Walking Function in Individuals with Diabetic Peripheral Neuropathy: Biomechanical Mechanisms and Implications for Clinical Outcomes and Gait Retraining

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PROJECT SUMMARY/ABSTRACT Over 34 million adults in the United States (~1 in 10) are living with Diabetes Mellitus (DM). Diabetic peripheral neuropathy (DPN) is the most common complication, affecting more than 50% of individuals with DM. People with DPN display marked reductions in quality of life (QoL) and functional mobility. Consequences of DPN include reduced sensation and feedback from the foot and lower limb and increased plantar pressures, predisposing patients to ulcers and lower extremity amputation. We predict that persons with DPN who show reduced functional mobility and walking speed, will have an associated reduction in propulsion during gait. Our rationale for this work is that plantar pressure and propulsion are two key inter-related gait parameters that contribute to ulceration, amputation risk, and reduced walking function in people with DPN, adversely impacting QOL. Traditional gait training programs used to improve walking function may increase ulceration risk, making these interventions unsuitable if not tailored for people with DPN. The goal of this proposal is to elucidate the underlying biomechanical mechanisms contributing to the inter-relationships between plantar pressure and propulsion in individuals with DPN, and to examine the safety and feasibility of using real-time biofeedback to modify plantar pressure and propulsion during gait. To meet this goal, we propose to perform a comprehensive biomechanical analysis including measurements of plantar pressure and propulsion, as well as ankle kinematics, kinetics, and joint stiffness during walking. We will use plantar pressure and propulsion biofeedback during walking as a probe to illuminate underlying biomechanical mechanisms of walking dysfunction in people with DPN, while evaluating the individual-specific optimum dosage of biofeedback to reduce plantar pressure while maintaining or enhancing propulsion. Additionally, we will conduct a preliminary clinical trial to examine the feasibility and safety of using individualized real-time gait biofeedback as a gait training method in individuals with DPN. The aims of this research plan proposal are to evaluate (1) biomechanical mechanisms contributing to abnormal plantar pressure and propulsion during gait in individuals with DPN; (2) biofeedback-induced changes in plantar pressure, propulsion, and biomechanics during gait in individuals with DPN and age-similar controls; and (3) the acceptability, feasibility, safety, and preliminary effects of gait training in individuals with DPN. Insights into the biomechanical mechanisms underlying plantar pressure and propulsion in people with DPN will allow us to design more informed and effective gait rehabilitation interventions aimed at preventing deleterious outcomes such as ulceration and amputation that can be tailored to individual patient characteristics. The K01 training plan will prepare the PI with training in the clinical disease processes of DM, mechanisms underlying gait dysfunction, gait biofeedback, and clinical trial design. Consistent with the NIH mission, the long-term goals of this work are to enhance health, lengthen life, and reduce the burden of illness and disability in people living with DM complications.