An altered spatiotemporal gait adjustment during a virtual obstacle crossing task in patients with diabetic peripheral neuropathy

Abstract

This study investigates spatiotemporal gait adjustments that occur while stepping over virtual obstacles during treadmill walking in people with/without diabetic peripheral neuropathy (DPN). Eleven adults with Type 2 diabetes mellitus, ten DPN, and 11 age-matched healthy adults (HTY) participated in this study. They stepped over forthcoming virtual obstacles during treadmill walking. Outcomes such as success rate, spatiotemporal gait characteristics during obstacle crossing, and correlations between these variables were evaluated. The results partially supported our hypotheses that when comparing with HTY and DM, people with DPN adopted a crossing strategy which decreased obstacle crossing success rate and maximal toe elevation, and increased stride time and stance time during virtual obstacle crossing. This might be due to the compromised somatosensory functions of their lower extremity which may increase the risk of falling. This study also found an inter-leg relationship which may be applied to future stepping or obstacle crossing training that incorporates both legs as a means for improving outcomes of the trailing leg during daily obstacle negotiation.

Keywords: Anticipatory; Diabetes; Gait; Obstacle avoidance; Virtual reality.

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

Figure 1.

The experimental set-up of virtual OCT (left) and task synchronized in Vicon (right).

Figure 2.

a) The crossing phase is defined by the stride length while stepping over the virtual obstacle; b) heel marker displacement over time in anteroposterior direction where each number represents the moment of heel contact in Figure 2.a; c) toe marker displacement over time in vertical direction (i.e., maximal toe elevation, MTE). Note the MTE before, during and after OCT were remarked.