Step length after discrete perturbation predicts accidental falls and fall-related injury in elderly people with a range of peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions.

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Retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with Type 2 diabetes

Diabetic Medicine ◽

10.1111/dme.12327 ◽

2013 ◽

Vol 31 (1) ◽

pp. 107-111 ◽

Cited By ~ 18

Author(s):

J.-P. Le Floch ◽

J. Doucet ◽

B. Bauduceau ◽

C. Verny ◽

Keyword(s):

Type 2 Diabetes ◽

Peripheral Neuropathy ◽

Elderly People ◽

Scale Scores

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Accidental Falls Involving Elderly People: An Integrative Literature Review / Acidentes por Quedas em Pessoas Idosas: Um Estudo de Revisão

Revista de Pesquisa Cuidado é Fundamental Online ◽

10.9789/2175-5361.2018.v10i4.1188-1193 ◽

2018 ◽

Vol 10 (4) ◽

pp. 1188

Author(s):

Maria das Graças Duarte Miguel ◽

Maria Adelaide Silva Paredes Moreira ◽

Olívia Galvão Lucena Ferreira ◽

Laura De Sousa Gomes Veloso ◽

Haydee Cassé da Silva ◽

...

Keyword(s):

Literature Review ◽

Elderly People ◽

Accidental Falls

Objetivo: Identificar as produções científicas sobre acidentes por quedas em pessoas idosas no período entre 2012 a 2016. Método: Estudo descritivo, do tipo Revisão Integrativo de Literatura, com abordagem quantitativa. A amostra foi composta por 69 produções científicas referenciadas na Biblioteca Virtual em Saúde (SCIELO, LILACS e BDENF), selecionadas em 2017, a partir dos descritores “acidentes por quedas”, “idosos” e “envelhecimento”, conforme critérios de inclusão e exclusão estabelecidos. Como instrumento para coleta dos dados utilizou-se roteiro estruturado no sentido de extrair as principais variáveis dos artigos. Os dados coletados foram organizados em planilhas e submetidos à análise quantitativa por meio de estatística descritiva simples (frequência absoluta e percentual). Resultados: Encontrou-se maior quantitativo de publicações em 2012, nas bibliotecas virtuais SCIELO e LILACS, com uma linearidade decrescente ao longo dos anos. Mais de 50% dos artigos produzidos foram de responsabilidade de estudiosos da fisioterapia e da enfermagem; a Revista Brasileira de Geriatria e Gerontologia foi a que mais publicou sobre tais acidentes (n=12; 17,9%); houve predomínio de estudos da região sudeste e sul, que, juntas, totalizaram a maioria de publicações registradas no país (63,77%). O método de análise de dados quantitativo representou 94,20% (n=65) e o qualitativo foram 4,35% (n=3) dos estudos identificados. Conclusão: O olhar dos profissionais da saúde para a pesquisa e a publicação referente aos acidentes por quedas ainda são escassos, apesar de esses eventos acontecerem com frequência e serem sugestivos de um grave problema de saúde pública com tendência a morbi-mortalidade das pessoas idosas.

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Are the Timed Up and Go Test and Functional Reach Test Useful Predictors of Temporal and Spatial Gait Parameters in Elderly People?

Human Movement ◽

10.1515/humo-2016-0025 ◽

2016 ◽

Vol 17 (3) ◽

Author(s):

Dorota Sadowska ◽

Margareta Gumny ◽

Wiesław Osiński

Keyword(s):

Elderly People ◽

Step Length ◽

Functional Fitness ◽

Timed Up And Go ◽

Double Support ◽

Functional Reach ◽

Gait Parameters ◽

Functional Reach Test ◽

Temporal And Spatial ◽

Support Time

AbstractThe study aim was to analyse the relationships between the results of the Timed Up and Go (TUG) test and the Functional Reach Test (FRT), and the temporal and spatial gait parameters determined with the GAITRite system.The study included 60 healthy, physically active elderly people aged 70.4 ± 5.1 years. The participants’ functional fitness was evaluated with the TUG and FRT, and their temporal and spatial gait parameters – with the GAITRite system.The TUG results correlated inversely with the step length (Basic temporal and spatial parameters of gait at the preferred speed, i.e. velocity, step length, stance time, single support time, swing time, and double support time, explain up to 43% of the TUG outcome variance and 26% of the FRT results variance.

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