Service of Therapeutic Education for Chronic Diseases, WHO Collaborating Centre, Department of Community Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Diabet Med. 2010 Jan;27(1):61-4. doi: 10.1111/j.1464-5491.2009.02875.x.
The reduction of high plantar pressure in diabetic patients with peripheral neuropathy is mandatory for prevention of foot ulcers and amputations. We used a new biofeedback-based method to reduce the plantar pressure at an at-risk area of foot in diabetic patients with peripheral neuropathy.
Thirteen diabetic patients (age 60.8 +/- 12.3 years, body mass index 29.0 +/- 5.0 kg/m(2)) with peripheral neuropathy of the lower limbs were studied. Patients with memory impairment were excluded. The portable in-shoe foot pressure measurement system (PEDAR) was used for foot offloading training by biofeedback. The learning procedure consisted in sequences of walking (10 steps), each followed by a subjective estimation of performance and objective feedback. The goal was to achieve three consecutive walking cycles of 10 steps, with a minimum of seven steps inside the range of 40-80% of the baseline peak plantar pressure. The peak plantar pressure was assessed during the learning period and at retention tests.
A significant difference in peak plantar pressure was recorded between the beginning and the end of the learning period (when the target for plantar pressure was achieved) (262 +/- 70 vs. 191 +/- 53 kPa; P = 0.002). The statistically significant difference between the beginning of learning and all retention tests persisted, even at the 10-day follow-up.
Terminal augmented feedback training may positively affect motor learning in diabetic patients with peripheral neuropathy and could possibly lead to suitable foot offloading. Additional research is needed to confirm the maintenance of offloading in the long term.
降低伴有周围神经病变的糖尿病患者的足底高压力对于预防足部溃疡和截肢是必需的。我们使用一种新的基于生物反馈的方法来降低伴有周围神经病变的糖尿病患者足部高危区域的足底压力。
研究了 13 例下肢周围神经病变的糖尿病患者（年龄 60.8±12.3 岁，体重指数 29.0±5.0kg/m²）。排除有记忆障碍的患者。使用便携式鞋内足底压力测量系统（PEDAR）通过生物反馈进行足底减压训练。学习过程包括行走（10 步）序列，每步后跟进行主观表现评估和客观反馈。目标是实现 3 个连续的 10 步行走周期，至少有 7 步在基线峰值足底压力的 40-80%范围内。在学习期间和保留测试中评估峰值足底压力。
在学习期开始和结束时（达到足底压力目标时），峰值足底压力有显著差异（262±70kPa 与 191±53kPa；P=0.002）。即使在 10 天的随访中，学习开始和所有保留测试之间的统计学显著差异仍然存在。
终端增强反馈训练可能会对伴有周围神经病变的糖尿病患者的运动学习产生积极影响，并可能导致适当的足底减压。需要进一步的研究来确认长期的减压维持。
