Sains Malaysiana 50(1)(2021): 191-199

http://dx.doi.org/10.17576/jsm-2021-5001-19

The Impact of Diabetic Peripheral Neuropathy on Spatiotemporal Gait Parameters in Stroke Survivors: A Case-Control Study

(Kesan Diabetik Neuropati Periferi ke atas Parameter Berjalan dalam Aspek Masa dan Jarak dalam Kalangan Pesakit Strok: Suatu Kajian Kes Kawalan)

AMIRAH MUSTAPA¹, MARIA JUSTINE², NADIA MOHD MUSTAFAH⁴ & HAIDZIR MANAF^2,3*

¹Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, 25200 Kuantan, Pahang Darul Makmur, Malaysia

²Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, 42300 Puncak Alam, Selangor Darul Ehsan, Malaysia

³Clinical and Rehabilitation Research Group, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, 42300 Puncak Alam, Selangor Darul Ehsan, Malaysia

⁴Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor Darul Ehsan, Malaysia

Received: 1 February 2019/Accepted: 17 June 2020

ABSTRACT

The deterioration of gait performance following stroke is related to the impairment of sensorimotor function on the paretic side. Improper gait performance in post-stroke with additional diabetic peripheral neuropathy (DPN) on paretic and non-paretic legs may create destabilizing effects, including serious injuries and falls. Therefore, this study aimed to investigate the effect of DPN on spatiotemporal gait parameters in stroke survivors and determine the correlation of movement functioning and functional balance post-stroke with gait parameters. Ten stroke survivors with DPN, 10 stroke survivors without DPN and 10 healthy controls participated in this case-control study. Movement functioning and functional balance were assessed before the actual testing. Spatiotemporal gait parameters were recorded using the Nexus Vicon motion analysis system. Kruskal-Wallis test was used to analyze the gait parameters and Spearman’s rank-order correlation coefficient was used to identify the correlation between variables. Results showed that stroke survivors with DPN had longer stride time (temporal gait parameter, p = 0.001), lower cadence (p = 0.001) and greater gait variability than those without DPN and the healthy controls. The gait parameters were significantly correlated with movement functioning and functional balance in stroke survivors with DPN (p < 0.05). These findings suggested that DPN possibly affected the gait parameters in stroke survivors. DPN could also play a role in movement functioning and functional balance in stroke survivors.

Keywords: Diabetic peripheral neuropathy; gait; spatiotemporal; stroke

ABSTRAK

Kecelaruan fungsi berjalan dalam kalangan pesakit strok dilaporkan kerana masalah fungsi sensorimotor pada sisi lumpuh. Kecelaruan fungsi berjalan dalam kalangan pesakit strok dengan pertambahan gangguan saraf kaki akibat kencing manis pada sisi lumpuh dan baik boleh menimbulkan kesan buruk yang boleh mempengaruhi risiko jatuh. Oleh itu, kajian ini ingin mengkaji kesan gangguan saraf kaki akibat kencing manis terhadap parameter berjalan dalam aspek masa dan jarak dalam kalangan pesakit strok dan menentukan hubung kait antara fungsi pergerakan, keseimbangn badan dengan parameter berjalan. Sepuluh pesakit strok dengan gangguan saraf kaki akibat kencing manis, 10 pesakit strok yang tiada gangguan saraf kaki akibat kencing manis dan 10 peserta yang sihat telah menyertai kajian ini. Fungsi pergerakan dan keseimbangn badan diuji sebelum ujian yang sebenar. Parameter berjalan dalam aspek masa dan jarak dirakam menggunakan sistem analisis pergerakan Nexus Vicon. Ujian Kruskal-Wallis telah digunakan untuk menganalisis parameter berjalan dan pekali korelasi tataan peringkat Spearman telah digunakan untuk mengenali hubung kait antara pemboleh ubah. Kajian ini menunjukkan pesakit strok dengan gangguan saraf kaki akibat kencing manis mempunyai masa melangkah yang lebih panjang (parameter berjalan dalam aspek masa), jumlah langkah yang rendah dalam satu minit dan kelainan berjalan yang besar daripada pesakit strok yang tiada gangguan saraf kaki akibat kencing manis dan peserta yang sihat. Parameter berjalan mempunyai hubung kait yang signifikan dengan fungsi pergerakan dan keseimbangn badan pada pesakit strok dengan gangguan saraf kaki akibat kencing manis. Keputusan ini mencadangkan parameter berjalan pada pesakit strok terjejas kerana gangguan saraf kaki akibat kencing manis. Gangguan saraf kaki akibat kencing manis juga memainkan peranan penting dalam keterukan strok dan keseimbangn badan.

Kata kunci: Aspek masa dan jarak; berjalan; gangguan saraf kaki akibat kencing manis; strok

REFERENCES

Ahmed, S., Mayo, N.E., Higgins, J., Salbach, N.M., Finch, L. & Wood-Dauphinée, S.L. 2003. The stroke rehabilitation assessment of movement (STREAM): A comparison with other measures used to evaluate effects of stroke and rehabilitation. Physical Therapy 83(7): 617-630.

Al-Geffari, M. 2012. Comparison of different screening tests for diagnosis of diabetic peripheral neuropathy in primary health care setting. International Journal of Health Sciences 6(2): 127-134.

Balaban, B. & Tok, F. 2014. Gait disturbances in stroke patients. The Journal of Injury, Function and Rehabilitation 6(7): 635-642.

Beauchet, O., Annweiler, C., Lecordroch, Y., Allali, G., Dubost, V., Herrmann, F.R. & Kressig, R.W. 2009. Walking speed-related changes in stride time variability: Effects of decreased speed. Journal of Neuroengineering and Rehabilitation 6(1): 22-29.

Beyaert, C., Vasa, R. & Frykberg, G.E. 2015. Gait post-stroke: Pathophysiology and rehabilitation strategies. Neurophysiologie Clinique/Clinical Neurophysiology 45(4-5): 335-355.

Blum, L. & Korner-Bitensky, N. 2008. Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Physical Therapy 88(5): 559-566.

Boudarham, J., Roche, N., Pradon, D., Bonnyaud, C., Bensmail, D. & Zory, R. 2013. Variations in kinematics during clinical gait analysis in stroke patients. PloS ONE 8(6): e66421.

Bowden, M.G., Clark, D.J. & Kautz, S.A. 2010. Evaluation of abnormal synergy patterns poststroke: Relationship of the Fugl-Meyer assessment to hemiparetic locomotion. Neurorehabilitation and Neural Repair 24(4): 328-337.

Courtemanche, R., Teasdale, N., Boucher, P., Fleury, M., Lajoie, Y. & Bard, C. 1996. Gait problems in diabetic neuropathic patients. Archives of Physical Medicine and Rehabilitation 77(9): 849-855.

de Mettelinge, T.R., Delbaere, K., Calders, P., Gysel, T., Van Den Noortgate, N. & Cambier, D. 2013. The impact of peripheral neuropathy and cognitive decrements on gait in older adults with type 2 diabetes mellitus. Archives of Physical Medicine and Rehabilitation 94(6): 1074-1079.

Dingwell, J.B. & Cavanagh, P.R. 2001. Increased variability of continuous overground walking in neuropathic patients is only indirectly related to sensory loss. Gait & Posture 14(1): 1-10.

Dixit, S. & Maiya, A. 2014. Diabetic peripheral neuropathy and its evaluation in a clinical scenario: A review. Journal of Postgraduate Medicine 60(1): 33-35.

Espy, D.D., Yang, F., Bhatt, T. & Pai, Y.C. 2010. Independent influence of gait speed and step length on stability and fall risk. Gait & Posture 32(3): 378-382.

Fahmy, I.M., Ramzy, G.M., Salem, N.A., Ahmed, G.M. & Mohammed, A.A. 2014. Balance disturbance in patients with diabetic sensory polyneuropathy. Egyptian Journal of Neurology, Psychiatry and Neurosurgery 51(1): 21-29.

Fortaleza, A.C.D.S., Chagas, E.F., Ferreira, D.M.A., Mantovani, A.M., Barela, J.A., Chagas, E.F.B. & Fregonesi, C.E.P.T. 2013. Postural control and functional balance in individuals with diabetic peripheral neuropathy. Revista Brasileira de Cineantropometria & Desempenho Humano 15(3): 305-314.

Garland, S.J., Gray, V.L. & Knorr, S. 2009. Muscle activation patterns and postural control following stroke. Motor Control 13(4): 387-411.

Haral, P.P., Yardi, S. & Karajgi, A. 2014. Effect of sensorimotor integration on balance and gait in chronic stroke patients. Indian Journal of Physiotherapy and Occupational Therapy 8(1): 64-70.

Hsu, A.L., Tang, P.F. & Jan, M.H. 2003. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Archives of Physical Medicine and Rehabilitation 84(8): 1185-1193.

Jongbloed, L. 1986. Prediction of function after stroke: A critical review. Stroke 17(4): 765-776.

Katoulis, E.C., Ebdon-Parry, M., Lanshammar, H., Vileikyte, L., Kulkarni, J. & Boulton, A.J. 1997. Gait abnormalities in diabetic neuropathy. Diabetes Care 20(12): 1904-1907.

Kluding, P. & Gajewski, B. 2009. Lower-extremity strength differences predict activity limitations in people with chronic stroke. Physical Therapy 89(1): 73-81.

Ko, S.U., Stenholm, S., Chia, C.W., Simonsick, E.M. & Ferrucci, L. 2011. Gait pattern alterations in older adults associated with type 2 diabetes in the absence of peripheral neuropathy-results from the baltimore longitudinal study of aging. Gait & Posture 34(4): 548-552.

Manor, B., Wolenski, P. & Li, L. 2008. Faster walking speeds increase local instability among people with peripheral neuropathy. Journal of Biomechanics 41(13): 2787-2792.

Martinelli, A.R., Mantovani, A.M., Nozabieli, A.J.L., Ferreira, D.M.A., Barela, J.A., de Camargo, M.R. & Fregonesi, C.E.P.T. 2013. Muscle strength and ankle mobility for the gait parameters in diabetic neuropathies. The Foot 23(1): 17-21.

Menz, H.B., Lord, S.R., St George, R. & Fitzpatrick, R.C. 2004. Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Archives of Physical Medicine and Rehabilitation 85(2): 245-252.

Mustapa, A., Justine, M., Mustafah, N.M. & Manaf, H. 2017. The effect of diabetic peripheral neuropathy on ground reaction forces during straight walking in stroke survivors. Rehabilitation Research and Practice 2017: 1-9.

Najafi, B., Khan, T., Fleischer, A. & Wrobel, J. 2013. The impact of footwear and walking distance on gait stability in diabetic patients with peripheral neuropathy. Journal of the American Podiatric Medical Association 103(3): 165-173.

Ng, S.S. & Fong, S.S. 2014. Visual perception correlates with balance and motor performance in patients with stroke. Indian Journal of Physiotherapy & Occupational Therapy 8(1): 54-59.

Paul, L., Ellis, B.M., Leese, G.P., McFadyen, A.K. & McMurray, B. 2009. The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy. Diabetic Medicine 26(3): 234-239.

Portney, L.G. & Watkins, P.M. 2014. Foundations of Clinical Research: Applications to Practice. 3rd ed. Upper Saddle River: Pearson Education Limited. pp. 569-584.

Raja, B., Neptune, R.R. & Kautz, S.A. 2012. Coordination of the non-paretic leg during hemiparetic gait: Expected and novel compensatory patterns. Clinical Biomechanics 27(10): 1023-1030.

Ricci, N.A., Ferrarias, G.P., Molina, K.I., Dib, P.M. & Alouche, S.R. 2015. Gait speed and falls self-efficacy in individuals with hemiparesis after stroke. Fisioter. Pesqui. 22(2): 191-196.

Rosén, E., Sunnerhagen, K.S. & Kreuter, M. 2005. Fear of falling, balance and gait velocity in patients with stroke. Physiotherapy Theory and Practice 21(2): 113-120.

Shaughnessy, M., Michael, K.M., Sorkin, J.D. & Macko, R.F. 2005. Steps after stroke: Capturing ambulatory recovery. Stroke 36(6): 1305-1307.

Tanenberg, R.J. 2009. Diabetic peripheral neuropathy: Painful or painless. Hospital Physician 45(7): 1-8.

Toosizadeh, N., Mohler, J., Armstrong, D.G., Talal, T.K. & Najafi, B. 2015. The influence of diabetic peripheral neuropathy on local postural muscle and central sensory feedback balance control. PloS ONE 10(8): e0135255.

Tyson, S.F., Hanley, M., Chillala, J., Selley, A. & Tallis, R.C. 2006. Balance disability after stroke. Physical Therapy 86(1): 30-38.

Von Schroeder, H.P., Coutts, R.D., Lyden, P.D., Billings, E. & Nickel, V.L. 1995. Gait parameters following stroke: A practical assessment. Journal of Rehabilitation Research and Development 32(1): 25-31.

Ward, A.B. 2012. A literature review of the pathophysiology and onset of post‐stroke spasticity. European Journal of Neurology 19(1): 21-27.

Woolley, S.M. 2001. Characteristics of gait in hemiplegia. Topics in Stroke Rehabilitation 7(4): 1-18.

Wuehr, M., Schniepp, R., Schlick, C., Huth, S., Pradhan, C., Dieterich, M., Brandt, T. & Jahn, K. 2014. Sensory loss and walking speed related factors for gait alterations in patients with peripheral neuropathy. Gait & Posture 39(3): 852-858.

*Corresponding author; email: haidzir5894@uitm.edu.my