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Gait characteristics in people with type 2 diabetes mellitus

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Abstract

Sixteen control subjects and 15 subjects with type 2 diabetes were examined to compare gait characteristics during walking in a linear path and in turns of 0.33 and 0.66 m diameter. Subjects were excluded if there was diminished sensation in the feet or impairment of strength in the legs. This was done to isolate the effect of diabetes gait independent of loss of sensation. Gait was assessed through contact sensors on the foot, video, and two axis accelerometers mounted bilaterally on the head, shoulders, hips, knees and ankles. The results of these experiments showed that subjects with diabetes walked significantly slower (P<0.05) than control subjects and with a wider stance (P<0.01), both for walking in a linear path (velocity of subjects with diabetes was 62.2% that of controls and stance was 134.9% wider than controls) and when making turns (velocity 50.6% of controls and stance 120.1% wider than that of controls). Accelerometry showed increased flexion/extension and lateral movement of the major joints in subjects with diabetes during both walking in a linear path and turns compared to control subjects. Part of the increased movement at the joints in the subjects with diabetes was due to tremor in both the 8 Hz and 16 Hz bands. These findings suggest that at least some of the increased joint movement during walking in people with diabetes is likely neurological in origin and not related to muscle weakness or loss of sensation in the feet.

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References

  • Bilsborough W, O’Driscoll G, Stanton K, Weerasooriya R, Dembo L, Taylor R, Green D (2002) Effect of lowering tumour necrosis factor-alpha on vascular endothelial function in Type II diabetes. Clin Sci (Lond) 103:163–169

    Google Scholar 

  • Booth J, Young MJ (2000) Differences in the performance of commercially available 10-g monofilaments. Diabetes Care 23:984–948

    CAS  PubMed  Google Scholar 

  • Boulton AJ (2004) Pressure and the diabetic foot: clinical science and offloading techniques. Am J Surg 187 (5A):17S–24S

    Article  PubMed  Google Scholar 

  • Cao C, Ashton-Miller JA, Schultz AB, Alexander NB (1997) Abilities to turn suddenly while walking: effects of age, gender, and available response time. J Gerontol A Biol Sci Med Sci 52: M88–M93

    CAS  PubMed  Google Scholar 

  • Cao C, Schultz AB, Ashton-Miller JA, Alexander NB (1998) Sudden turns and stops while walking: kinematic sources of age and gender differences. Gait Posture 7:45–52

    Article  PubMed  Google Scholar 

  • Cefalu WT, Gerich, J., LeRoth, D (2004) Handbook of diabetes management. CMD Publishing, New York

  • Darlington CL, Erasmus J, Nicholson M, King J, Smith PF (2000) Comparison of visual-vestibular interaction in insulin-dependent and non-insulin-dependent diabetes mellitus. Neuroreport 11:487–490

    CAS  PubMed  Google Scholar 

  • Di Nardo W, Ghirlanda G, Cercone S, Pitocco D, Soponara C, Cosenza A, Paludetti G, Di Leo MA, Galli I (1999) The use of dynamic posturography to detect neurosensorial disorder in IDDM without clinical neuropathy. J Diabetes Complications 13:79–85

    Article  PubMed  Google Scholar 

  • Dingwell JB, Cavanagh PR (2001) Increased variability of continuous overground walking in neuropathic subjects is only indirectly related to sensory loss. Gait osture 14:1–10

    Article  CAS  Google Scholar 

  • Elble RJ (2000) Diagnostic criteria for essential tremor and differential diagnosis. Neurology 54 [Suppl 4]:S2–S6

    Google Scholar 

  • The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. (1997) Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 20:1183–1197

    PubMed  Google Scholar 

  • Fried AV, Cwikel J, Ring H, Galinsky D (1990) ELGAM-extra-laboratory gait assessment method: identification of risk factors for falls among the elderly at home. Int Disabil Stud 12:161–164

    CAS  PubMed  Google Scholar 

  • Hiltunen LA (2001) Does glucose tolerance affect elderly persons’ balance, gait or muscle strength? Cent Eur J Public Health 9:22–25

    CAS  PubMed  Google Scholar 

  • Lasker RD (1993) The diabetes control and complications trial. Implications for policy and practice. N Engl J Med 329:1035–1036

    Article  CAS  PubMed  Google Scholar 

  • Lohman EB, Petrofsky JS, Lee S (2004) The effects of diabetes mellitus on postural tremor, balance, and gait. Diabetes 2237 PO

  • Low P, Kihara M, Cameron N, Cotter M, Poduslo J (1993) Cause and effect of ischemia in chronic experimental diabetic neuropathy. Diabet Med 10 [Suppl 2]:52S–55S

    Google Scholar 

  • Maluf KS, Mueller MJ (2003) Comparison of physical activity and cumulative plantar tissue stress among subjects with and without diabetes mellitus and a history of recurrent plantar ulcers. Clin Biomech (Bristol, Avon) 18:567–575

    Google Scholar 

  • Menz HB, Lord SR, St George R, Fitzpatrick RC (2004) Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Arch Phys Med Rehabil 85:245–252

    Article  PubMed  Google Scholar 

  • Mueller MJ, Minor SD, Sahrmann SA, Schaaf JA, Strube MJ (1994) Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls. Phys Ther 74:299–308

    CAS  PubMed  Google Scholar 

  • Mueller MJ, Salsich GB, Bastian AJ (1998) Differences in the gait characteristics of people with diabetes and transmetatarsal amputation compared with age-matched controls. Gait Posture 7:200–206

    Article  PubMed  Google Scholar 

  • Petrofsky JS, Bweir S (2002) Variable output foot sensors to provide pressure distribution on the fott during gait. Saudi J Rehab 8:137–142

    Google Scholar 

  • Petrofsky JS, Besonis C, Rivera D, Schwab E, Lee S (2003a) Does local heating really help diabetic patients increase circulation. J Orthop Neurol Surg 21:40–46

    Google Scholar 

  • Petrofsky JS, Besonis C, Rivera D, Schwab E, Lee S (2003b) Heat tolerance in patients with diabetes. J Appl Res 3:28–34

    Google Scholar 

  • Petrofsky JS, Bweir S, Andal A, Chavez BS, Crane BS, Saunders B, Laymon M (2003c) Toward a more objective analysis of gait. Int J Rehabil 10:463–472

    Google Scholar 

  • Petrofsky J, Macnider BS, Navarro BS, Bweir S, Lee S (2003d) Toward a more objective analysis of gait in patients with diabetes. Diabetes 52:2465 PO

    Google Scholar 

  • Petrofsky JS, Bweir S, Andal A, Chavez J, Crane A, Saunders J, Laymon M (2004) Joint acceleration during gait in relation to age. Eur J Appl Physiol 92 :254–262

    Google Scholar 

  • Prabhu KG, Patil KM, Srinivasan S (2001) Diabetic feet at risk: a new method of analysis of walking foot pressure images at different levels of neuropathy for early detection of plantar ulcers. Med Biol Eng Comput 39:288–293

    CAS  PubMed  Google Scholar 

  • Richardson JK (2002) Factors associated with falls in older patients with diffuse polyneuropathy. J Am Geriatr Soc 50:1767–1773

    Article  PubMed  Google Scholar 

  • Rijken PM, Dekker J, Dekker E, Lankhorst GJ, Bakker K, Dooren J, Rauwerda JA (1998) Clinical and functional correlates of foot pain in diabetic patients. Disabil Rehabil 20:330–336

    CAS  PubMed  Google Scholar 

  • Sacco IC, Amadio AC (2000) A study of biomechanical parameters in gait analysis. Clin Biomech 15:196–202

    Article  CAS  Google Scholar 

  • Sagliocco L, Sartucci F, Giampietro O, Murri L (1999) Amplitude loss of electrically and magnetically evoked sympathetic skin responses in early stages of type 1 (insulin-dependent) diabetes mellitus without signs of dysautonomia. Clin Auton Res 9:5–10

    CAS  PubMed  Google Scholar 

  • Salsich GB, Mueller MJ (2000) Effect of plantar flexor muscle stiffness on selected gait characteristics. Gait Posture 11:207–216

    Article  CAS  PubMed  Google Scholar 

  • Schmidt RE (1993) The role of nerve growth factor in the pathogenesis and therapy of diabetic neuropathy. Diabet Med 10 [Suppl 2]:10S–13S

  • Simoneau GG, Ulbrecht JS, Derr JA, Becker MB, Cavanagh PR (1994) Postural instability in patients with diabetic sensory neuropathy. Diabetes Care 17:1411–1421

    CAS  PubMed  Google Scholar 

  • Simoneau GG, Derr JA, Ulbrecht JS, Becker MB, Cavanagh PR (1996) Diabetic sensory neuropathy effect on ankle joint movement perception. Arch Phys Med Rehabil 77:453–460

    Article  CAS  PubMed  Google Scholar 

  • Sosenko JM, Sparling YH, Hu D, Welty T, Howard BV, Lee E, Robbins DC (1999) Use of the Semmes-Weinstein monofilament in the strong heart study. Risk factors for clinical neuropathy. Diabetes Care 22:1715–1721

    CAS  PubMed  Google Scholar 

  • Stansberry KB, Hill MA, Shapiro SA, McNitt PM, Bhatt BA, Vinik AI (1997) Impairment of peripheral blood flow responses in diabetes resembles an enhanced aging effect. Diabetes Care 20:1711–1716

    CAS  PubMed  Google Scholar 

  • Thigpen MT, Light KE, Creel GL, Flynn SM (2000) Turning difficulty characteristics of adults aged 65 years or older. Phys Ther 80:1174–1187

    CAS  PubMed  Google Scholar 

  • Turgut N, Karasalihoglu S, Kucukugurluoglu Y, Balci K, Ekuklu G, Tutunculer F (2004) Clinical utility of dorsal sural nerve conduction studies in healthy and diabetic children. Clin Neurophysiol 115:1452–1456

    Article  PubMed  Google Scholar 

  • Veltink PH, Bussmann HB, de Vries W, Martens WL, Van Lummel RC (1996) Detection of static and dynamic activities using uniaxial accelerometers. IEEE Trans Rehabil Eng 4:375–385

    Article  CAS  PubMed  Google Scholar 

  • Vinik AI, Freeman R, Erbas T (2003) Diabetic autonomic neuropathy. Semin Neurol 23:365–372

    Article  PubMed  Google Scholar 

  • Yagihashi S, Kamijo M, Baba M, Yagihashi N, Nagai K (1992 ) Effect of aminoguanidine on functional and structural abnormalities in peripheral nerve of STZ-induced diabetic rats. Diabetes 41:47–52

    Google Scholar 

  • Ziegler D (1994) Diabetic cardiovascular autonomic neuropathy: prognosis, diagnosis and treatment. Diabetes Metab Rev 10:339–383

    CAS  PubMed  Google Scholar 

Download references

Acknowledgement

This work was supported in part by a grant from Glaxo Smith Kline 0313473100

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Authors and Affiliations

  1. Department of Physical Therapy and Internal Medicine, Loma Linda University, Loma Linda, California, CA 92350, USA

    Jerrold Petrofsky, Scott Lee & Salameh Bweir

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  1. Jerrold Petrofsky
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  2. Scott Lee
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  3. Salameh Bweir
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Correspondence to Jerrold Petrofsky.

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Petrofsky, J., Lee, S. & Bweir, S. Gait characteristics in people with type 2 diabetes mellitus. Eur J Appl Physiol 93, 640–647 (2005). https://doi.org/10.1007/s00421-004-1246-7

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