Diabetes stair fall risk
NEW RESEARCH suggests that people with diabetic peripheral neuropathy (DPN), a complication of diabetes that affects the nerves in the limbs, often sway more during stair climbing and are, therefore, more likely to fall.
Researchers at Manchester Metropolitan University and the University of Manchester acknowledge that while it would be impractical to suggest patients with DPN avoid stairs completely, they are at higher risk of having a fall and should take measures to keep themselves safe.
Stephen Brown from Manchester Met’s Department of Life Sciences Science said: “Avoiding particularly steep and/or long flights of stairs may be advisable, especially if an elevator is available as an alternative. Using a handrail on stairs if available could also help patients with DPN prevent falls.”
Patients with DPN are known to be unsteady on their feet and to have an increased risk of falling. Whilst some studies have found increased postural sway during quiet standing and walking on level ground in patients with DPN, no data exists on measures of balance when using the stairs.
3D motion analysis
Since walking on stairs is one of the most dangerous daily activities in terms of fall risk, this study, investigated the underlying mechanisms of unsteadiness in patients with DPN during stair ascent and descent.
Motion and pressure data were collected for 22 diabetes patients with DPN (average age 57) and 40 diabetes patients without DPN (average age also 57), plus 32 healthy people without diabetes (average age 50 years). All patients were from Manchester or the surrounding area.
Movement was measured using a 3D motion analysis system from reflective markers placed on the body to calculate whole-body centre-of-mass.
The centre-of-pressure under the feet was measured using sensitive pads mounted into the middle four steps of a seven step staircase, which participants ascended and descended at least three times.
Difficulty
The ability of a person to maintain balance was quantified by assessing the separation between the centre-of-mass and centre-of-pressure.
The authors conclude: ” Diabetes patients with peripheral neuropathy display greater extremes in magnitude of medial-lateral sway during stair ascent and descent as well as displaying higher variability during stair ascent and descent. This indicates that patients with DPN have difficulty regulating control of balance during this challenging task.
“A larger and more variable medial-lateral sway means that patients with DPN are more likely to lose control of balance and experience a fall during what is known to be an activity —using stairs —where the risk of falls is already very high.”
The findings have been presented at this year’s annual meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria.
Future interventions
The Manchester research team, which also involves the Department’s Professor Neil Reeves, is carrying out more investigations to identify and further understand factors that may contribute to unsteadiness and in turn the increased risk of falls.
They add: “Many issues that affect balance in patients with DPN stem from deterioration of muscle size and function, so whilst it is not currently possible to positively improve the sensory deterioration, we have been looking at elements that we can positively influence, such as strength training and interventions to help vision focus and avoidance of obstacles. We are investigating the impact of such interventions and how they might translate to improvements in gait and balance control.”
