BACKGROUND: Individuals with diabetes have a higher risk of falls and fall-related injuries. People with diabetes often develop peripheral neuropathy (DPN) as well as nerve damage throughout the body. In particular, reduced lower extremity proprioception due to DPN may cause a misjudgment of foot position and thus increase the risk of fall. OBJECTIVE: An innovative virtual obstacle-crossing paradigm using wearable sensors was developed in an attempt to assess lower extremity position perception damage due to DPN. METHODS: 67 participants (age 55.4 ± 8.9, BMI 28.1 ± 5.8) including diabetics with and without DPN as well as aged-matched healthy controls were recruited. Severity of neuropathy was quantified using a vibratory perception threshold (VPT) test. The ability of perception of lower extremity was quantified by measuring obstacle-crossing success rate (OCSR), toe-obstacle clearance (TOC), and reaction time (T(R)) while crossing a series of virtual obstacles with heights at 10% and 20% of the subject's leg length. RESULTS: No significant difference was found between groups for age and BMI. The data revealed that DPN subjects had a significantly lower OCSR compared to diabetics with no neuropathy and controls at an obstacle size of 10% of leg length (p < 0.05). DPN subjects also demonstrated longer T(R) compared to other groups and for both obstacle sizes. In addition, TOC was reduced in neuropathy groups. Interestingly, a significant correlation between T(R) and VPT (r = 0.5, p < 10(-3)) was observed indicating a delay in reaction with increasing neuropathy severity. The delay becomes more pronounced by increasing the size of the obstacle. Using a regression model suggests that the change in T(R) between obstacle sizes of 10% and 20% of leg length is the most sensitive predictor for neuropathy severity with an odds ratio of 2.70 (p = 0.02). CONCLUSION: The findings demonstrate proof of a concept of virtual-reality application as a promising method for objective assessment of neuropathy severity, however a further study is warranted to establish a stronger relationship between the measured parameters and neuropathy.
BACKGROUND: Individuals with diabetes have a higher risk of falls and fall-related injuries. People with diabetes often develop peripheral neuropathy (DPN) as well as nerve damage throughout the body. In particular, reduced lower extremity proprioception due to DPN may cause a misjudgment of foot position and thus increase the risk of fall. OBJECTIVE: An innovative virtual obstacle-crossing paradigm using wearable sensors was developed in an attempt to assess lower extremity position perception damage due to DPN. METHODS: 67 participants (age 55.4 ± 8.9, BMI 28.1 ± 5.8) including diabetics with and without DPN as well as aged-matched healthy controls were recruited. Severity of neuropathy was quantified using a vibratory perception threshold (VPT) test. The ability of perception of lower extremity was quantified by measuring obstacle-crossing success rate (OCSR), toe-obstacle clearance (TOC), and reaction time (T(R)) while crossing a series of virtual obstacles with heights at 10% and 20% of the subject's leg length. RESULTS: No significant difference was found between groups for age and BMI. The data revealed that DPN subjects had a significantly lower OCSR compared to diabetics with no neuropathy and controls at an obstacle size of 10% of leg length (p < 0.05). DPN subjects also demonstrated longer T(R) compared to other groups and for both obstacle sizes. In addition, TOC was reduced in neuropathy groups. Interestingly, a significant correlation between T(R) and VPT (r = 0.5, p < 10(-3)) was observed indicating a delay in reaction with increasing neuropathy severity. The delay becomes more pronounced by increasing the size of the obstacle. Using a regression model suggests that the change in T(R) between obstacle sizes of 10% and 20% of leg length is the most sensitive predictor for neuropathy severity with an odds ratio of 2.70 (p = 0.02). CONCLUSION: The findings demonstrate proof of a concept of virtual-reality application as a promising method for objective assessment of neuropathy severity, however a further study is warranted to establish a stronger relationship between the measured parameters and neuropathy.
Authors: Andrew J M Boulton; Arthur I Vinik; Joseph C Arezzo; Vera Bril; Eva L Feldman; Roy Freeman; Rayaz A Malik; Raelene E Maser; Jay M Sosenko; Dan Ziegler Journal: Diabetes Care Date: 2005-04 Impact factor: 19.112
Authors: E M Gutierrez; M D Helber; D Dealva; J A Ashton-Miller; J K Richardson Journal: Clin Biomech (Bristol, Avon) Date: 2001-07 Impact factor: 2.063
Authors: Ann V Schwartz; Teresa A Hillier; Deborah E Sellmeyer; Helaine E Resnick; Edward Gregg; Kristine E Ensrud; Pamela J Schreiner; Karen L Margolis; Jane A Cauley; Michael C Nevitt; Dennis M Black; Steven R Cummings Journal: Diabetes Care Date: 2002-10 Impact factor: 19.112
Authors: Michael Schwenk; Marwan Sabbagh; Ivy Lin; Pharah Morgan; Gurtej S Grewal; Jane Mohler; David W Coon; Bijan Najafi Journal: J Rehabil Res Dev Date: 2016