Slower speeds in patients with diabetic neuropathy lead to improved local dynamic stability of continuous overground walking
Slower speeds in patients with diabetic neuropathy lead to improved local dynamic stability of continuous overground walking
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DOI：
10.1016/s0021-9290(00)00092-0
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发表时间：
2000-10-01
影响因子：
2.4
通讯作者：
Cavanagh, PR
中科院分区：
文献类型：
--
作者：
Dingwell, JB;Cusumano, JP;Cavanagh, PR
患有糖尿病周围神经病变的患者比感觉完整的患者更有可能在行走时摔倒。虽然有人建议这些患者走得较慢以改善运动稳定性，但速度较慢也与运动可变性增加有关，而可变性增加传统上被等同于失去稳定性。如果后者是真的，这将表明，减速作为一种运动控制策略，应该与维持稳定的目标完全相反。通过使用非线性时间序列分析的方法，直接量化运动系统对表现为自然运动可变性的局部扰动的敏感性，本研究解决了这些看似自相矛盾的发现。14名有严重周围神经病变的患者和12名性别、年龄、身高和体重匹配的非糖尿病对照组参加了研究。以选定的速度进行连续地面行走10min，测量右髋关节、膝关节和踝关节的矢状面角度和躯干的三轴加速度。计算每个时间序列的最大有限时间Lyapunov指数，以量化这些运动的局部动态稳定性。与对照组相比，神经病患者的行走速度较慢，上半身在水平面上的运动具有更好的局部动态稳定性。行走速度的差异显著地预测了局部动态稳定性的差异，但感觉状态的差异并不能显著预测局部动态稳定性的差异。这些结果支持这样一种假设，即降低步行速度是神经病患者在水平行走过程中保持上半身动态稳定所使用的一种补偿策略。(C)2000爱思唯尔科学有限公司。保留所有权利。
Patients with diabetic peripheral neuropathy are significantly more likely to fall while walking than subjects with intact sensation. While it has been suggested that these patients walk slower to improve locomotor stability, slower speeds are also associated with increased locomotor variability, and increased variability has traditionally been equated with loss of stability. If the latter were true, this would suggest that slowing down, as a locomotor control strategy, should be completely antithetical to the goal of maintaining stability. The present study resolves these seemingly paradoxical findings by using methods from nonlinear time series analysis to directly quantify the sensitivity of the locomotor system to local perturbations that are manifested as natural kinematic variability. Fourteen patients with severe peripheral neuropathy and 12 gender-, age-, height-, and weight-matched non-diabetic controls participated. Sagittal plane angles of the right hip, knee, and ankle joints and tri-axial accelerations of the trunk were measured during 10 min of continuous overground walking at self-selected speeds. Maximum finite-time Lyapunov exponents were computed for each time series to quantify the local dynamic stability of these movements. Neuropathic patients exhibited slower walking speeds and better local dynamic stability of upper body movements in the horizontal plane than did control subjects. The differences in local dynamic stability were significantly predicted by differences in walking speed, but not by differences in sensory status. These results support the hypothesis that reductions in walking speed are a compensatory strategy used by neuropathic patients to maintain dynamic stability of the upper body during level walking. (C) 2000 Elsevier Science Ltd. All rights reserved.