Why are patients with diabetic peripheral neuropathy more likely to fall? An examination of the underpinning biomechanical mechanisms of locomotion and the influence of intervention.

Handsaker, Joseph Charles (2014) Why are patients with diabetic peripheral neuropathy more likely to fall? An examination of the underpinning biomechanical mechanisms of locomotion and the influence of intervention. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

The research for this thesis examined the effects of diabetic peripheral neuropathy (DPN) on biomechanical factors related to the risk of falling during locomotor tasks, and the effects of a 16-week multi-factorial intervention on the identified impairments. The speed of ankle and knee strength generation, and muscular activations were measured during stair ascent and descent; and minimum toe clearance, stepping accuracy, and visual gaze parameters were measured during level ground walking. Patients with DPN, diabetes patients with no neuropathy and non-diabetic controls were measured before and after a 16-week intervention consisting of high-load resistance exercises and a visual gaze training task. Patients with DPN displayed slower ankle and knee strength generation during stair ascent and descent than healthy controls (p<0.05). Post-intervention, strength was generated faster at the ankle and knee during both tasks (p<0.05), which is expected to improve stability during the weight acceptance phase. During level ground walking, patients with DPN displayed a higher minimum toe clearance (p<0.05), which is expected to reduce the risk of tripping on smaller, less observable hazards; but displayed a decreased stepping accuracy (p<0.05), which may reduce the ability to avoid tripping hazards. Stepping accuracy was improved as a result of the intervention (p<0.05), which may originate from improvements in visual gaze strategy and motor control, contributing to reduce the risk of tripping in patients with DPN. Biomechanical impairments during locomotion were observed in patients with DPN; however, the intervention improved these aspects and may reduce the risk of falling in this population.