Diabetic Gait Is Not Just Slow Gait: Gait Compensations in Diabetic Neuropathy
Diabetic Gait Is Not Just Slow Gait: Gait Compensations in Diabetic Neuropathy
复制标题
DOI：
10.1155/2019/4512501
复制
发表时间：
2019-11-11
影响因子：
4.3
通讯作者：
Bruening, Dustin A.
中科院分区：
文献类型：
--
作者：
Henderson, Adrienne D.;Johnson, A. Wayne;Bruening, Dustin A.
背景。糖尿病引起的神经性并发症影响多种神经类型，并可能表现为步态。然而，人们对步态补偿仍然知之甚少，因为狭隘的分析和缺乏速度控制导致了相互矛盾或模棱两可的结果。目的。评估糖尿病周围性多发性神经病的步态力学和能量学。方法。对 14 名患有糖尿病周围性多发性神经病的参与者和 14 名匹配的对照者进行了仪器步态分析，步行速度为 1.0 m/s。使用具有多节脚的全身模型来计算逆动力学并分析整个站立阶段的矢状面指标和时间序列波形。结果。改变包括在早期站立时增加髋部和膝部屈曲，随后在站立中期延长髋部伸展时刻。站立后期踝关节背屈和力量吸收增加，最终推地被延迟和缩短。结论。神经性糖尿病步态与足部和踝关节无力/功能障碍的轻度蹲伏步态具有重要的相似之处。这项研究强调了先前文献中被忽视的两种主要补偿机制。首先，在站立末期增加小腿三头肌的伸展可用于增加本体感觉和/或能量储存，而在站立中间延长髋部伸展力矩可以补偿有限的推出。这导致总体工作负荷从远端关节转移到近端关节。通过关注这些特定的功能改变，神经病的临床评估、监测和治疗可能会受益。
Background. Neuropathic complications from diabetes mellitus affect multiple nerve types and may manifest in gait. However, gait compensations are still poorly understood, as narrow analyses and lack of speed controls have contributed to conflicting or equivocal results. Purpose. To evaluate gait mechanics and energetics in diabetic peripheral polyneuropathy. Methods. Instrumented gait analysis was performed on 14 participants with diabetic peripheral polyneuropathy and 14 matched controls, walking at 1.0 m/s. A full-body model with a multisegment foot was used to calculate inverse dynamics and analyze sagittal plane metrics and time series waveforms across stance phase. Results. Alterations included increased hip and knee flexion in early stance followed by a prolonged hip extension moment in midstance. Late stance ankle dorsiflexion and power absorption were increased, and final push-off was delayed and truncated. Conclusion. A neuropathic diabetic gait shares important similarities to a mild crouch gait with weakness/dysfunction in the foot and ankle. This study highlights two main compensation mechanisms that have been overlooked in previous literature. First, increased triceps surae stretch in terminal stance may be used to increase proprioception and/or energy storage, while a prolonged hip extension moment in midstance compensates for a limited push-off. These result in an overall workload shift from distal to proximal joints. Clinical assessment, monitoring, and treatment of neuropathy may benefit by focusing on these specific functional alterations.