Savelberg Hans H C M, Ilgin Duygu, Angin Salih, Willems Paul J B, Schaper Nicolaas C, Meijer Kenneth
Department of Human Movement Sciences, Nutrition and Toxicology Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Clin Biomech (Bristol). 2010 Jun;25(5):468-75. doi: 10.1016/j.clinbiomech.2010.02.005. Epub 2010 Mar 5.
People with diabetes or diabetic polyneuropathy often experience limitations in mobility and gait. These limitations are believed to be related to disturbed muscle function and sensory information. In previous studies on diabetic gait, results were confounded by a lower, preferred walking speed in people with diabetes or diabetic polyneuropathy. This study aimed to identify gait-velocity independent effects of diabetes and diabetic polyneuropathy on lower extremity kinematics and muscle activation patterns.
Eight people with diabetic polyneuropathy, 10 diabetic controls without polyneuropathy and ten healthy, age-matched controls walked at their preferred velocity and a standard velocity of 1.4 ms(-1). Muscle activation patterns of gluteus maximus, biceps femoris, rectus femoris, vastus medialis, gastrocnemius medialis, soleus, and tibialis anterior, and spatiotemporal and joint angles characteristics were analysed.
Independent of walking speed, muscle activation differed between groups. In diabetic polyneuropathy participants activation of ankle-joint dorsal flexors was prolonged by 5-10% of the stride cycle. Activity of monoarticular knee-joint extensors lasted about 10% longer in both diabetic groups compared to healthy elderly. Initiation of muscle activity did not differ between groups. If gait velocity was controlled, spatiotemporal characteristics were similar between groups.
The study showed that independent of the preferred lower gait velocity, people with diabetes or diabetic polyneuropathy adjust the timing of muscle activity. Contrarily, the concurrent changes in spatiotemporal characteristics occurred to be the result of changed velocity only. The delayed cessation of muscle activity suggested a reduced rate of force development underlying the adjusted timing of muscle activation.
糖尿病患者或糖尿病性多发性神经病患者常出现行动能力和步态受限。这些限制被认为与肌肉功能紊乱和感觉信息有关。在先前关于糖尿病步态的研究中，糖尿病患者或糖尿病性多发性神经病患者较低的偏好步行速度混淆了研究结果。本研究旨在确定糖尿病和糖尿病性多发性神经病对下肢运动学和肌肉激活模式的与步态速度无关的影响。
8名糖尿病性多发性神经病患者、10名无多发性神经病的糖尿病对照者和10名年龄匹配的健康对照者以各自的偏好速度和1.4米/秒的标准速度行走。分析了臀大肌、股二头肌、股直肌、股内侧肌、腓肠肌内侧头、比目鱼肌和胫骨前肌的肌肉激活模式，以及时空和关节角度特征。
与步行速度无关，各组之间的肌肉激活情况有所不同。在糖尿病性多发性神经病参与者中，踝关节背屈肌的激活在步幅周期中延长了5%-10%。与健康老年人相比，两个糖尿病组的单关节膝关节伸肌活动持续时间约长10%。各组之间肌肉活动的起始没有差异。如果控制步态速度，各组之间的时空特征相似。
该研究表明，与偏好的较低步态速度无关，糖尿病患者或糖尿病性多发性神经病患者会调整肌肉活动的时间。相反，时空特征的同时变化似乎仅是速度改变的结果。肌肉活动停止延迟表明在调整后的肌肉激活时间背后，力量发展速率降低。
