INFLUENCE OF DIABETIC NEUROPATHY ON GAIT COMPLEXITY

ABSTRACT Introduction: Human gait is a complex movement dependent on multilevel neural control, which allows a consistent, regular and complex periodic pattern, properties that characterize it as a nonlinear system. Sensory and motor deficits, with diminished proprioceptive responses, may reduce the adaptive capacity of the system, as demonstrated in Parkinson's, Alzheimer's and Huntington's diseases. However, little is known about the effect of peripheral diabetic neuropathy on these responses. Objectives: To analyze the influence of peripheral diabetic neuropathy on entropy in different gait environments. Methods: Ten elderly patients, with and without a diagnosis of peripheral diabetic neuropathy, walked on a treadmill (initial speed of 3 km/h, with 0.5 km/h increments every 5 minutes up to the speed of 5 km/h) to record center of mass acceleration in the vertical, mediolateral and anteroposterior components throughout the test. The sample entropy of the three vectors was calculated for each test speed. Results: The vertical component did not show any statistically significant differences. The mediolateral component showed statistically significant difference for the factors group, speed, and interaction between factors (group and speed). The anteroposterior component showed statistically significant differences for the group factor, but not for speed and interaction between factors (group and speed). Effect sizes classified as large were found in all the comparisons. Conclusions: Peripheral diabetic neuropathy produced changes in the ability to adapt to changes in the environment during gait, probably due to changes in the complexity of the multilevel neural control system, which depends on motor and sensory feedback, known to be affected by peripheral diabetic neuropathy. Level of Evidence II; Diagnostic studies - Investigating a diagnostic test.

摘要
引言：人类步态是一种依赖于多级神经调控的复杂运动，可呈现出稳定、规则且复杂的周期性模式，上述特征将其归类为非线性系统。感觉运动功能缺损伴本体感受反应减弱，会降低该系统的自适应能力，这一点在帕金森病、阿尔茨海默病和亨廷顿舞蹈症中已得到证实。然而目前对周围糖尿病性神经病（peripheral diabetic neuropathy）对这类反应的影响尚不清楚。
研究目的：分析周围糖尿病性神经病对不同步态环境下熵（entropy）的影响。
研究方法：招募10名老年患者，分为确诊周围糖尿病性神经病组与未确诊组，令其在跑步机（初始速度3 km/h，每5分钟以0.5 km/h的幅度递增，直至速度达5 km/h）上行走，全程记录其质心加速度的垂直、内侧-外侧及前后方向分量。针对每个测试速度，计算三个加速度向量的样本熵（sample entropy）。
研究结果：垂直方向分量未表现出任何统计学显著性差异。内侧-外侧方向分量在组别、速度以及二者的交互作用上均存在统计学显著性差异。前后方向分量仅在组别因素上存在统计学显著性差异，而在速度因素及其交互作用上无显著差异。所有对比的效应量均被归类为大效应量。
研究结论：周围糖尿病性神经病会改变步态过程中对环境变化的自适应能力，这可能源于依赖于运动与感觉反馈的多级神经调控系统的复杂性改变，而运动与感觉反馈已知会受到周围糖尿病性神经病的影响。
证据等级Ⅱ；诊断性研究——针对诊断试验的探索性研究。