Hsu Wei-Chun, Liu Ming-Wei, Lu Tung-Wu
Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan.
Gait Posture. 2016 Mar;45:103-9. doi: 10.1016/j.gaitpost.2016.01.010. Epub 2016 Jan 20.
People with type II diabetes mellitus (DM) are at a high risk of falling especially during more challenging locomotor tasks such as obstacle-crossing. The current study aimed to identify the risk factors for tripping in these patients during trailing-limb obstacle-crossing. Fourteen patients with type II DM with or without mild peripheral neuropathy (PN) and 14 healthy controls walked and crossed obstacles of three different heights while their motion data were measured using a motion capture system and two forceplates. The DM group was found to cross obstacles with significantly reduced trailing toe clearance (p<0.05), increasing the probability of the foot hitting the obstacle, and thus the risk of tripping. This altered end-point control was associated with significantly reduced knee flexion and hip adduction of the trailing swing limb (p<0.05), as well as significantly increased ankle plantarflexor moments in the leading stance limb (p<0.05). Therefore, reduced knee flexion and hip adduction of the swing limb are identified as risk factors for tripping during obstacle-crossing. Increased mechanical demands on the ankle plantarflexors suggest that weakness of these muscles may further reduce the already compromised performance of obstacle-crossing in these patients. The current results showed that obstacle-crossing can be used to detect gait deviations and to identify the associated risk of tripping in patients with type II DM without or at an early stage of PN.
2型糖尿病（DM）患者跌倒风险很高，尤其是在进行诸如跨越障碍物等更具挑战性的运动任务时。本研究旨在确定这些患者在后肢跨越障碍物过程中绊倒的风险因素。14例患有或未患有轻度周围神经病变（PN）的2型糖尿病患者以及14名健康对照者在行走并跨越三种不同高度的障碍物时，使用动作捕捉系统和两个测力板测量他们的运动数据。研究发现，糖尿病组跨越障碍物时后足趾间隙明显减小（p<0.05），增加了足部碰到障碍物的可能性，进而增加了绊倒风险。这种改变的终点控制与后摆腿的膝关节屈曲和髋关节内收明显减少有关（p<0.05），同时支撑腿踝关节跖屈力矩明显增加（p<0.05）。因此，摆动腿膝关节屈曲和髋关节内收减少被确定为跨越障碍物时绊倒的风险因素。踝关节跖屈肌的机械需求增加表明，这些肌肉的无力可能会进一步降低这些患者本已受损的跨越障碍物的能力。目前的结果表明，跨越障碍物可用于检测2型糖尿病患者在无PN或处于PN早期时的步态偏差，并识别相关的绊倒风险。
