Virtualizing the Assessment: A Novel Pragmatic Paradigm to Evaluate Lower Extremity Joint Perception in Diabetes
Virtualizing the Assessment: A Novel Pragmatic Paradigm to Evaluate Lower Extremity Joint Perception in Diabetes
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DOI：
10.1159/000338095
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发表时间：
2012-01-01
期刊：
影响因子：
3.5
通讯作者：
Najafi, Bijan
中科院分区：
文献类型：
--
作者：
Grewal, Gurtej;Sayeed, Rashad;Najafi, Bijan
背景：糖尿病患者发生跌倒和跌倒相关损伤的风险较高。糖尿病患者经常发展周围神经病变（DPN）以及全身神经损伤。特别是，由于DPN导致的下肢本体感觉降低可能导致对足部位置的错误判断，从而增加跌倒的风险。目的：利用可穿戴传感器开发了一种创新的虚拟过障模式，试图评估DPN引起的下肢位置感知损伤。方法：招募67名参与者（年龄55.4 +/- 8.9,BMI 28.1 +/- 5.8），包括伴有和不伴有DPN的糖尿病患者以及年龄匹配的健康对照。采用振动感知阈值（VPT）测试量化神经病变的严重程度。通过测量受试者在跨越高度为其腿长10%和20%的虚拟障碍物时的障碍物穿越成功率（OCSR）、脚趾与障碍物的间隙（TOC）和反应时间（T-R），对下肢感知能力进行量化。结果：两组间年龄、BMI无显著差异。数据显示，在障碍物尺寸为腿长10%时，DPN受试者的OCSR显著低于无神经病变的糖尿病患者和对照组（p < 0.05）。DPN受试者与其他组相比，在两种障碍大小下均表现出更长的T R。此外，神经病变组TOC降低。有趣的是，观察到T-R和VPT之间的显著相关性（r = 0.5, p < 10(-3)），表明随着神经病变严重程度的增加，反应延迟。随着障碍物的增大，延迟变得更加明显。使用回归模型表明，障碍大小在腿长的10%和20%之间的T-R变化是神经病变严重程度的最敏感预测因子，比值比为2.70 （p = 0.02）。结论：研究结果证明了虚拟现实应用的概念是客观评估神经病变严重程度的一种有前途的方法，然而，需要进一步的研究来建立测量参数与神经病变之间更强的关系。巴塞尔S. Karger股份有限公司版权所有
Background: Individuals with diabetes have a higher risk of falls and fall-related injuries. People with diabetes often develop peripheral neuropathy (DPN) as well as nerve damage throughout the body. In particular, reduced lower extremity proprioception due to DPN may cause a misjudgment of foot position and thus increase the risk of fall. Objective: An innovative virtual obstacle-crossing paradigm using wearable sensors was developed in an attempt to assess lower extremity position perception damage due to DPN. Methods: 67 participants (age 55.4 +/- 8.9, BMI 28.1 +/- 5.8) including diabetics with and without DPN as well as aged-matched healthy controls were recruited. Severity of neuropathy was quantified using a vibratory perception threshold (VPT) test. The ability of perception of lower extremity was quantified by measuring obstacle-crossing success rate (OCSR), toe-obstacle clearance (TOC), and reaction time (T-R) while crossing a series of virtual obstacles with heights at 10% and 20% of the subject's leg length. Results: No significant difference was found between groups for age and BMI. The data revealed that DPN subjects had a significantly lower OCSR compared to diabetics with no neuropathy and controls at an obstacle size of 10% of leg length (p < 0.05). DPN subjects also demonstrated longer T R compared to other groups and for both obstacle sizes. In addition, TOC was reduced in neuropathy groups. Interestingly, a significant correlation between T-R and VPT (r = 0.5, p < 10(-3)) was observed indicating a delay in reaction with increasing neuropathy severity. The delay becomes more pronounced by increasing the size of the obstacle. Using a regression model suggests that the change in T-R between obstacle sizes of 10% and 20% of leg length is the most sensitive predictor for neuropathy severity with an odds ratio of 2.70 (p = 0.02). Conclusion: The findings demonstrate proof of a concept of virtual-reality application as a promising method for objective assessment of neuropathy severity, however a further study is warranted to establish a stronger relationship between the measured parameters and neuropathy. Copyright (C) 2012 S. Karger AG, Basel