Effect of type II diabetic peripheral neuropathy on gait termination in the elderly

Abstract

Aims/hypothesis. Healthy elderly people can have difficulties in precisely terminating gait due to age-related decline. Diabetes mellitus accelerates the neurodegenerative process, which results in an additional decline in motor control. This biomechanical study investigated goal-oriented gait termination in healthy elderly and elderly diabetic subjects. The trajectories of the centre of pressure and the centre of mass during the gait termination process were analysed in particular. It was hypothesised that the pathology results in an unstable gait termination, expressed in larger overshoots of the centre of pressure and the centre of mass than in healthy control subjects. Methods. A total of 15 subjects with Type II (non-insulin-dependent) diabetes mellitus with impaired foot sensitivity due to polyneuropathy (median, 66 years) were matched according to age, gender and body mass index with 15 healthy elderly subjects (median, 67 years). The participants walked at their own pace along the walkway and stopped in front of a marked stopping line while kinetic and kinematic data were recorded. Results. The diabetic subjects approached the stopping line more slowly (p = 0.002) than the healthy elderly subjects. They also exhibited a weaker maximal braking force (p = 0.011) and a prolonged relative time to develop this force (p = 0.023). Despite this slower motion, the centre of pressure overshoots were larger in the diabetic subjects than in the healthy elderly (p = 0.027). Conclusion/interpretation. The results show differences between healthy elderly and diabetic subjects during easy goal-oriented stopping tasks. Changes in gait termination parameters and the increased overshoots in particular document the pathology-related decline in postural stability.