Evaluating static postural control in subjects with controlled-diabetes mellitus II
Keywords:Diabetes, Static balance, Sways, Centre of pressure, Pressure mat, Weight distribution
AbstractDiabetes and neuropathy have been linked to postural instability. Aims: The purpose of this study is to determine how each system involved in balance is affected when challenged in a static standing posture. The goal was to identify postural instability by measuring balance through the amount of sway and weight bearing distribution in non-neuropathic controlled type II diabetics. Methods: Twelve participants (five males and seven females) with controlled type II diabetes mellitus and no history of peripheral neuropathy (Non-PN cDMII) formed the diabetic group, whereas eighteen participants (7 males and 11 females) without type II diabetes formed the control group. The exclusion criteria was applied via a series of screening tests (Berg Balance Scale, Five Times Sit To Stand Test, Functional Reach Test and Monofilament Test). Postural stability and weight distribution during quiet standing were measured using a Tekscan Matscan pressure mat, which measured the amount of sway and weight distribution. Static postural control was evaluated during eight sensory conditions that perturbed or stimulated the visual, proprioceptive, and vestibular systems. Results: Postural control was found to be significantly deficient when the vestibular system was stimulated, whereas the proprioceptive system was perturbed. After the data analysis, there was a significant difference in antero-posterior sway (p = .05) with the following tasks: eyes open with head movements on an unstable surface, and eyes closed with head movements on a firm surface. Conclusions: The results revealed that the experimental group with type II diabetes had greater postural instability when compared to the control group during tasks with the vestibular system on an unstable surface. This demonstrates that, due to their deficits, individuals with non-PN cDMII are unable to maintain their balance when the vestibular and proprioceptive systems are challenged simultaneously.
FundingSchool of Health Professionals of the University of Puerto Rico, Medical Sciences Campus
Agrawal, Y., Carey, J., Della, C., Schubert, M., Minor, L. Diabetes, vestibular dysfunction, and falls: Analyses from the National Health and Nutrition Examination Survey. Otol Neurotol. 2010;31(9);1445-1450.
Ahmmed, A., Mackenzie, I. Posture changes in diabetes mellitus. The Journal of Laryngology & Otology. May, 2003;117:358-364. https://doi.org/10.1258/002221503321626393
Azidah, A.K., Hasniza, H., Zunaina, E. Prevalence of Falls and Its Associated Factors among Elderly Diabetes in A Tertiary Center, Malaysia. Curr Geriontol Geriatr Res. 2012:1-5. https://doi.org/10.1155/2012/539073
Balady, G.J., Chaitman, B., Driscoll, D., Foster, C., Froelicher, E., Gordon, N., Pate, R., Rippe, J., Bazzarre, T. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation. 1998 Jun 9;97(22):2283-93. https://doi.org/10.1161/01.cir.97.22.2283
Bell-Krotoski, J., Weinstein, S., Weinstein, C. Testing sensibility, including touch-pressure, two-point discrimination, point localization, and vibration. J Hand Ther. April-June 1993;6(2):114-23. https://doi.org/10.1016/s0894-1130(12)80292-4
Berg K., Wood-Dauphinee, S., Williams, J.I. The Balance Scale: Reliability Assessment with Elderly Residents and Patients with an Acute Stroke. Scand J Rehab Med. 1995;27(1):27-36.
Bohannon, R. W., Larkin, P. A., et al. Decrease in timed balance test scores with aging. Physical Therapy. 1984;64(7):1067-1070. https://doi.org/10.1093/ptj/64.7.1067
Bonnet, C., Ray, C. Peripheral neuropathy may be not the only fundamental reason explaining increased sway in diabetic individuals. Clin Biomech.2011;26;699-706. https://doi.org/10.1016/j.clinbiomech.2011.03.004
Brenton-Rule, A., Mattock, J., Carroll, M., et al. Reliability of the TekScan MatScan® system for the measurement of postural stability in older people with rheumatoid arthritis. J Foot Ankle Res.2012; 5: 21. https://doi.org/10.1186/1757-1146-5-21
Center for Disease Control and Prevention. New CDC report: More than 100 million Americans have diabetes or prediabetes. Published: July 18, 2017 https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
Dingwell, J.B., Cusmano, J.P., Sternad, D., Cavanagh, P.R. Slower speeds in patients with diabetic neuropathy lead to improved local dynamic stability of continuous overground walking. J Biomech. 2000; 33:1269-1277. https://doi.org/10.1016/s0021-9290(00)00092-0
Duncan, P. W., Weiner, D. K., et al. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45(6):M192-197.
Grewal, G.S., Schwenk, M., Lee-Eng, J.Parvaneh, S., Bharara, M., Menzies, R.A., Talal, T.K., Armstrong, D.G., Najafi B. Sensor-Based Interactive Balance Training with Visual Joint Movement Feedback for Improving Postural Stability in Diabetics with Peripheral Neuropathy: A Randomized Controlled Trial. Gerontology. 2015;61:567-574. https://doi.org/10.1159/000371846
Kisner, C., Colby, L. Therapeutic Exercise: Foundations and Techniques.Philadelphia, PA: F.A.Davis; 2012.
Lafond, D., Corriveau, H., Prince, F. Postural control mechanisms during quiet standing in patients with diebetic sensory neuropathy. Diabetes Care.Jan 2004;27(1):173-178. https://doi.org/10.2337/diacare.27.1.173
Low, D.C., Walsh, G.S., & Arkesteijn, M. Sports Med (2017) 47: 101. Effectiveness of Exercise Interventions to Improve Postural Control in Older Adults: A Systematic Review and Meta-Analyses of Centre of Pressure Measurements. Sports Med. 2017 Jan;47(1):101-112. https://doi.org/10.1007/s40279-016-0559-0
Maurer, M.S., Burcham, J., Cheng, H. Diabetes Mellitus Is Associated With an Increased Risk of Falls in Elderly Residents of a Long-Term Care Facility. J Ger Med Sci.2005; 60A(9): 1157-62. https://doi.org/10.1093/gerona/60.9.1157
Mueller, M.J., Minor, S.D., Sahrmann, S.A., Schaaf, J.A., Strube, M.J. Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls. Phys Ther. 1994 Apr;74(4):299-308. https://doi.org/10.1093/ptj/74.4.299
Oppenheim, U., Kohen-Raz, R., Alex, D., et al. Postural Characteristic of Diabetic Neuropathy. Diabetes Care.1992;22:328-332. https://doi.org/10.2337/diacare.22.2.328
Palma, F.H., Antigual, D.U., Martínez, S.F., Monrroy, M.A., Gajardo, R.E. Static balance in patients presenting diabetes mellitus type 2 with and without diabetic polyneuropathy. Arq Bras Endocrinol Metabol. 2013 Dec;57(9):722-6. https://doi.org/10.1590/s0004-27302013000900008
Petrofsky, J., Lee, S., Bweir, S. Gait characteristics in people with type 2 diabetes mellitus. Eur J Appl Physiol. 2005 Mar;93(5-6):640-7. https://doi.org/10.1007/s00421-004-1246-7
Simoneau, G., Ulbrecht, J., Derr, J., Cavanagh, P. Role of somatosensory input in the control of human posture. Gait and Posture. 1995;3:115-122. https://doi.org/10.1016/0966-6362(95)99061-o
Rosario, M.G., Collazo, H., Mateo, M., et al. Increased static postural sway after energy drink consumption: A randomized trial [version 1; referees: 2 approved with reservations]. F1000Research 2017, 6:2036. https://doi.org/10.12688/f1000research.12565.1
Rosario, M.G., Orozco, E., Babilonia, N., et al. Evaluation of controlled type II diabetics ascending and descending a ramp surface at an imposed speed: A case-control study [version 1; referees: awaiting peer review]. F1000Research 2018, 7:408. https://doi.org/10.12688/f1000research.14401.1
Rosario, M.G., López, L., Méndez, M., et al. Proprioception and vestibular alterations affect postural control in children with mild autism: A pilot study [version 1; referees: awaiting peer review]. F1000Research 2018, 7:305. https://doi.org/10.12688/f1000research.14179.1
Syed, N., Maiya, A., Hanifa, N., Goud, S. Plantar pressure in diabetes with no know neuropathy. J Diabetes.2013;5(3):302-8.
Thapa, P., Gideon, P., Brockman, K., Fought, R., Ray, W. Clinical and biomechanical Measures of balances as fall predictors in ambulatory nursing home residents. The Journals of Gerontology.1996;51A(5):M239-M246. https://doi.org/10.1093/gerona/51a.5.m239
Toosizadeh, N., Mohler, J., Armstrong, D.G., Talal, T.K., Najafi, B. The influence of diabetic peripheral neuropathy on local postural muscle and central sensory feedback balance control. PLoS One. 2015 Aug 10;10(8):e0135255. https://doi.org/10.1371/journal.pone.0135255
Vision Problems in the U.S. Prevalence of Adults Vision Impairment and Age-Related Eye Disease in America. http://www.visionproblemsus.org/diabetic-retinopathy/diabetic-retinopathy-map.html Published: 2012. Accessed: March 24, 2018.
Wallace, C., Reiber, G. E., LeMaster, J., Smith, D.G., Sullivan, K., Hayes, S., Vath, C. Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care. 2002 Nov;25(11):1983-6. https://doi.org/10.2337/diacare.25.11.1983
Whiney, S.L., Wrisley, D.M., Marchetti, G.F., Gee, M.A., Redfern, M.S., Furman, J.M. Clinical Measurement of Sit-to-Stand Performnce in People With Balance Disorders: Validity of Data for the Five-Times-Sit-to-Stand Test. PHYS THER. 2005;85:1034-1045. https://doi.org/10.1093/ptj/85.10.1034
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