Neuropathic Gait, Irregular Surfaces and Fall Risk

神经性步态、不规则表面和跌倒风险

• 批准号: 8067764
• 负责人: JAMES K RICHARDSON
• 金额: $ 28.91万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8067764
• 关键词: Affect; American; Ankle; Articular Range of Motion; Body Weight; Characteristics; Clinical; Data; Development; Diabetes Mellitus; Elderly; Equilibrium; Evaluation; Exercise; Feedback; Functional disorder; Gait; Generations; Health; Impairment; Incidence; Injury; Lateral; Lead; Leg; Limb structure; Lower Extremity; Measurement; Measures; Medial; Motion; Motor; Muscle; Musculoskeletal Equilibrium; Nerve; Neural Conduction; Neuropathy; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Output; Patients; Peripheral Nerves; Peripheral Nervous System Diseases; Phase; Population; Postural response; Prevalence; Prospective Studies; Recovery; Research; Risk Factors; Sensory; Severities; Shoes; Source; Speed; Sum; Surface; Technology; Testing; Time; Torque; Walking; Width; Work; ankle joint; diabetic; fall risk; falls; foot; gait examination; high risk; injured; insight; kinematics; meter; novel; older patient; response

DESCRIPTION (provided by applicant): Diabetic peripheral neuropathy (DPN) is increasingly common among older Americans, with a prevalence approaching 15%, and is a potent risk factor for falls. Previous work has shown that older persons with DPN have functionally significant impairments in lower extremity sensory and motor function that impacts postural control. An irregular surface, which challenges postural control, is a common source of falls in this population. Moreover, measures of gait variability on an irregular surface more effectively differentiate between older persons with DPN and those without, and between older persons with DPN who fall and those who do not, than similar measures on a smooth surface. We hypothesize that feedback loop delay in ankle joint force output in response to a perturbation, related primarily to a DPN-associated impairment in rate of strength generation, is the mechanism by which DPN leads to postural instability, which in turn results in increased gait variability and fall risk. Therefore the aims of this research are: 1) To measure feedback loop delay in ankle joint force output in a group of 40 subjects (30 DPN, stratified by severity, and 10 healthy old) and determine its ability to predict postural responses to discrete perturbations, provided by a novel shoe, under the medial and lateral forefoot using kinematic and force plate data; 2) To further evaluate the effect of feedback loop delay, utilizing the same subjects, by determining its ability to predict measures of gait variability on smooth and irregular surfaces; 3) To investigate the extent to which measures of gait variability, determined separately on smooth and irregular surfaces, predict the incidence of falls and fall-related injuries observed prospectively over one year in a group of 100 subjects with DPN. The resulting research will provide insights into the mechanism by which DPN impairs recovery from surface irregularities and identify the gait measure best able to predict falls and fall-related injuries in this high risk population. PUBLIC HEALTH RELEVANCE Walking as a form of exercise is a common and important treatment of adult onset diabetes mellitus. However, many older patients with diabetes have nerve damage in their feet and legs that causes them to fall, particularly when walking on irregular surfaces. This research will identify the reasons that such patients fall, and which patients are at greatest risk of falling and being injured. This information will lead to strategies for making such patient safer while walking.

描述（由申请人提供）：糖尿病周围神经病（DPN）在老年人中越来越普遍，患病率接近15％，并且是跌倒的有效风险因素。先前的工作表明，患有DPN的老年人在下肢感觉和运动功能方面具有重大损害，从而影响姿势控制。挑战姿势控制的不规则表面是该人群中跌倒的常见来源。此外，在不规则表面上的步态变异性测量可以更有效地区分DPN的老年人和没有DPN的老年人，而DPN的老年人跌倒了，而没有掉落的老年人，而不是在平滑表面上的类似措施。我们假设反馈回路响应于扰动的踝关节输出的反馈回路延迟，这主要与DPN相关的势力产生速率相关的损害是DPN导致姿势不稳定的机制，从而导致步态变异性和下降风险增加。因此，这项研究的目的是：1）在一组40名受试者（30个DPN，按严重程度分层和10个健康的旧）中测量踝关节输出的反馈回路延迟，并确定其预测由新型鞋子的姿势反应，由新型鞋子，使用KINEMATIC和FORCTATIC PLATER PLATE PLATER PLATER PATER提供的新型鞋子提供的姿势反应； 2）通过确定其预测步态变异性对光滑和不规则表面的步态可变性度量的能力，进一步评估反馈回路延迟的影响； 3）研究步态变异性测量的程度，在光滑和不规则的表面上分别确定，预测跌倒和与跌倒有关的伤害的发生率在100名DPN受试者中预期一年中预期观察到了一年。最终的研究将提供有关DPN损害表面不规则恢复的机制的见解，并确定步态措施可以最好地预测这种高风险人群中与跌倒相关的伤害。公共卫生相关性作为一种运动形式是对成人发作糖尿病的一种常见而重要的治疗方法。但是，许多老年糖尿病患者的脚和腿部有神经损伤，导致他们跌落，尤其是在不规则表面行走时。这项研究将确定此类患者跌倒的原因，以及哪些患者跌倒和受伤的最大风险。这些信息将导致行走时使患者更安全的策略。