Scarton Alessandra, Jonkers Ilse, Guiotto Annamaria, Spolaor Fabiola, Guarneri Gabriella, Avogaro Angelo, Cobelli Claudio, Sawacha Zimi
Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy.
Department of Kinesiology, KU Leuven, Tervuursevest 101 - Box 1501, 3001, Leuven, Belgium.
Gait Posture. 2017 Oct;58:194-200. doi: 10.1016/j.gaitpost.2017.07.117. Epub 2017 Jul 31.
Diabetes neuropathy and vasculopathy are the two major complications of diabetes mellitus, leading to diabetic foot disease, of which the worst consequences are plantar ulcers and amputations. Motor impairments like joint stiffness and loss of balance are distinctive effects of diabetes and they have been extensively explored. However, while altered muscle function has been also assessed through experimentally measured surface electromyography, little is known about muscle forces. The objective of this study was to estimate muscle forces in subjects with diabetes and to use these data to identify differences with respect to a population of healthy subjects matched for age and BMI. This was obtained by generating musculoskeletal models of 10 diabetic and 10 control subjects in OpenSim starting from experimentally recorded data. Dynamic simulations of motion were run and hence muscle forces calculated. Student T test (p<0.05) was used to compare joints kinematics, kinetics and muscle forces between the two populations. Significant changes were observed between lower limb muscle forces and activation of diabetic and healthy subjects, as well as between joints kinematics and kinetics. In particular muscles related to foot movements proved to be stronger in the healthy population. The typical ankle rigidity of the diabetic population was confirmed by a lower range of motion registered at the ankle plantar/flexion angle associated with weaker dorsal-plantar flexor muscles. The information provided by this methodology can help planning specific training programs aiming at augmenting muscle strength and joints mobility, and they can also improve the evaluation of the potential benefits.
糖尿病神经病变和血管病变是糖尿病的两大主要并发症，可导致糖尿病足病，其最严重的后果是足底溃疡和截肢。诸如关节僵硬和平衡丧失等运动障碍是糖尿病的典型症状，并且已经得到了广泛研究。然而，尽管已经通过实验测量的表面肌电图对肌肉功能改变进行了评估，但对肌肉力量却知之甚少。本研究的目的是估计糖尿病患者的肌肉力量，并利用这些数据确定与年龄和体重指数相匹配的健康人群之间的差异。这是通过从实验记录的数据开始，在OpenSim中生成10名糖尿病患者和10名对照受试者的肌肉骨骼模型来实现的。进行了运动的动态模拟，从而计算出肌肉力量。使用学生t检验（p<0.05）比较两组人群之间的关节运动学、动力学和肌肉力量。在糖尿病患者和健康受试者的下肢肌肉力量与激活情况之间，以及在关节运动学和动力学之间观察到了显著变化。特别是，与足部运动相关的肌肉在健康人群中更强壮。糖尿病患者典型的踝关节僵硬表现为，在踝关节跖屈/背屈角度记录到的运动范围较小，同时背侧-跖侧屈肌较弱。这种方法提供的信息有助于制定旨在增强肌肉力量和关节活动度的特定训练计划，并且还可以改善对潜在益处的评估。
