Diabetic peripheral neuropathy has been shown in previous studies to cause postural sway during standing and walking on level ground in diabetic patients but no data is available regarding the effect of DPN on balance of diabetic patients during stair walking.

Steve Brown from Manchester Metropolitan University, United Kingdom and colleagues assessed the motion and pressure data of 3 groups of patients: 22 diabetic patients with DPN (PN; average age = 57 years), 40 diabetic patients with no DPN (DM; average age = 57 years) and 32 healthy adults (Ctrl; average age = 50 years).

These patients were invited to a gait lab where their movement and pressure under their feet would be measured. Movement was measured using a 3D motion analysis system from reflective markers placed at anatomical locations on the body to calculate whole-body centre-of-mass (CoM). The centre-of-pressure (CoP) under the feet was measured using 4 force platforms mounted into the middle of a 7-step staircase, which patients ascended and descended at least 3 times.

Results of the study revealed that patients in the PN group experienced significant higher maximum CoM-CoP separation (p<0.01) and significantly increased variation in CoM-CoP separation (p<0.05) compared to the Ctrl group during stair ascent as well as decent. In addition, the PN group also displayed a significantly wider stance width compared to Ctrl group during stair descent only (p<0.05). No differences in any variable were observed in the DM group compared to the Ctrl group during stair ascent or descent.

According to the authors, ”a larger and more variable medial-lateral sway means that patients with DPN are more likely to lose control of balance and experience a fall during what is known to be an activity where the risk of falls in already very high (stair walking).”

Practice Pearls:

• Patients with DPN would be more likely to lose control of balance and experience a fall during stair walking.
• Health practitioners should counseling patients with DPN to take extra precaution during stair walking.
• The result of this study suggested that the risk of falling in patients without DPN was not significant; however, counseling on safety during stair walking should still be considered.

Brown S, Handsaker J, Bowling F, et al. Diabetic peripheral neuropathy adversely affects balance during stair ascent and descent. EASD Virtual Meeting. 17 Sep 2014. Web. 25 Sep 2014.

From http://www.diabetesincontrol.com/

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