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

糖尿病周围神经病变患者的步行功能：生物力学机制以及对临床结果和步态再训练的影响

• 批准号: 10688297
• 负责人: Nicole Kristen Rendos
• 金额: $ 13.11万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10688297
• 关键词: Address; Adult; Affect; Age; Amputation; Ankle; Biofeedback; Biofeedback Training; Biomechanics; Characteristics; Clinical; Clinical Management; Clinical Trials; Clinical Trials Design; Communities; Complication; Complications of Diabetes Mellitus; Cutaneous; Data; Diabetes Mellitus; Diabetic Foot; Disease; Dose; Educational Intervention; Epidemiology; Esthesia; Evaluation; Feedback; Foot Diseases; Foot Ulcer; Fostering; Functional disorder; Future; Gait; Gait abnormality; Generations; Goals; Health; Hypesthesia; Impairment; Individual; Intervention; K-Series Research Career Programs; Kinetics; Knowledge; Life; Lower Extremity; Measurement; Measures; Mentors; Methods; Mission; Outcome; Participant; Patients; Peripheral Nervous System Diseases; Persons; Phase; Process; Quality of life; Research; Risk; Safety; Scientist; Sensory; Structure; Symptoms; Time; Training; Training Programs; Ulcer; United States; United States National Institutes of Health; Vision; Walking; Work; ankle joint; biomechanical test; burden of illness; design; diabetic; disability; dosage; exercise program; foot; gait rehabilitation; improved; individual patient; insight; joint stiffness; kinematics; multidisciplinary; multimodality; pressure; prevent; rehabilitation strategy; response; safety and feasibility; walking program; walking speed

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.

项目摘要/摘要 在美国，超过3400万成年人(约十分之一)患有糖尿病。糖尿病外周 神经病变(DPN)是最常见的并发症，影响超过50%的糖尿病患者。人民 与DPN显示显着降低的生活质量(QOL)和功能活动。DPN的后果 包括脚部和下肢的感觉和反馈减少以及足底压力增加， 使患者容易出现溃疡和截肢。我们预测患有DPN的人如果出现 功能活动能力和行走速度的降低，将导致步态中推进力的降低。我们的 这项工作的基本原理是足底压力和推进力是两个相互关联的关键步态参数 对糖尿病周围神经营养不良患者造成溃疡、截肢风险和行走功能减退。 影响生活质量。用于改善步行功能的传统步态训练方案可能会增加溃疡 如果不是为DPN患者量身定做，这些干预措施就不适合。这项提议的目标是 阐明影响足底之间相互关系的潜在生物力学机制 DPN患者的压力和推进能力，并检查实时使用的安全性和可行性 生物反馈调节步态中的足底压力和推进力。为了达到这一目标，我们建议执行一项 综合生物力学分析，包括测量足底压力和推进力，以及 步行过程中的踝关节运动学、动力学和关节僵硬。我们将使用足底压力和推进力 以步行过程中的生物反馈为探针阐明步行潜在的生物力学机制 DPN患者的功能障碍，同时评估生物反馈治疗的个体特异性最佳剂量 在保持或增强推进力的同时降低足底压力。此外，我们还将进行初步的 使用个性化实时步态生物反馈作为步态的可行性和安全性的临床试验 DPN患者的训练方法。本研究计划建议的目的是评估(1) 人体步态过程中足底压力和推进异常的生物力学机制 (2)生物反馈在步态过程中引起足底压力、推进和生物力学的变化。 有DPN和年龄相似对照的个体；(3)可接受性、可行性、安全性和初步 步态训练对糖尿病周围神经病变患者的影响。对足底生物力学机制的洞察 DPN患者的压力和推进力将使我们能够设计更有见地和更有效的步态 旨在防止溃疡和截肢等有害后果的康复干预措施 可以根据个别患者的特点量身定做。K01培训计划将准备PI，并在 糖尿病的临床疾病过程、步态功能障碍的机制、步态生物反馈和临床试验 设计。与美国国立卫生研究院的使命一致，这项工作的长期目标是增进健康，延长生命， 并减轻糖尿病并发症患者的疾病和残疾负担。