Physical Education and Physiotherapy Faculty, Federal University of Amazonas, Manaus, AM, Brazil.
Physical Therapy, Speech and Occupational Therapy department, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil.
J Neuroeng Rehabil. 2017 Nov 9;14(1):111. doi: 10.1186/s12984-017-0327-x.
Muscle force estimation could advance the comprehension of the neuromuscular strategies that diabetic patients adopt to preserve walking ability, which guarantees their independence as they deal with their neural and muscular impairments due to diabetes and neuropathy. In this study, the lower limb's muscle force distribution during gait was estimated and compared in diabetic patients with and without polyneuropathy.
Thirty individuals were evaluated in a cross-sectional study, equally divided among controls (CG) and diabetic patients with (DNG) and without (DG) polyneuropathy. The acquired ground reaction forces and kinematic data were used as input variables for a scaled musculoskeletal model in the OpenSim software. The maximum isometric force of the ankle extensors and flexors was reduced in the model of DNG by 30% and 20%, respectively. The muscle force was calculated using static optimization, and peak forces were compared among groups (flexors and extensors of hip, knee, and ankle; ankle evertors; and hip abductors) using MANOVAs, followed by univariate ANOVAs and Newman-Keuls post-hoc tests (p < 0.05).
From the middle to late stance phase, DG showed a lower soleus muscle peak force compared to the CG (p=0.024) and the DNG showed lower forces in the gastrocnemius medialis compared to the DG (p=0.037). At the terminal swing phase, the semitendinosus and semimembranosus peak forces showed lower values in the DG compared to the CG and DNG. At the late stance, the DNG showed a higher peak force in the biceps short head, semimembranosus, and semitendinosus compared to the CG and DG.
Peak forces of ankle (flexors, extensors, and evertors), knee (flexors and extensors), and hip abductors distinguished DNG from DG, and both of those from CG. Both diabetic groups showed alterations in the force production of the ankle extensors with reductions in the forces of soleus (DG) and gastrocnemius medialis (DNG) seen in both diabetic groups, but only DNG showed an increase in the hamstrings (knee flexor) at push-off. A therapeutic approach focused on preserving the functionality of the knee muscles is a promising strategy, even if the ankle dorsiflexors and plantarflexors are included in the resistance training.
肌肉力量估计可以帮助深入了解糖尿病患者为了保持行走能力而采用的神经肌肉策略，这可以保证他们的独立性，因为他们要应对由于糖尿病和神经病变而导致的神经和肌肉损伤。在这项研究中，我们比较了患有和不患有多发性神经病的糖尿病患者在行走过程中下肢肌肉力量的分布。
在一项横断面研究中，我们评估了 30 名个体，他们在对照组（CG）和患有（DNG）和不患有（DG）多发性神经病的糖尿病患者中平均分为两组。使用地面反作用力和运动学数据作为 OpenSim 软件中比例肌肉骨骼模型的输入变量。DNG 模型中踝关节伸肌和屈肌的最大等长力分别降低了 30%和 20%。使用静态优化计算肌肉力量，并使用 MANOVAs 比较组间（髋关节、膝关节和踝关节的屈肌和伸肌；踝关节外翻肌；髋关节外展肌）的峰值力，然后进行单因素 ANOVA 和 Newman-Keuls 事后检验（p<0.05）。
从中到晚期站立阶段，DG 的比目鱼肌峰值力低于 CG（p=0.024）和 DNG 的腓肠肌内侧（p=0.037）。在终末期摆动阶段，半腱肌和半膜肌的峰值力在 DG 中低于 CG 和 DNG。在晚期站立阶段，DNG 的肱二头肌短头、半膜肌和半腱肌的峰值力高于 CG 和 DG。
踝关节（屈肌、伸肌和外翻肌）、膝关节（屈肌和伸肌）和髋关节外展肌的峰值力将 DNG 与 DG 和 CG 区分开来。两组糖尿病患者的踝关节伸肌的力量都发生了改变，两组糖尿病患者的比目鱼肌（DG）和腓肠肌内侧（DNG）的力量都降低了，但只有 DNG 在蹬离时出现了腘绳肌（膝关节屈肌）力量的增加。一种专注于保持膝关节肌肉功能的治疗方法是一种很有前途的策略，即使将踝关节背屈肌和跖屈肌包括在阻力训练中。
