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Hand function in neuropathic diabetic patients: control and coordination of forces acting on the digits-object interaction in manipulation tasks


The ability to manipulate objects (hand function) is crucial for people to keep an independent lifestyle. One could visualize the challenges a person that, for any reason, lose his/her ability to use the hands encounters to perform simple tasks such as dressing, using silverware to feed him/herself, handwriting, driving a car. Therefore, the importance of hand function in people's life justifies the investigation of the factors related to the control of manipulation skills and related to the ‘dyscontrol’ caused by neurological alterations, which would directly affect hand function. An underlying requisite to a proper object manipulation is to control the forces acting on the digits-object interface in order to prevent slippage of the manipulated object. The grip force (GF), perpendicular to the object surface, should be large enough to prevent slippage caused by external forces (e.g. object weight) and by forces generated by person self-motion that act tangentially to the digits-object interface, but it should not be too large to cause object deformation or earlier muscle fatigue. In this case, the central nervous system (CNS) has to coordinate the muscles that control or generate tangential forces (i.e. load force - LF) and that generate GF. Earlier studies have shown that the CNS controls and coordinates the muscles responsible for generating GF and LF in an anticipatory fashion (feedforward control). In addition, other studies have shown that the cutaneous sensors located at the tip of the digits play a fundamental role in the control of hand function by providing sensory information which constantly updates the CNS about what is taking place at the digits-object interface. It is well known that neurological disorders affect the ability of the CNS to control LF and coordinate LF and GF, which would lead to problems in hand function and, therefore, difficulties in performing activities of daily living. Surprisingly, we could not find studies that investigated the control of hand function in individuals with diabetes without and with peripheral diabetic neuropathy (PDN). A large number of studies revealed that individuals with PDN show neurological changes leading to a decrease of the hand/digits and feet sensitivity, and even diabetic patients without PDN present such problems. Hence, it would not be a surprise if diabetic patients with and without PDN would show changes in the control of hand function, which after certain moment, would reflect in their ability to perform manipulation tasks. Therefore, the main aims of this project are to assess hand function and to examine the control of hand function in diabetic patients without and with PDN. In order to reach the aims we will make use of traditional tools for hand function assessment as well as of an innovative experimental apparatus developed at the University of Delaware (USA) and used by the author of this project during his doctoral studies, which accurately measures GF and LF during static and dynamic manipulation tasks. The results of the studies that utilized this apparatus showed that it is able to assess the control of hand function of neurological patients (e.g., mild and moderate involved multiple sclerosis patients) and to easily distinguish these patients from healthy individuals. Therefore, we propose to build a similar apparatus and develop research related to the control of hand function in diabetic patients without and with PDN and in healthy pairs. The participants of the study will be assessed in different tests. Using the new apparatus, they will be asked to perform manipulation tasks similar to those performed in daily basis such as lifting and holding an object and using certain amount of force against a fixed object to keep posture. We expect with the results of this project to gain a better understanding about how the sensory impairment as a consequence of the diabetes affects the (control of) hand function. (AU)

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Scientific publications (6)
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
CUNHA, BIANCA P.; FREITAS, SANDRA M. S. F.; GOMES, GEORGIA F. O.; DE FREITAS, PAULO B. Hand Grip and Load Force Coordination of the Ipsilesional Hand of Chronic Stroke Individuals. JOURNAL OF MOTOR BEHAVIOR, v. 51, n. 6, p. 610-621, NOV 2 2019. Web of Science Citations: 0.
DE ALMEIDA LIMA, KAUE CARVALHO; BORGES, LEANDRO DA SILVA; HATANAKA, ELAINE; ROLIM, LUIZ CLEMENTE; DE FREITAS, PAULO BARBOSA. Grip force control and hand dexterity are impaired in individuals with diabetic peripheral neuropathy. Neuroscience Letters, v. 659, p. 54-59, OCT 17 2017. Web of Science Citations: 5.
PEDAO, SABRINA TIAGO; AGUIAR, STEFANE ALINE; CUNHA, BIANCA PINTO; DE FREITAS, PAULO BARBOSA. Grip and load force control and coordination in object manipulation during a night of sleep deprivation. SLEEP AND BIOLOGICAL RHYTHMS, v. 13, n. 2, p. 163-171, APR 2015. Web of Science Citations: 1.
DE FREITAS, P. B.; LIMA, K. C. A. Grip force control during simple manipulation tasks in non-neuropathic diabetic individuals. CLINICAL NEUROPHYSIOLOGY, v. 124, n. 9, p. 1904-1910, SEP 2013. Web of Science Citations: 9.
PEDAO, SABRINA TIAGO; BARELA, JOSE ANGELO; DE ALMEIDA LIMA, KAUE CARVALHO; DE FREITAS, PAULO BARBOSA. Grip and load force coordination in cyclical isometric manipulation task is not affected by the feedback type. JOURNAL OF NEUROENGINEERING AND REHABILITATION, v. 10, APR 4 2013. Web of Science Citations: 2.
KAUÊ CARVALHO DE ALMEIDA LIMA; PAULO BARBOSA DE FREITAS. Avaliação da função manual e da força de preensão palmar máxima em indivíduos com diabetes mellitus. Fisioter. Pesqui., v. 19, n. 4, p. 375-380, Dez. 2012.

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