Sacco I C, Amadio A C
School of Physical Education and Sport, University of Sao Paulo, Av. Prof. Mello Moraes, 65, Cidade Universitária, 05508-900, São Paulo, Brazil.
Clin Biomech (Bristol). 2000 Mar;15(3):196-202. doi: 10.1016/s0268-0033(99)00060-1.
The present investigation aims at studying the sensitive cronaxie in neuropathic and non-neuropathic diabetic patients as a measure of sensorial deficit. We seek to describe the gait using dynamic and temporal parameters. We have compared the results of the neuropathic patients to the results of a non-diabetic group. We have looked for relationships between peak plantar pressure and sensitive cronaxie in selected plantar areas.
The experimental procedures were divided in: (a) determination of the sensitive cronaxie in four selected plantar areas, (b) determination and description of peak plantar pressure, ground reaction force variables and single and double stance time. We analyzed and compared the results of the sensitive cronaxie and the biomechanical parameters obtained by three experimental groups: diabetic, neuropathic and non-diabetic subjects.
The pathological response of the sensitive cronaxie worsened progressively for neuropathic and diabetic patients, respectively. Longer double and single stance times, lower minimum vertical force and lower growth rates were seen in the neuropathic patients when compared to diabetic and non-diabetic subjects.
These results indicate an alteration in the neuropathic patient movement structure. We have speculated that compensatory musculoskeletal mechanisms have been developed by neuropathic patients to compensate for their sensorial deficit. Future research is necessary to verify the relationship between neurophysiological and dynamic variables, since this relationship seems to be a good parameter for the interpretation and comprehension of the peripheral neuropathy. RelevancePeripheral neuropathy is one of the most insidious chronic complications of diabetes. It has been observed that dynamic changes in gait are usually associated with the peripheral neuropathy somatosensory deficits. Biomechanical studies have highlighted that dynamic gait evaluation can identify functional alterations, besides the analysis of sensitive cronaxie as a measure of sensorial deficits. They are also useful as a complimentary routine in the clinic treatment of diabetes and its further long-term complications.
本研究旨在探究神经性和非神经性糖尿病患者的敏感时值，以此作为感觉缺陷的一项指标。我们试图通过动态和时间参数来描述步态。我们将神经性患者的结果与非糖尿病组的结果进行了比较。我们还在选定的足底区域寻找峰值足底压力与敏感时值之间的关系。
实验步骤分为：(a) 测定四个选定足底区域的敏感时值，(b) 测定并描述峰值足底压力、地面反作用力变量以及单支撑和双支撑时间。我们分析并比较了敏感时值的结果以及三个实验组（糖尿病患者、神经性患者和非糖尿病受试者）获得的生物力学参数。
敏感时值的病理反应在神经性和糖尿病患者中分别逐渐恶化。与糖尿病患者和非糖尿病受试者相比，神经性患者的双支撑和单支撑时间更长，最小垂直力更低，增长率更低。
这些结果表明神经性患者的运动结构发生了改变。我们推测神经性患者已形成代偿性肌肉骨骼机制来弥补其感觉缺陷。由于这种关系似乎是解释和理解周围神经病变的一个良好参数，因此未来有必要进行研究以验证神经生理变量与动态变量之间的关系。相关性周围神经病变是糖尿病最隐匿的慢性并发症之一。据观察，步态的动态变化通常与周围神经病变的体感缺陷有关。生物力学研究强调，除了将敏感时值分析作为感觉缺陷的一项指标外，动态步态评估还可以识别功能改变。它们在糖尿病及其远期并发症的临床治疗中作为辅助常规检查也很有用。
