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

项目概要/摘要 美国有超过3400万成年人（约十分之一）患有糖尿病（DM）。糖尿病周围 神经病变（DPN）是最常见的并发症，影响超过50%的DM患者。人 DPN患者的生活质量（QoL）和功能活动度明显降低。DPN的后果 包括来自足部和下肢的感觉和反馈减少以及足底压力增加， 易使患者患溃疡和下肢截肢。我们预测，DPN患者， 降低的功能移动性和行走速度将具有步态期间推进力的相关降低。我们 这项工作的基本原理是足底压力和推进力是两个关键的相互关联的步态参数， 有助于溃疡，截肢的风险，并减少行走功能的人与DPN，不利 影响QOL。用于改善行走功能的传统步态训练计划可能会增加溃疡 风险，使这些干预措施不适合，如果不适合DPN的人。本提案的目的是 阐明了潜在的生物力学机制，有助于足底 DPN患者的压力和推进力，并检查使用实时 生物反馈以在步态期间修改足底压力和推进力。为了达到这个目标，我们建议进行一项 全面的生物力学分析，包括足底压力和推进力的测量，以及 踝关节运动学、动力学和行走过程中的关节僵硬。我们将利用足底压力和推进力 步行过程中的生物反馈作为一个探针，以阐明步行的基本生物力学机制 DPN患者的功能障碍，同时评估生物反馈的个体特异性最佳剂量， 减少足底压力，同时保持或增强推进力。此外，我们将进行初步调查， 临床试验，以检查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 DPN患者的训练方法。本研究计划提案的目的是评估（1） 导致个体步态期间足底压力和推进力异常的生物力学机制 DPN;（2）生物反馈引起的足底压力，推进力和生物力学在步态中的变化， DPN患者和年龄相似的对照组;（3）可接受性，可行性，安全性和初步 步态训练对DPN患者的影响。深入了解足底的生物力学机制 DPN患者的压力和推进力将使我们能够设计更明智和有效的步态 康复干预，旨在防止有害的结果，如溃疡和截肢， 可以根据患者的个人特征进行调整。K01培训计划将为PI提供以下培训： 糖尿病的临床病程、步态障碍的机制、步态生物反馈和临床试验 设计与NIH的使命一致，这项工作的长期目标是增强健康，延长寿命， 减轻糖尿病并发症患者的疾病和残疾负担。

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.