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Assessment and Trèatment of Gait in Diabetic Peripheral Neuropathy: A Focused Review of Evidence

Kumar Senthil P. , Kumar Senthil P. , Adhikari Prabha , Jeganathan , Misri Z.K. , D’Souza Sydney C.

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International Journal of Neurology and Neurosurgery 6(1):p 5-12, January - June 2014. | DOI:

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Abstract

Background: Walking is an integrated function of neurophysiological and musculoskeletal systems which in turn depends upon cardiorespiratory and metabolic systems for energy cost and expenditure. Objective: To evaluate the abnormalities of gait in patients with diabetic peripheral neuropathy (DPN) by reviewing studies on assessment and treatment. Methods: A systematic review of PubMed was done using search terms of diabetic neuropathy and gait for articles in English with abstracts and independent blinded data extraction and synthesis was performed to identify studies on assessment and treatment. Results: Reduced gait speed, reduced double support time, reduced step length, reduced ankle range of motion, with increased ankle invertor-evertor moment; altered plantar pressures with increased load under midfoot compared to rearfoot; earlier muscle activity of soleus, tibialis anterior, vastus medialis and medial hamstrings with delayed muscle activity of vastus lateralis and lateral gastrocnemius; longer loading time with decreased mediolateral and longitudinal center of pressure excursions were reported in gait of individuals with DPN. Gait-related interventions in DPN population studied were physiotherapy including walking prescription, lower extremity strengthening and balance exercises, footwear and insoles, and visual feedback which were shown to improve balance, gait speed, muscle activity and plantar pressures in this population. Conclusion: There were alterations in temporal and spatial gait parameters, muscle activation patterns, and loading time responses which is essential for clinicians examining patients with DPN, and interventions such as physiotherapy, footwear and insoles and visual feedback were reported to be useful to improve gait in people with DPN.

Keywords: Gait; Human walking; Bipedal locomotion; Diabetic neuropathy; Functional mobility. 

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