17 Sep Neuropathy Predisposes Diabetics To Falls on Stairs
Medical Research: What are the main findings of the study?
Answer: Our main findings were increased extremes of sideways sway in patients with diabetes and severe peripheral neuropathy during stair negotiation. Measured by an increase in the amount of lateral separation between the centre-of-mass and centre-of-pressure. Our results showed a 3cm increase in maximum sway in patients with diabetic peripheral neuropathy during both stair descent and stair ascent.
Medical Research: What was most surprising about the results?
Answer: The most surprising aspect of these findings was that average sway over the four steps we measured did not show any signs of increase, despite clear increases in both maximal sway, and range of sway. This seems to indicate that whilst patients with diabetic peripheral neuropathy may experience larger maximal sway, during the majority of gait they perform at a similar level to healthy non-diabetic controls. These findings suggest then that the increased risk of falling stems from momentary periods of instability rather than continuously poor control of sway.
Medical Research: What should clinicians and patients take away from your report?
Answer: Our study suggests that the increased risk of falls present in patients with diabetic peripheral neuropathy stems largely from momentary periods of poorer balance, and it is during these moments that patients are more likely to fall. Whilst patients can do little to improve the deterioration in plantar sensation and proprioception that results from peripheral neuropathy, they can take measures to increase their stability on stairs. Using a banister whenever available is suggested, as it provides an extra point of contact with which individuals can control the amount they sway. To provide further stability a step-by-step approach to stairs, whereby both feet contact each step before moving on to the next step, will increase stability by reducing the amount of forwards and backwards sway, keeping the body’s centre-of-mass closer to the base-of-support and maximising stability.
Medical Research: What recommendations do you have for future research as a result of this study?
Answer: Continued research into the mechanisms behind falling in patients with diabetic peripheral neuropathy is crucial to maintaining quality of life of this population, as well as reducing the financial burden of dealing with the associated injuries. Our research suggests during stair negotiation there are periodic extremes in sway when patients are at most risk of losing balance. Therefore it would be beneficial to asertain why exactly these moments of imbalance occur, whether patients with peripheral neuropathy stumble more frequently causing them to sway more extremely, or whether there is another mechanism at work that limits their ability to maintain control of balance for sustained periods. It would also be beneficial to investigate some of the possible mechanisms for improving safety during this gait task, both by assessment of the efficacy of natural compensatory techniques such as using banisters, or walking slower, and by looking for balance training interventions that can improve patients confidence and capabilities in dealing with stair negotiation and coping with the poorer plantar sensation and proprioception that hinders them.
EASD Meeting 2014