Effect of diabetic neuropathy severity classified by a fuzzy model in muscle dynamics during gait

Autor(es)

Watari, Ricky ^[1] ; Sartor, Cristina D. ^[1] ; Picon, Andreja P. ^[1] ; Butugan, Marco K. ^[1] ; Amorim, Cesar F. ^[2] ; Ortega, Neli R. S. ^[3] ; Sacco, Isabel C. N. ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Med, Dept Phys Therapy Speech & Occupat Therapy, Sao Paulo - Brazil

^[2] Univ City Sao Paulo UNICID, Phys Therapy Masters Program, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Sch Med, Ctr Fuzzy Syst Hlth, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF NEUROENGINEERING AND REHABILITATION; v. 11, FEB 8 2014.
• Citações Web of Science: 16

Resumo

Background: Electromyography (EMG) alterations during gait, supposedly caused by diabetic sensorimotor polyneuropathy, are subtle and still inconsistent, due to difficulties in defining homogeneous experimental groups with a clear definition of disease stages. Since evaluating these patients involve many uncertainties, the use of a fuzzy model could enable a better discrimination among different stages of diabetic polyneuropathy and lead to a clarification of when changes in muscle activation start occurring. The aim of this study was to investigate EMG patterns during gait in diabetic individuals with different stages of DSP severity, classified by a fuzzy system. Methods: 147 subjects were divided into a control group (n = 30) and four diabetic groups: absent (n = 43), mild (n = 30), moderate (n = 16), and severe (n = 28) neuropathy, classified by a fuzzy model. The EMG activity of the vastus lateralis, tibialis anterior, and gastrocnemius medialis were measured during gait. Temporal and relative magnitude variables were compared among groups using ANOVA tests. Results: Muscle activity changes are present even before an established neural involvement, with delay in vastus lateralis peak and lower tibialis anterior relative magnitude. These alterations suggest an impaired ankle shock absorption mechanism, with compensation at the knee. This condition seems to be more pronounced in higher degrees of neuropathy, as there is an increased vastus lateralis activity in the mild and severe neuropathy groups. Tibialis anterior onset at terminal stance was anticipated in all diabetic groups; at higher degrees of neuropathy, the gastrocnemius medialis exhibited activity reduction and peak delay. Conclusion: EMG alterations in the vastus lateralis and tibialis anterior occur even in the absence of diabetic neuropathy and in mild neuropathic subjects, seemingly causing changes in the shock absorption mechanisms at the heel strike. These changes increase with the onset of neural impairments, and the gastrocnemius medialis starts presenting altered activity in the later stages of the disease (moderate and severe neuropathy). The degree of severity of diabetic neuropathy must be taken into account when analyzing diabetic patients' biomechanical patterns of locomotion; we recommend the use of a fuzzy model for classification of disease stages. (AU)

• Processo FAPESP: 13/05580-5 - Padrões dinâmicos de recrutamento muscular por EMG de alta densidade de diabéticos em diferentes níveis de severidade de neuropatia classificados por um modelo linguístico fuzzy
• Beneficiário: Isabel de Camargo Neves Sacco
• Modalidade de apoio: Auxílio à Pesquisa - Regular
• Processo FAPESP: 11/15770-0 - Influência da progressão da diabetes nos padrões dinâmicos de recrutamento de fibras musculares analisados através de eletromiografia de alta densidade
• Beneficiário: Marco Kenji Butugan
• Modalidade de apoio: Bolsas no Brasil - Mestrado
• Processo FAPESP: 11/19304-4 - Influência da intervenção cinesioterapêutica em tornozelo e pé na biomecânica da marcha de diabéticos neuropatas: um ensaio clínico randomizado
• Beneficiário: Cristina Dallemole Sartor
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto