Motor control in gait characteristics in people with type 1 and type 2 diabetes without sensory impairment in the foot

摘要

Twenty-five control subjects, fifteen subjects with Type 2 and ten subjects with Type 1 diabetes were examined to compare motor control during walking in a linear path and during turns. To eliminate the contribution of sensory neuropathies to the feet and myopathies of the lower leg muscles, subjects were selected with no sensory impairment in their feet or muscle strength deficits. To measure deviations in gait and motor control errors, timing of gait was measured from foot sensors worn in the shoes, from accelerometers (2 axis) mounted on the head, shoulder, hips, knees and ankles, bilaterally and from the electromyogram of the major muscle groups in the legs. As a measure of peripheral reflex activity, the H reflex was also measured in the gastrocnemius muscle. The results showed that subjects with diabetes took more steps when walking in a linear path and during turns, significantly more time to walk a given distance than control subjects, and an increase in flexion/extension and lateral movement at the major joints in the body. Joint movement at the hip, knee, ankle and shoulders, showed a 50 to 100% increase during gait for subjects with diabetes compared to control subjects with significantly greater tremor occurring at the joints in the 8Hz and 16Hz bands indicating central motor control deficits in subjects with both Type 1 and Type 2 diabetes. H reflex was also about 50% less in subjects with diabetes compared to control subjects. These findings suggest that for individuals with Type 1 and Type 2 diabetes, impairments in both the timing and quality of gait are likely caused by dysfunction of central motor control found equally by both Types of diabetes.so-