Gait problems in diabetic neuropathic patients

Objective: To examine whether a reduced peripheral sensibility caused by diabetic neuropathy increases the attentional demands necessary for controlling and regulating gait. Design: Nonrandomized control trial. Setting: University motor performance laboratory. Subjects: Twelve diabetic patients with peripheral neuropathy and 7 control subjects, all volunteers. Interventions: All subjects first performed a control seated reaction time task. For the walking task, auditory stimuli were randomly presented in the third, fourth, or fifth walking cycle on left foot toe off or on left foot heel contact. The subject's task was to respond verbally as fast as possible to the auditory stimulus, while maintaining progression. Main Outcome Measures: Simple reaction times and kinematics of the gait pattern (cycle amplitude, cycle duration, cycle speed, cadence and percentage of time spent in the single support phase) were evaluated, Results: For the walking task, diabetic neuropathic patients had a smaller cycle amplitude, cycle speed, and percentage of time spent in the single support phase than control subjects. Also, reaction times while walking were higher for diabetic neuropathic patients than for control subjects. Conclusions: Diabetic neuropathic patients show a less destabilizing and more conservative gait than control subjects. The increased attentional demands in gait for the diabetic neuropathic patients, along with their more conservative gait pattern, suggest that a lack of proprioception from the legs affects the control of gait. Diminished sensory information makes gait control more cognitively dependent in diabetic neuropathic persons than in control subjects. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation