 22 features from the chi-square feature ranking technique for features from GL and VL muscles combined. In the GRF analysis, the model showed 98.68% accuracy using the top 7 features from the Feature selection using neighborhood component analysis for the feature combinations from the GRFx-GRFz signal. In conclusion, our study has shown a potential solution for ML application in DN and DFU patient identification using EMG and GRF parameters. With careful signal preprocessing with strategic feature extraction from the biomechanical parameters, optimization of the ML model can provide a potential solution in the diagnosis and stratification of DN and DFU patients from the EMG and GRF signals.
Collapse
Affiliation(s)
- Fahmida Haque
- Department of Electrical, Electronic and System Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (F.H.); (S.H.M.A.); (A.A.A.B.)
| | - Mamun Bin Ibne Reaz
- Department of Electrical, Electronic and System Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (F.H.); (S.H.M.A.); (A.A.A.B.)
| | | | - Maymouna Ezeddin
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar; (M.E.); (S.K.)
| | - Serkan Kiranyaz
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar; (M.E.); (S.K.)
| | - Mohammed Alhatou
- Neuromuscular Division, Hamad General Hospital, Doha 3050, Qatar;
- Department of Neurology, Al khor Hospital, Doha 3050, Qatar
| | - Sawal Hamid Md Ali
- Department of Electrical, Electronic and System Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (F.H.); (S.H.M.A.); (A.A.A.B.)
| | - Ahmad Ashrif A Bakar
- Department of Electrical, Electronic and System Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (F.H.); (S.H.M.A.); (A.A.A.B.)
| | - Geetika Srivastava
- Department of Physics and Electronics, Dr. Ram Manohar Lohia Avadh University, Faizabad, Uttar Pradesh 224001, India;
| |
Collapse
|
7
|
Muscle forces and power are significantly reduced during walking in patients with peripheral artery disease. J Biomech 2022; 135:111024. [PMID: 35248803 PMCID: PMC9064980 DOI: 10.1016/j.jbiomech.2022.111024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/21/2022]
Abstract
Patients with peripheral artery disease (PAD) have significantly reduced lower extremity muscle strength compared with healthy individuals as measured during isolated, single plane joint motion by isometric and isokinetic strength dynamometers. Alterations to the force contribution of muscles during walking caused by PAD are not well understood. Therefore, this study used simulations with PAD biomechanics data to understand lower extremity muscle functions in patients with PAD during walking and to compare that with healthy older individuals. A total of 12 patients with PAD and 10 age-matched healthy older controls walked across a 10-meter pathway with reflective markers on their lower limbs. Marker coordinates and ground reaction forces were recorded and exported to OpenSim software to perform gait simulations. Walking velocity, joint angles, muscle force, muscle power, and metabolic rate were calculated and compared between patients with PAD and healthy older controls. Our results suggest that patients with PAD walked slower with less hip extension during propulsion. Significant force and power reductions were observed in knee extensors during weight acceptance and in plantar flexors and hip flexors during propulsion in patients with PAD. The estimated metabolic rate of walking during stance was not different between patients with PAD and controls. This study is the first to analyze lower limb muscular responses during walking in patients with PAD using the OpenSim simulation software. The simulation results of this study identified important information about alterations to muscle force and power during walking in those with PAD.
Collapse
|
8
|
Ravanbod R, Eslami N, Ashtiani MN. Immediate effects of footwear with vibration applied to the swing phase of the gait cycle on dynamic balance in patients with diabetic peripheral neuropathy. J Biomech 2021; 128:110710. [PMID: 34474373 DOI: 10.1016/j.jbiomech.2021.110710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022]
Abstract
Sensory and sub-sensory foot vibration have beneficial effects on the static and dynamic balance of patients with diabetic peripheral neuropathy (DPN). Previous foot vibration during walking was applied at sub-sensory threshold in both stance and swing phases of the gait cycle in DPN. This study aimed to investigate the effects of footwear with vibration above the sensory threshold applied to the swing phase of the gait cycle on the dynamic balance of DPN. Fifteen patients with DPN and 10 matched healthy control participants were enrolled in this study. Dynamic balance assessment was investigated by the sit to stand and turn tests while electromyography activity (root mean square, RMS) of the vastus lateralis (VL), tibialis anterior (TA), and peroneus longus (PL) muscles were recorded at baseline, after 10 min of wearing the vibratory sandal without vibration, and after 10 min of wearing the sandal with vibration. Repeated measure analysis of variance was conducted for data analysis. Wearing the vibratory sandal slightly increased the speed of weight transfer in both groups and COP sway in DPN (P > 0.05), and close to significant decrease of turn sway (P = 0.07) in both groups. There were significant differences of the PL RMS in turn test (P = 0.03) in DPN and peak RMS of the PL after 10 min of wearing the sandal with vibration in both groups (P < 0.05). The results of the present study demonstrated that PL activity was significantly influenced by the vibratory sandal as its tendon passing across the sole and in direct contact with the source of the vibration.
Collapse
Affiliation(s)
- Roya Ravanbod
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115-111, Iran.
| | - Niloofar Eslami
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115-111, Iran
| | - Mohammed N Ashtiani
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115-111, Iran
| |
Collapse
|
9
|
Han B, Wang B. MUSCULOSKELETAL TRAINING AND MECHANICAL CHARACTERISTICS OF ATHLETES. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127072021_0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: Studying the biomechanical characteristics of lower limb muscles during depth jumps is of great significance, but it is also important in meeting the practical needs of strength training. Objective: To explore the musculoskeletal exercise training and mechanical characteristics of athletes’ lower limbs. Methods: Analysis and discussion of the test results of kinematics, dynamics and the EMG of 8 muscles of the lower extremity when athletes jump at different falling heights and different motion states. Results: only by using different falling heights in a certain proportion can training efficiency be improved and the training effect of depth jumps reach the practical purpose of sports training. Conclusions: from the point of view of exercise physiology, the generation, storage and reuse of muscle elastic deformation energy and the reflex regulation of the central nervous system are the main reasons for the economic and efficient contractive ability of the extensor muscle group of lower limbs during depth jumps. From the point of view of muscle mechanical properties, the centrifugal contractility of lower limb muscles is the primary factor that determines the athletes’ lower limb muscle explosive push ability. Level of evidence II; Therapeutic studies - investigation of treatment results.
Collapse
Affiliation(s)
- Bo Han
- Lanzhou City University, China
| | | |
Collapse
|
10
|
Robinson MA, Vanrenterghem J, Pataky TC. Sample size estimation for biomechanical waveforms: Current practice, recommendations and a comparison to discrete power analysis. J Biomech 2021; 122:110451. [PMID: 33933866 DOI: 10.1016/j.jbiomech.2021.110451] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022]
Abstract
Testing a prediction is fundamental to scientific experiments. Where biomechanical experiments involve analysis of 1-Dimensional (waveform) data, sample size estimation should consider both 1D variance and hypothesised 1D effects. This study exemplifies 1D sample size estimation using typical biomechanical signals and contrasts this with 0D (discrete) power analysis. For context, biomechanics papers from 2018 and 2019 were reviewed to characterise current practice. Sample size estimation occurred in approximately 4% of 653 papers and reporting practice was mixed. To estimate sample sizes, common biomechanical signals were sourced from the literature and 1D effects were generated artificially using the open-source power1d software. Smooth Gaussian noise was added to the modelled 1D effect to numerically estimate the sample size required. Sample sizes estimated using 1D power procedures varied according to the characteristics of the dataset, requiring only small-to-moderate sample sizes of approximately 5-40 to achieve target powers of 0.8 for reported 1D effects, but were always larger than 0D sample sizes (from N + 1 to >N + 20). The importance of a priori sample size estimation is highlighted and recommendations are provided to improve the consistency of reporting. This study should enable researchers to construct 1D biomechanical effects to address adequately powered, hypothesis-driven, predictive research questions.
Collapse
Affiliation(s)
- Mark A Robinson
- School of Sport and Exercise Sciences, Liverpool John Moores University, UK.
| | - Jos Vanrenterghem
- Musculoskeletal Rehabilitation Research Group, Faculty of Movement and Rehabilitation Sciences, Leuven KU, Belgium
| | - Todd C Pataky
- Department of Human Health Sciences, Kyoto University, Japan
| |
Collapse
|
11
|
Rippetoe J, Wang H, James SA, Dionne C, Block B, Beckner M. Improvement of Gait after 4 Weeks of Wearable Focal Muscle Vibration Therapy for Individuals with Diabetic Peripheral Neuropathy. J Clin Med 2020; 9:E3767. [PMID: 33266464 PMCID: PMC7700661 DOI: 10.3390/jcm9113767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
People with diabetic peripheral neuropathy (DPN) experience lower quality of life caused by associated balance, posture, and gait impairments. While focal muscle vibration (FMV) has been associated with improvements in gait performance in individuals with neurological disorders, little is known about its effectiveness in patients with DPN. The purpose of this study was to investigate the effect of FMV on gait outcomes in patients with DPN. The authors randomized 23 participants into three FMV intervention groups depending upon the delivery of vibration. Participants applied wearable FMV to the bilateral quadriceps, gastrocnemius, and tibialis anterior, 10 min per muscle, three times per week over a four-week period. Spatiotemporal, kinematic, and kinetic gait parameters at baseline and post-intervention were calculated and analyzed. Gait speed, cadence, stride time, left and right stance time, duration of double limb support, and left and right knee flexor moments significantly improved after four weeks of FMV. Trends toward significant improvements were noted in maximum left and right knee flexion. Results indicate that FMV therapy was associated with improvements in gait parameters in individuals with DPN, warranting expanded study of FMV therapy for long-term gait performance improvement in these individuals.
Collapse
Affiliation(s)
- Josiah Rippetoe
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| | - Hongwu Wang
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
- Peggy and Charles Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Shirley A. James
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| | - Carol Dionne
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| | - Bethany Block
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| | - Matthew Beckner
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (J.R.); (S.A.J.); (C.D.); (B.B.); (M.B.)
| |
Collapse
|
12
|
Wearable Health Technology to Quantify the Functional Impact of Peripheral Neuropathy on Mobility in Parkinson's Disease: A Systematic Review. SENSORS 2020; 20:s20226627. [PMID: 33228056 PMCID: PMC7699399 DOI: 10.3390/s20226627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
The occurrence of peripheral neuropathy (PNP) is often observed in Parkinson’s disease (PD) patients with a prevalence up to 55%, leading to more prominent functional deficits. Motor assessment with mobile health technologies allows high sensitivity and accuracy and is widely adopted in PD, but scarcely used for PNP assessments. This review provides a comprehensive overview of the methodologies and the most relevant features to investigate PNP and PD motor deficits with wearables. Because of the lack of studies investigating motor impairments in this specific subset of PNP-PD patients, Pubmed, Scopus, and Web of Science electronic databases were used to summarize the state of the art on PNP motor assessment with wearable technology and compare it with the existing evidence on PD. A total of 24 papers on PNP and 13 on PD were selected for data extraction: The main characteristics were described, highlighting major findings, clinical applications, and the most relevant features. The information from both groups (PNP and PD) was merged for defining future directions for the assessment of PNP-PD patients with wearable technology. We established suggestions on the assessment protocol aiming at accurate patient monitoring, targeting personalized treatments and strategies to prevent falls and to investigate PD and PNP motor characteristics.
Collapse
|
13
|
Korada H, Maiya A, Rao SK, Hande M. Effectiveness of customized insoles on maximum plantar pressure in diabetic foot syndrome: A systematic review. Diabetes Metab Syndr 2020; 14:1093-1099. [PMID: 32652497 DOI: 10.1016/j.dsx.2020.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Diabetic foot syndrome is a severe complication of type 2 diabetes mellitus with diabetic peripheral neuropathy. Increased maximum plantar pressure is a strong predictor that may be detrimental and cause a plantar ulcer. This present systematic review aims to evaluate the effectiveness of customized insoles on reducing maximum plantar pressure in diabetic foot syndrome. METHODS We conducted a systematic review (PubMed, Cochrane Database of Systematic Reviews, CINAHL, Pedro, Scopus) to summarize the evidence on the customized insole on maximum plantar pressure in diabetic foot syndrome. Randomized and non-randomized studies were included in the review. The quality of the included studies was assessed independently by the two review authors with the Modified Downs and Black checklist for the assessment of the methodological quality of both randomized and non-randomized studies. RESULTS A total of 1512 studies screened. After the exclusion criteria, 5 studies were included in the study. The outcome measure that was considered is maximum plantar pressure and pressure-time integral. CONCLUSIONS We concluded that the practice of customized insoles could significantly reduce maximum plantar pressure. While developing an insole, parameters like contoured insoles with shape and pressure based, weight-bearing position, and duration with good adherence to footwear application can significantly reduce maximum plantar pressure.
Collapse
Affiliation(s)
- Hrishikesh Korada
- Centre for Diabetic Foot Care and Research, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Centre for Diabetic Foot Care and Research, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Sharath Kumar Rao
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Manjunath Hande
- Comprehensive Geriatric Clinic, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| |
Collapse
|
14
|
Liu C, Lv H, Niu P, Tan J, Ma Y. Association between diabetic neuropathy and osteoporosis in patients: a systematic review and meta-analysis. Arch Osteoporos 2020; 15:125. [PMID: 32779030 DOI: 10.1007/s11657-020-00804-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/31/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Many studies have explored the association between neuropathy and osteoporosis in patients with diabetes mellitus. However, the results still remain inconsistent and controversial. We aimed to estimate the association between diabetic neuropathy and osteoporosis. METHODS Databases, including PubMed, Embase, Web of Science, the Cochrane library, Chinese Biomedical Literature Database (CBM), and Wanfang, were screened from inception to 30 March 2020. Studies were selected and data were extracted by two independent reviewers. Study characteristics and quality sections were reviewed independently. Pooled ORs and 95% CIs were calculated using random effects model when evidence of heterogeneity was present; otherwise, fixed effects model was used. Meta-regression and subgroup analyses were performed to explore the source of heterogeneity. Sensitivity analysis and publication bias were also tested. RESULTS A total of 11 studies with 27,585 participants were included in this analysis which indicated that there was an increased odd between diabetic neuropathy and osteoporosis (overall OR 2.20, 95% CI 1.71-2.83). In the subgroup analyses and meta-regression, diabetic neuropathy has no significant difference in osteoporosis or fracture (p = 0.532). And osteoporosis also has no significant difference in type 1 or type 2 diabetic neuropathy (p = 0.668). CONCLUSIONS This meta-analysis suggests that patients with diabetic neuropathy have a significantly increased chance of developing osteoporosis, even fragility fracture. The clinicians should pay more attention to the patients with diabetic neuropathy. Further studies were still needed to explore the confounding factors among studies and to elucidate the underlying biological mechanisms.
Collapse
Affiliation(s)
- Chunhua Liu
- Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, 730000, People's Republic of China
| | - Haihong Lv
- Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, 730000, People's Republic of China.
| | - Peng Niu
- Department of Orthopaedics, Tongchuan Mining Central Hospital, The affiliated Shaanxi University of Chinese Medicine, 15 Chuankou Road, Tongchuan, Shaanxi, 727000, People's Republic of China
| | - Jiaojiao Tan
- Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, 730000, People's Republic of China
| | - Yuping Ma
- Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, 730000, People's Republic of China
| |
Collapse
|
15
|
Ferreira G, Silva-Filho E, de Oliveira A, de Lucena C, Lopes J, Pegado R. Transcranial direct current stimulation improves quality of life and physical fitness in diabetic polyneuropathy: a pilot double blind randomized controlled trial. J Diabetes Metab Disord 2020; 19:327-335. [PMID: 32550183 DOI: 10.1007/s40200-020-00513-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/09/2020] [Indexed: 12/30/2022]
Abstract
Purpose Diabetes Mellitus (DM) is a chronic disease which presents a big prevalence in the world and several patients with this condition fail to respond to the available treatments. There is a huge unmet clinical need for the development of new therapeutic approaches for this condition. This study aims to evaluate the effects of anodal tDCS on Quality of Life and physical fitness in patients with diabetic polyneuropathy. Methods A pilot, parallel, sham, randomized, double-blind trial was conducted with twenty patients. Five consecutive sessions of C3/Fp2 tDCS montage were performed. To assess the primary outcome Short Form 36 Health Survey (SF-36) was used. Physical fitness level, according to lower and upper body strength, flexibility, Time Up and Go Test (TUG) and Six-Minute Walking Test (6MWT) were measured as secondary outcomes. The measures were performed at 3 different times (baseline, 1st and 2nd weeks). Results SF-36 increased throughout the protocol, but no difference between groups were found. However, there was a significant difference between groups at 1st and 2nd weeks, which shows a permanent growth in the active-tDCS group. Physical health and functioning, functional capacity and bodily pain showed significant improvements in active-tDCS group in 1st and 2nd weeks during inter-group analysis. Emotional scores showed significant interaction group-time with interaction effects only for active-group in 1st and 2nd weeks. TUG and 6MWT showed significant improvements only in active-tDCS group. Conclusions It is suggested that five sessions of anodal M1 tDCS improves QoL and functionality of patients with diabetic polyneuropathy.
Collapse
Affiliation(s)
- Galeno Ferreira
- Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
| | - Edson Silva-Filho
- Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil.,Faculty of Health Science of Trairi, Federal University of Rio Grande do Norte, Trairi St, 59200- 000 Santa Cruz, RN Brazil
| | | | | | - Johnnatas Lopes
- Federal University Vale of São Francisco, Pernanbuco, Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
| |
Collapse
|
16
|
Ferreira JSSP, Cruvinel Junior RH, Silva EQ, Veríssimo JL, Monteiro RL, Pereira DS, Suda EY, Sartor CD, Sacco ICN. Study protocol for a randomized controlled trial on the effect of the Diabetic Foot Guidance System (SOPeD) for the prevention and treatment of foot musculoskeletal dysfunctions in people with diabetic neuropathy: the FOotCAre (FOCA) trial I. Trials 2020; 21:73. [PMID: 31931855 PMCID: PMC6958734 DOI: 10.1186/s13063-019-4017-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/19/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This study is part of a series of two clinical trials. Taking into account the various musculoskeletal alterations of the foot and ankle in people with diabetic peripheral neuropathy (DPN) and the need for self-care to avoid more serious dysfunctions and complications, a self-manageable exercise protocol that focuses on strengthening the foot muscles is presented as a potentially effective preventive method for foot and gait complications. The aim of this trial is to investigate the effect of a customized rehabilitation technology, the Diabetic Foot Guidance System (SOPeD), on DPN status, functional outcomes and gait biomechanics in people with DPN. METHODS/DESIGN Footcare (FOCA) trial I is a randomized, controlled and parallel two-arm trial with blind assessment. A total of 62 patients with DPN will be allocated into either a control group (recommended foot care by international consensus with no foot exercises) or an intervention group (who will perform exercises through SOPeD at home three times a week for 12 weeks). The exercise program will be customized throughout its course by a perceived effort scale reported by the participant after completion of each exercise. The participants will be assessed at three different times (baseline, completion at 12 weeks, and follow-up at 24 weeks) for all outcomes. The primary outcomes will be DPN symptoms and severity classification. The secondary outcomes will be foot-ankle kinematics and kinetic and plantar pressure distribution during gait, tactile and vibration sensitivities, foot health and functionality, foot strength, and functional balance. DISCUSSION As there is no evidence about the efficacy of rehabilitation technology in reducing DPN symptoms and severity or improving biomechanical, clinical, and functional outcomes for people with DPN, this research can contribute substantially to clarifying the therapeutic merits of software interventions. We hope that the use of our application for people with DPN complications will reduce or attenuate the deficits caused by DPN. This rehabilitation technology is freely available, and we intend to introduce it into the public health system in Brazil after demonstrating its effectiveness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.
Collapse
Affiliation(s)
- J. S. S. P. Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - R. H. Cruvinel Junior
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - E. Q. Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - J. L. Veríssimo
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - R. L. Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
- Department of Physical Therapy, Federal University of Amapá, Amapá, Brazil
| | - D. S. Pereira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - E. Y. Suda
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| | - C. D. Sartor
- Department of Physical Therapy, Ibirapuera University, São Paulo, SP Brazil
| | - I. C. N. Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo 05360-160 Brazil
| |
Collapse
|
17
|
Navarro-Flores E, Pérez-Ros P, Martínez-Arnau FM, Julían-Rochina I, Cauli O. Neuro-Psychiatric Alterations in Patients with Diabetic Foot Syndrome. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2019; 18:598-608. [DOI: 10.2174/1871527318666191002094406] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022]
Abstract
Diabetic Foot Syndrome (DFS) is a common long-term complication of diabetes mellitus.
DFS has recently been associated with adverse effects on brain function which could further impair the
quality of life of these patients, as well as increase the social and economic burden, morbidity, and
premature mortality of the disease. The current knowledge of neuropsychiatric alterations e.g. cognitive
impairment, gait disorder, depression, and quality of life in patients with diabetic foot syndrome is
summarized. The cognitive domains altered in DFS are executive function, memory, and psychomotor
speed. Compared to diabetic patients without DFS, individuals with DFS present gait alterations
caused by changes in several spatio-temporal parameters and lower-limb kinematics. The increased
rates of anxiety and depression among patients with DFS were related to several factors, including female
sex, a smoking habit, age under 50 years, and foot ulceration exceeding 7 months' duration. The
role of infections and the use of preventive antimicrobial treatment need further studies regarding their
effect on comorbid neuropsychiatric disorders. The care of these patients should include the prevention,
detection and treatment of these neuropsychiatric disorders in order to improve their quality of
life.
Collapse
Affiliation(s)
- Emmanuel Navarro-Flores
- Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia, Spain
| | - Pilar Pérez-Ros
- Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia, Spain
| | | | - Iván Julían-Rochina
- Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia, Spain
| | - Omar Cauli
- Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia, Spain
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW The goal of this review is to explore clinical associations between peripheral neuropathy and diabetic bone disease and to discuss how nerve dysfunction may contribute to dysregulation of bone metabolism, reduced bone quality, and fracture risk. RECENT FINDINGS Diabetic neuropathy can decrease peripheral sensation (sensory neuropathy), impair motor coordination (motor neuropathy), and increase postural hypotension (autonomic neuropathy). Together, this can impair overall balance and increase the risk for falls and fractures. In addition, the peripheral nervous system has the potential to regulate bone metabolism directly through the action of local neurotransmitters on bone cells and indirectly through neuroregulation of the skeletal vascular supply. This review critically evaluates existing evidence for diabetic peripheral neuropathy as a risk factor or direct actor on bone disease. In addition, we address therapeutic and experimental considerations to guide patient care and future research evaluating the emerging relationship between diabetic neuropathy and bone health.
Collapse
Affiliation(s)
- Alec T Beeve
- Department of Medicine, Division of Bone and Mineral Diseases, Washington University, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA
- Department of Biomedical Engineering, Washington University, 6201 Forsyth Blvd, Saint Louis, MO, 63105, USA
| | - Jennifer M Brazill
- Department of Medicine, Division of Bone and Mineral Diseases, Washington University, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA
| | - Erica L Scheller
- Department of Medicine, Division of Bone and Mineral Diseases, Washington University, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
- Department of Biomedical Engineering, Washington University, 6201 Forsyth Blvd, Saint Louis, MO, 63105, USA.
- Department of Cell Biology and Physiology, Washington University, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
| |
Collapse
|
19
|
Maharaj JN, Cresswell AG, Lichtwark GA. Tibialis anterior tendinous tissue plays a key role in energy absorption during human walking. ACTA ACUST UNITED AC 2019; 222:jeb.191247. [PMID: 31064856 DOI: 10.1242/jeb.191247] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/30/2019] [Indexed: 01/13/2023]
Abstract
The elastic tendinous tissues of distal lower limb muscles can improve the economy of walking and running, amplify the power generated by a muscle and absorb energy. This paper explores the behaviour of the tibialis anterior (TA) muscle and its tendinous tissue during gait, as it absorbs energy during contact and controls foot position during swing. Simultaneous measurements of ultrasound, surface electromyography and 3D motion capture with musculoskeletal modelling from 12 healthy participants were recorded as they walked at preferred and fast walking speeds. We quantified the length changes and velocities of the TA muscle-tendon unit (MTU) and its fascicles across the stride at each speed. Fascicle length changes and velocities were relatively consistent across speeds, although the magnitude of fascicle length change differed between the deep and superficial regions. At contact, when the TA is actively generating force, the fascicles remained relatively isometric as the MTU actively lengthened, presumably stretching the TA tendinous tissue and absorbing energy. This potentially protects the muscle fibres from damage during weight acceptance and allows energy to be returned to the system later in the stride. During early swing, the fascicles and MTU both actively shortened to dorsiflex the foot, clearing the toes from the ground; however, at the fast walking velocity, the majority of shortening occurred through tendinous tissue recoil, highlighting its role in accelerating ankle dorsiflexion to power rapid foot clearance in swing.
Collapse
Affiliation(s)
- Jayishni N Maharaj
- The University of Queensland, School of Human Movement and Nutrition Sciences, Centre for Sensorimotor Neuroscience, Brisbane, QLD 4072, Australia
| | - Andrew G Cresswell
- The University of Queensland, School of Human Movement and Nutrition Sciences, Centre for Sensorimotor Neuroscience, Brisbane, QLD 4072, Australia
| | - Glen A Lichtwark
- The University of Queensland, School of Human Movement and Nutrition Sciences, Centre for Sensorimotor Neuroscience, Brisbane, QLD 4072, Australia
| |
Collapse
|
20
|
Ferreira JSSP, Panighel JP, Silva ÉQ, Monteiro RL, Cruvinel Júnior RH, Sacco ICN. Foot function and strength of patients with diabetes grouped by ulcer risk classification (IWGDF). Diabetol Metab Syndr 2019; 11:89. [PMID: 31695753 PMCID: PMC6822353 DOI: 10.1186/s13098-019-0487-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/22/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The stratification system from the International Working Group on the Diabetic Foot (IWGDF) was used to classify the participants as to the ulcer risk. However, it is not yet known what the classification groups' individual deficits are regarding sensitivity, function, and musculoskeletal properties and mechanics. This makes it difficult to design proper ulcer prevention strategies for patients. Thus, this study aimed to investigate the foot function, foot strength and health of people with diabetes mellitus (DM)-with or without DPN-while considering the different ulcer risk classifications determined by the IWGDF. METHODS The subject pool comprised 72 people with DM, with and without DPN. The patients were divided into three groups: Group 0 (G0), which comprised diabetic patients without DPN; Group 1 (G1), which comprised patients with DPN; and Group 2 (G2), which comprised patients with DPN who had foot deformities. The health and foot function of the subjects' feet were assessed using a foot health status questionnaire (FHSQ-BR) that investigated four domains: foot pain, foot function, footwear, and general foot health. The patients' foot strength was evaluated using the maximum force under each subject's hallux and toes on a pressure platform (emed q-100, Novel, Munich, Germany). RESULTS Moderate differences were found between G0 and G1 and G2 for the foot pain, foot function, general foot health, and footwear. There was also a small but significant difference between G0 and G2 in regards to hallux strength. CONCLUSION Foot health, foot function and strength levels of people with DM and DPN classified by the ulcer risk are different and this must be taken into account when evaluating and developing treatment strategies for these patients.
Collapse
Affiliation(s)
- Jane S. S. P. Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51-Cidade Universitária, São Paulo, 05360-160 Brazil
| | - João P. Panighel
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51-Cidade Universitária, São Paulo, 05360-160 Brazil
| | - Érica Q. Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51-Cidade Universitária, São Paulo, 05360-160 Brazil
| | - Renan L. Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51-Cidade Universitária, São Paulo, 05360-160 Brazil
- Departamento de Ciências da Saúde, Universidade Federal do Amapá, Macapá, Amapá Brazil
| | - Ronaldo H. Cruvinel Júnior
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51-Cidade Universitária, São Paulo, 05360-160 Brazil
| | - Isabel C. N. Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51-Cidade Universitária, São Paulo, 05360-160 Brazil
| |
Collapse
|