Biomechanics and Inter-Joint Coordination of the Lower Limb Joints in Patients with Diabetes Mellitus During Obstacle-Crossing
Date Issued
2010
Date
2010
Author(s)
Liu, Ming-Wei
Abstract
Patients with type II diabetes mellitus (DM) have been reported to be at a high risk of falling which may be related to the presence of multiple risk factors, including the disease itself, problems with gait and balance, and peripheral neuropathy (PN). However, PN alone may not be enough for the assessment of fall risks in patients with DM, especially for those with no to minimal PN. It is noted that patients with no to minimal diabetic PN show degraded postural control and gait performance. Apart from deviations in gait, other changes are also present in these patients before PN is diagnosed, including reduced ankle muscle strength and impaired joint position sense (JPS) of the distal joints, which have been shown to affect gait performance. The purpose of this study was to compare the end-point trajectory and joint kinematic and kinetic patterns of the lower extremities as well as inter-joint coordination between healthy subjects and individuals with DM during obstacle-crossing.
Fourteen patients with type II DM, with no to minimal PN, and fourteen healthy controls walked and crossed obstacles of three different heights (10%, 20% and 30% of leg length) while kinematic and kinetic data were measured using a motion analysis system and two forceplates.
Compared to normal controls, the DM group had similar walking speeds and horizontal foot-obstacle distances but significantly reduced leading and trailing toe-obstacle clearances, suggesting an increased risk of tripping over the obstacle. When the leading swing toe was above the obstacle, the DM group showed greater pelvic anterior tilt, stance ankle dorsiflexion, and smaller swing hip abduction, with reduced hip abductor moments but greater knee flexor and ankle plantarflexor. When the trailing swing toe was above the obstacle, patients with DM showed smaller swing hip and knee flexion which resulted in reduced trailing toe-obstacle clearance. It appears that the DM group had adopted a particular biomechanical strategy using altered but stable inter-joint coordination control. Although the stable inter-joint coordination may enable the patients with DM to accommodate reliably the mechanical demands related to DM complications during obstacle-crossing, the altered inter-joint coordination control with reduced swing toe-clearance may increase the risk of falling during obstacle-crossing.
It is suggested that patients with type II DM, with no to minimal PN, should also be targeted for fall prevention. Possible therapeutic intervention to decrease falls may include strengthening of the knee flexors and ankle plantarflexors, together with proprioception and balance training. Normal and reliable inter-joint coordination should both be considered as an outcome of therapeutic intervention, and the patterns and variability of inter-joint coordination can be used to evaluate treatment effects.
Subjects
Type II diabetes mellitus
obstacle-crossing
joint kinematics
joint kinetics
inter-joint coordination
SDGs
Type
thesis
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