Parâmetros da marcha em portadores de diabetes mellitus

Fregonesi, Cristina Elena Prado Teles; Camargo, Marcela Regina de

doi:10.5007/1980-0037.2010v12n2p155

Resumos

O Diabetes mellitus é uma enfermidade crônica que leva a alterações sensitivas e motoras. Tais alterações comprometem o equilíbrio e a deambulação, predispondo seus portadores à ocorrência de quedas. Esta revisão teve por objetivo levantar, na literatura recente, estudos que visassem avaliar parâmetros da marcha e aspectos envolvidos com a deambulação. Para isso, foi realizada uma busca nas bases de dados MEDLINE, SciELO, LILACS e PEDro, cruzando as palavras-chave: Neuropatias Diabéticas x Marcha; Diabetes Mellitus x Marcha e Pé Diabético x Marcha. Após passarem pelos critérios de seleção, foram obtidos 15 artigos, os quais foram sintetizados e discutidos, sendo, portanto, incluídos nesta revisão. Ficou claro que a neuropatia diabética leva a déficits na amplitude do passo, velocidade e cadência da marcha em superfícies planas, sem mudanças bruscas de direção ou paradas, e déficits de equilíbrio e coordenação em aclives, declives e terrenos irregulares. Acarreta, também, aumento dos índices de pressão plantar e, devido à alteração de ativação do tríceps sural, dificuldade na fase de apoio terminal e pré-balanço. Assim, o próximo contato inicial ocorrerá de maneira inadequada, com o antepé e sem absorção de choques.

Diabetes mellitus; Neuropatias diabéticas; Marcha; Acidentes por quedas

Diabetes mellitus is a chronic disease that results in sensorimotor alterations. These changes affect balance and walking and predispose affected patients to falls. The aim of this review was to identify studies in the recent literature that assess gait parameters and aspects involved in walking. The MEDLINE, SciELO, LILACS and PEDro databases were searched using the following combination of keywords: diabetic neuropathies x gait; diabetes mellitus x gait, and diabetic foot x gait. After the application of selection criteria, 15 articles were retrieved, summarized, discussed, and are included in this review. Diabetic neuropathy was found to lead to deficits in step amplitude, gait velocity and gait cadence on flat surfaces, without sudden changes in direction or stops, and to balance and coordination deficits on inclined and uneven terrain. Diabetic neuropathies also increase plantar pressure rates and lead to difficulties in the terminal stance phase and pre-swing phase due to changes in triceps surae activation. Thus, the next initial contact occurs in an inadequate manner, with the forefoot and without absorption of shocks.

Diabetes mellitus; Diabetic neuropathies; Gait; Accidental falls

ARTIGO DE REVISÃO

Parâmetros da marcha em portadores de diabetes mellitus

Gait parameters in patients with diabetes mellitus

Cristina Elena Prado Teles Fregonesi; Marcela Regina de Camargo

Universidade Estadual Paulista. Programa de Pós-Graduação em Fisioterapia da Faculdade de Ciências e Tecnologia. Presidente Prudente, SP, Brasil.

^{Correspondencia para} Marcela Regina de Camargo Rua José Manoel Fonseca, 97, Vila Euclides, CEP 19014-050 - Presidente Prudente SP, Brasil E-mail: amy.marcela@gmail.com

RESUMO

O Diabetes mellitus é uma enfermidade crônica que leva a alterações sensitivas e motoras. Tais alterações comprometem o equilíbrio e a deambulação, predispondo seus portadores à ocorrência de quedas. Esta revisão teve por objetivo levantar, na literatura recente, estudos que visassem avaliar parâmetros da marcha e aspectos envolvidos com a deambulação. Para isso, foi realizada uma busca nas bases de dados MEDLINE, SciELO, LILACS e PEDro, cruzando as palavras-chave: Neuropatias Diabéticas x Marcha; Diabetes Mellitus x Marcha e Pé Diabético x Marcha. Após passarem pelos critérios de seleção, foram obtidos 15 artigos, os quais foram sintetizados e discutidos, sendo, portanto, incluídos nesta revisão. Ficou claro que a neuropatia diabética leva a déficits na amplitude do passo, velocidade e cadência da marcha em superfícies planas, sem mudanças bruscas de direção ou paradas, e déficits de equilíbrio e coordenação em aclives, declives e terrenos irregulares. Acarreta, também, aumento dos índices de pressão plantar e, devido à alteração de ativação do tríceps sural, dificuldade na fase de apoio terminal e pré-balanço. Assim, o próximo contato inicial ocorrerá de maneira inadequada, com o antepé e sem absorção de choques.

Palavras-chave: Diabetes mellitus; Neuropatias diabéticas; Marcha; Acidentes por quedas

ABSTRACT

Diabetes mellitus is a chronic disease that results in sensorimotor alterations. These changes affect balance and walking and predispose affected patients to falls. The aim of this review was to identify studies in the recent literature that assess gait parameters and aspects involved in walking. The MEDLINE, SciELO, LILACS and PEDro databases were searched using the following combination of keywords: diabetic neuropathies x gait; diabetes mellitus x gait, and diabetic foot x gait. After the application of selection criteria, 15 articles were retrieved, summarized, discussed, and are included in this review. Diabetic neuropathy was found to lead to deficits in step amplitude, gait velocity and gait cadence on flat surfaces, without sudden changes in direction or stops, and to balance and coordination deficits on inclined and uneven terrain. Diabetic neuropathies also increase plantar pressure rates and lead to difficulties in the terminal stance phase and pre-swing phase due to changes in triceps surae activation. Thus, the next initial contact occurs in an inadequate manner, with the forefoot and without absorption of shocks.

Keywords: Diabetes mellitus; Diabetic neuropathies; Gait; Accidental falls

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Endereço para correspondência:

Recebido em 22/08/08

Revisado em 16/02/09

Aprovado em 24/06/09

Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27(5):1047-1053.
Gregg EW, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, Burt V, et al Prevalence of Lower-Extremity Disease in the U.S. adult population >40 years of age with and without diabetes. Diabetes Care 2004;27(7):1591-1597.
Vinik AI, Park TS, Stansberry KB, Pittenger GL. Diabetic neuropathies. Diabetologia 2000;43(8):957-973.
Boulton AJM, Malik RA, Arezzo JC, Sosenko JM. Diabetic Somatic Neuropathies. Diabetes Care 2004;27(6):458-486.
Andersen H, Gadeberg PC, Brock B, Jakobsen J. Muscular atrophy in diabetic neuropathy: a stereological magnetic resonance imaging study. Diabetologia 1997;40(9):1062-1069.
Porciúncula MVP, Rolim LCP, Garofolo L, Ferreira SRG. Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica. Arq Bras Endocrinol Metabol 2007;51(7):1134-1142.
Giacomozzi C, Caselli A, Macellari V, Giurato L, Lardieri L, Uccioli L. Walking Strategy in Diabetic Patients With Peripheral Neuropathy. Diabetes Care 2002;25(8):1451-1457.
Sacco ICN, Amadio AC. A study of biomechanical parameters in gait analysis and sensitive cronaxie of diabetic neuropathic patients. Clin Biomech 2000;15(3):196-200.
Witzket KA, Vinik AI. Diabetic Neuropathy in Older Adults. Rev Endocr Metab Disord 2005;6(2):117-127.
Freiberger E, Menz HB. Characteristics of falls in physically active community-dwelling older people. Z Gerontol Geriat 2006;39(4):261-267.
Hollman JH, Kovash FM, Kubik JJ, Linbo RA. Age-related differences in spatiotemporal markers of gait stability during dual task walking. Gait Posture 2007;26(1):113-119.
Alfieri FM. Distribuição da pressão plantar em idosos após intervenção proprioceptiva. Rev Bras Cineantropom Desempenho Hum 2008;10(2):137-142.
Kanade RV, VanDeursen RWM, Harding K, Price P. Walking performance in people with diabetic neuropathy: benefits and threats. Diabetologia 2006;49(8):1747-1754.
Gutierrez EM, Helber MD, Dealva D, Ashton-Miller JA, Richardson JK. Mild diabetic neuropathy affects ankle motor function. Clin Biomech 2001;16(6):522-828.
Wallace C, Reiber GE, LeMaster J, Smith DG, Sullivan K, Hayes S, Vath C. Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care 2002;25(11):1983-1986.
Maurer MS, Burcham J, Cheng H. Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility. J Gerontol 2005;60(9):1157-1162.
Akashi PMH, Sacco ICN, Watari R, Hennig E. The effect of diabetic neuropathy and previous foot ulceration in EMG and ground reaction forces during gait. Clin Biomech 2008;23(5):584-592.
D'Ambrogi E, Giacomozzi C, Macellari V, Uccioli L. Abnormal foot function in diabetic patients: the altered onset of Windlass mechanism. Diabet Med 2005;22(12):1713-1719.
Gates DH, Dingwell JB. Peripheral neuropathy does not alter the fractal dynamics of stride intervals of gait. J Appl Physiol 2007;102(3):965-971.
Guldemond NA, Leffers P, Schaper NC, Sanders AP, Nieman F, Willems P, Walenkamp GHIM. The effects of insole configurations on forefoot plantar pressure and walking convenience in diabetic patients with neuropathic feet. Clin Biomech 2007;22(1):81-87.
Hsi WL, Chai HM, Lai JS. Evaluation of rocker sole by pressure-time curves in insensate forefoot during gait. Am J Phys Med Rehabil 2004;83(7):500-5-6.
Kwon OY, Minor SD, Maluf KS, Mueller MJ. Comparsion of muscle activity during walking in subjects with and without diabetic neuropathy. Gait Posture 2003;18(1):105-113.
Menz HB, Lord SR, St George R, Fitzpatrick RC. Walking stability and sensorimotor function older people with diabetic peripheral neuropathy. Arch Phys Med Rehabil 2004;85(2):245-252.
Petrofsky JS, Lee S, Cuneo ML. Gait characteristics in patients with type 2 diabetes; improvement after administration of rosiglitazone. Med Sci Monit 2005;11(6):PI43-P1451.
Petrofsky JS, Lee S, Bweir S. Gait characteristics in people with type 2 diabetes mellitus. Eur J Appl Physiol 2005;93(5-6):640-647.
Richardson JK, Thies SB, DeMott TK, Ashton-Miller JA. Interventions improve gait regularity in patients with peripheral neuropathy while walking on an irregular surface under low light. A Am Geriatr Soc 2004;52(4):510-515.
Richardson JK, Thies SB, DeMott TK, Ashton-Miller JA. Gait analysis in a challenging environmental differentiates between fallers and nonfallers among older patients with peripheral neuropathy. Arch Phys Med Rehabil 2005;86(8):1539-1544.
Sacco ICN, Amadio AC. Influence of the diabetic neuropathy on the behavior of electromyographic and sensorial responses in treadmill gait. Clin Biomech 2003;18(5):426-434.
Turner DE, Helliwell PS, Burton AK, Woodburn J. The relationship between passive range of motion and range of motion during gait and plantar pressure measurements. Diabet Med 2007;24(11):1240-1246.
Yavuz M, Tajaddini A, Botek G, Davis BL. Temporal characteristics of plantar shear distribuition: Relevance to diabetic patients. J Biomech 2008;41(3):556-559.
Yavuzer G, Yetkin I, Toruner FB, Koca N, Bolukbas N. Gait deviations of patients with diabetes mellitus: looking beyond peripheral neuropathy. Eura Medicophys 2006; 42(2):127-133.

Marcela Regina de Camargo

Rua José Manoel Fonseca, 97, Vila Euclides,

CEP 19014-050 - Presidente Prudente SP, Brasil

E-mail:

amy.marcela@gmail.com

Datas de Publicação

Publicação nesta coleção
09 Out 2012
Data do Fascículo
Abr 2010

Histórico

Aceito
24 Jun 2009
Revisado
16 Fev 2009
Recebido
22 Ago 2008

This work is licensed under a Creative Commons Attribution 4.0 International License.

[1] Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27(5):1047-1053.

[2] Gregg EW, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, Burt V, et al Prevalence of Lower-Extremity Disease in the U.S. adult population >40 years of age with and without diabetes. Diabetes Care 2004;27(7):1591-1597.

[3] Vinik AI, Park TS, Stansberry KB, Pittenger GL. Diabetic neuropathies. Diabetologia 2000;43(8):957-973.

[4] Boulton AJM, Malik RA, Arezzo JC, Sosenko JM. Diabetic Somatic Neuropathies. Diabetes Care 2004;27(6):458-486.

[5] Andersen H, Gadeberg PC, Brock B, Jakobsen J. Muscular atrophy in diabetic neuropathy: a stereological magnetic resonance imaging study. Diabetologia 1997;40(9):1062-1069.

[6] Porciúncula MVP, Rolim LCP, Garofolo L, Ferreira SRG. Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica. Arq Bras Endocrinol Metabol 2007;51(7):1134-1142.

[7] Giacomozzi C, Caselli A, Macellari V, Giurato L, Lardieri L, Uccioli L. Walking Strategy in Diabetic Patients With Peripheral Neuropathy. Diabetes Care 2002;25(8):1451-1457.

[8] Sacco ICN, Amadio AC. A study of biomechanical parameters in gait analysis and sensitive cronaxie of diabetic neuropathic patients. Clin Biomech 2000;15(3):196-200.

[9] Witzket KA, Vinik AI. Diabetic Neuropathy in Older Adults. Rev Endocr Metab Disord 2005;6(2):117-127.

[10] Freiberger E, Menz HB. Characteristics of falls in physically active community-dwelling older people. Z Gerontol Geriat 2006;39(4):261-267.

[11] Hollman JH, Kovash FM, Kubik JJ, Linbo RA. Age-related differences in spatiotemporal markers of gait stability during dual task walking. Gait Posture 2007;26(1):113-119.

[12] Alfieri FM. Distribuição da pressão plantar em idosos após intervenção proprioceptiva. Rev Bras Cineantropom Desempenho Hum 2008;10(2):137-142.

[13] Kanade RV, VanDeursen RWM, Harding K, Price P. Walking performance in people with diabetic neuropathy: benefits and threats. Diabetologia 2006;49(8):1747-1754.

[14] Gutierrez EM, Helber MD, Dealva D, Ashton-Miller JA, Richardson JK. Mild diabetic neuropathy affects ankle motor function. Clin Biomech 2001;16(6):522-828.

[15] Wallace C, Reiber GE, LeMaster J, Smith DG, Sullivan K, Hayes S, Vath C. Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care 2002;25(11):1983-1986.

[16] Maurer MS, Burcham J, Cheng H. Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility. J Gerontol 2005;60(9):1157-1162.

[17] Akashi PMH, Sacco ICN, Watari R, Hennig E. The effect of diabetic neuropathy and previous foot ulceration in EMG and ground reaction forces during gait. Clin Biomech 2008;23(5):584-592.

[18] D'Ambrogi E, Giacomozzi C, Macellari V, Uccioli L. Abnormal foot function in diabetic patients: the altered onset of Windlass mechanism. Diabet Med 2005;22(12):1713-1719.

[19] Gates DH, Dingwell JB. Peripheral neuropathy does not alter the fractal dynamics of stride intervals of gait. J Appl Physiol 2007;102(3):965-971.

[20] Guldemond NA, Leffers P, Schaper NC, Sanders AP, Nieman F, Willems P, Walenkamp GHIM. The effects of insole configurations on forefoot plantar pressure and walking convenience in diabetic patients with neuropathic feet. Clin Biomech 2007;22(1):81-87.

[21] Hsi WL, Chai HM, Lai JS. Evaluation of rocker sole by pressure-time curves in insensate forefoot during gait. Am J Phys Med Rehabil 2004;83(7):500-5-6.

[22] Kwon OY, Minor SD, Maluf KS, Mueller MJ. Comparsion of muscle activity during walking in subjects with and without diabetic neuropathy. Gait Posture 2003;18(1):105-113.

[23] Menz HB, Lord SR, St George R, Fitzpatrick RC. Walking stability and sensorimotor function older people with diabetic peripheral neuropathy. Arch Phys Med Rehabil 2004;85(2):245-252.

[24] Petrofsky JS, Lee S, Cuneo ML. Gait characteristics in patients with type 2 diabetes; improvement after administration of rosiglitazone. Med Sci Monit 2005;11(6):PI43-P1451.

[25] Petrofsky JS, Lee S, Bweir S. Gait characteristics in people with type 2 diabetes mellitus. Eur J Appl Physiol 2005;93(5-6):640-647.

[26] Richardson JK, Thies SB, DeMott TK, Ashton-Miller JA. Interventions improve gait regularity in patients with peripheral neuropathy while walking on an irregular surface under low light. A Am Geriatr Soc 2004;52(4):510-515.

[27] Richardson JK, Thies SB, DeMott TK, Ashton-Miller JA. Gait analysis in a challenging environmental differentiates between fallers and nonfallers among older patients with peripheral neuropathy. Arch Phys Med Rehabil 2005;86(8):1539-1544.

[28] Sacco ICN, Amadio AC. Influence of the diabetic neuropathy on the behavior of electromyographic and sensorial responses in treadmill gait. Clin Biomech 2003;18(5):426-434.

[29] Turner DE, Helliwell PS, Burton AK, Woodburn J. The relationship between passive range of motion and range of motion during gait and plantar pressure measurements. Diabet Med 2007;24(11):1240-1246.

[30] Yavuz M, Tajaddini A, Botek G, Davis BL. Temporal characteristics of plantar shear distribuition: Relevance to diabetic patients. J Biomech 2008;41(3):556-559.

[31] Yavuzer G, Yetkin I, Toruner FB, Koca N, Bolukbas N. Gait deviations of patients with diabetes mellitus: looking beyond peripheral neuropathy. Eura Medicophys 2006; 42(2):127-133.