Bonnet Cédrick T, Ray Christopher
Laboratoire de Neurosciences Fonctionnelles et Pathologies, Universitié Lille 2, CNRS, Lille, France.
Clin Biomech (Bristol). 2011 Aug;26(7):699-706. doi: 10.1016/j.clinbiomech.2011.03.004. Epub 2011 Mar 31.
Individuals with diabetic neuropathy sway more than control individuals while standing. This review specifically evaluated whether peripheral sensory neuropathy can be the only fundamental reason accounting for significant increased sway within this population.
Twenty-six experimental articles were selected using MEDLINE and reference lists of relevant articles. The articles chosen investigated kinematic data of postural behaviour in controls and individuals with diabetic neuropathy during stance. Results of literature were compared with four expectations related to the peripheral sensory neuropathy fundamental hypothesis.
Consistent with the peripheral sensory neuropathy hypothesis, the literature showed that individuals with diabetic neuropathy sway more than controls in quiet stance and even more so if their visual or vestibular systems were perturbed. Inconsistent with the hypothesis, individuals with diabetic neuropathy are more destabilised than controls in conditions altering sensation of the feet and legs (standing on a sway-referenced surface).
The review showed that the peripheral sensory neuropathy hypothesis may not be the only fundamental cause accounting for significant increased postural sway in individuals with diabetic neuropathy. Visual impairments and changes in postural coordination may explain the divergence between expectations and results. In order to develop interventions aimed at improving postural control in individuals with diabetic neuropathy, scientific exploration of these new expectations should be detailed. Also at the practical level, the review discussed which additional sensory information - at the level of the hands and feet - may be more beneficial in individuals with diabetic neuropathy to reduce their postural sway.
糖尿病神经病变患者站立时比对照组人群摇摆幅度更大。本综述专门评估了周围感觉神经病变是否可能是该人群摇摆显著增加的唯一根本原因。
通过医学文献数据库（MEDLINE）及相关文章的参考文献列表筛选出26篇实验性文章。所选文章研究了对照组和糖尿病神经病变患者站立时姿势行为的运动学数据。将文献结果与与周围感觉神经病变基本假设相关的四个预期进行了比较。
与周围感觉神经病变假设一致，文献表明糖尿病神经病变患者在安静站立时比对照组摇摆幅度更大，若其视觉或前庭系统受到干扰则摇摆更明显。与该假设不一致的是，在改变足部和腿部感觉的条件下（站在一个以摇摆为参考的表面上），糖尿病神经病变患者比对照组更不稳定。
该综述表明，周围感觉神经病变假设可能不是糖尿病神经病变患者姿势摇摆显著增加的唯一根本原因。视力障碍和姿势协调变化可能解释了预期与结果之间的差异。为了开发旨在改善糖尿病神经病变患者姿势控制的干预措施，应详细科学探索这些新的预期。在实践层面，该综述还讨论了在手部和足部水平上，哪些额外的感觉信息可能对糖尿病神经病变患者更有益，以减少他们的姿势摇摆。
