Individual Cofactors and Multisensory Contributions to the Postural Sway of Adults with Diabetes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
- Forty-eight patients with type 2 diabetes (mean age 58.0 ± standard deviation 11.2 years, 37 women/11 men), with a mean BMI of 28.9 ± 4.5, among whom eighteen (37.5%) had high blood pressure, which was controlled by medication.
- Twenty-one healthy subjects (age 51.3 ± 8.2 years, 13 women/8 men), with a BMI of 28.4 ± 4.2, among whom three (14.3%) had high blood pressure, which was controlled by medication.
2.2. Procedures
- Vision was assessed by an ophthalmologist, with retinoscopy.
- Vestibular assessment included both the angular vestibulo-ocular responses (VOR) to sinusoidal rotations (0.16 Hz and 1.28 Hz, 60°/s peak) and the dynamic subjective visual vertical (DVV) during right/left centrifugation for gravity perception [40] (I-Portal-NOCT-Professional, Neuro-Kinetics, Pittsburgh, PA, USA). According to the protocol of the manufacturer, unilateral centrifugation was performed at 300°/s peak velocity/3.85 cm linear translation to the right and to the left; with 2 s to start dwell, 60 s ramp-up time, 375 s peak time, 60 s centrifugation start time and 60 s ramp down time. Subjects were instructed to set a laser line to the vertical position where they were offset 3.85 cm to the right or left of the center of rotation during full speed rotation [40], the mean deviation for each position was used for the analysis.
- The body weight and height were measured to estimate the BMI. Obesity was considered when BMI ≥ 30 kg/m2.
- Peripheral artery function was evaluated by the ankle/brachial index (Homecare JPD-100b+, Shenzhen Jumper Medical Equipment Co, Shenzhen, China). This index is a clinical metric for arterial stiffness [41].
- Lower-extremity muscle strength was estimated by quadriceps isometric strength (average of 5 right and 5 left attempts) (Baseline, Back-leg-chest dynamometer, White Plains, NY, USA), which has been related to both hyperglycemia and peripheral neuropathy [42].
- Static posturography was performed using a force platform (900 points/kg resolution; 40 Hz sampling rate; 16 b. analogue-digital converter) (Posturolab 40/16, Medicapteurs, Balma, France). Subjects were asked to stand upright and barefoot on the platform as still as possible, with arms at their sides. According to the manufacturer reference, feet position was maintained to record each baseline and its corresponding sensory challenge (30° lateral rotation between the feet and heels 3.5 cm apart). Recordings were made during 51.2 s [27], either with eyes open/closed, with/without 30° neck extension, and while adding or not a layer of foam rubber (5 cm thick, density of 2.5 pounds per cubic foot) to the base of support. The order of the eight data sets to perform the four sensory challenges included in the study is described in Table 1. To take into account that the subjective perception of the task’s difficulty may lead to sway increase [43], all the participants were exposed from a condition similar to daily life activities (i.e., standing with the eyes open on a hard surface) to the most unusual condition (i.e., standing with the eyes open on a soft surface with neck extension). In order to identify the response to each sensory challenge, we calculated the proportional difference between each of the baselines and the corresponding consecutive recording (i.e., 1 and 2, 3 and 4, 5 and 6, and 7 and 8), which was considered as an ‘effect’ measure on the length of sway (mm) and the 90% confidence ellipse of the area of sway (mm2), which were obtained by the software provided by the manufacturer of the platform (Medicapteurs, Balma, France) (for review see [44]).
2.3. Statistical Analysis
3. Results
3.1. Characteristics of the Participants
3.2. Bivariate Analyses on Postural Sway
3.3. Repeated Measures Analysis among the Sensory Challenges
3.4. Multivariable Analysis of Each Sensory Challenge
3.4.1. Postural Sway after Closing the Eyes While Standing Either on Hard or Soft Surface
- Hard surface. The variables related to the effect in the length of sway were the age and the VOR gain at 1.28 Hz (Wald statistic ≥ 3.87, p < 0.05); in the area of sway the variables were the BMI, the VOR gain to rotation at 1.28 Hz, the average DVV, physical activity, polyneuropathy and an additive contribution of polyneuropathy and polypharmacy (Wald statistic ≥ 4.07, p < 0.05).
- Soft surface. The variables related to the effect in the length of sway were the VOR gain at 1.28 Hz and the average DVV (Wald statistic ≥ 4.33, p < 0.05); in the area of sway the variables were the BMI, physical activity and quadriceps strength (Wald statistic ≥ 3.86, p < 0.05).
3.4.2. Postural Sway after 30° Neck Extension While Standing Either on Hard or Soft Surface
- Hard surface. The variables related to the effect in the length of sway were the average DVV, the quadriceps strength and the ankle/brachial index, with an additive effect of polyneuropathy and polypharmacy that was observed just in men (Wald statistic ≥ 4.61, p < 0.05). In the area of sway the variables were the BMI, the VOR gain at 1.28 Hz, and polyneuropathy (particularly in men) (Wald statistic ≥ 4.38, p < 0.05).
- Soft surface. The variables related to the effect in the length of sway were the DVV, the physical activity score, the quadriceps strength, the ankle/brachial index and polypharmacy (Wald statistic ≥ 4.23, p < 0.05); in the area of sway the variable was the quadriceps strength, with a larger increase in the area of sway in patients with retinopathy and no polyneuropathy (Wald statistic ≥ 4.26, p < 0.05).
4. Discussion
4.1. Multisensory Contributions
4.2. Individual Cofactors
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Challenge | Recordings |
---|---|
I. | 1. Hard surface/open eyes (1st baseline) |
2. Hard surface/closed eyes | |
II. | 3. Hard surface/open eyes (2nd baseline) |
4. Hard surface/open eyes/30° neck extension | |
III. | 5. Soft surface/open eyes (3rd baseline) |
6. Soft surface/closed eyes | |
IV. | 7. Soft surface/open eyes (4th baseline) |
8. Soft surface/open eyes/30° neck extension |
Test | Diabetes | Healthy | p-Value |
---|---|---|---|
n (%) | n (%) | ||
Polypharmacy (≥5 drugs per day) | 15 (31.2%) | - | NA |
Polyneuropathy | 18 (37.5%) | - | NA |
Retinopathy | 17 (35.4%) | - | NA |
Polyneuropathy and retinopathy | 10 (20.8%) | - | NA |
No retinopathy or polyneuropathy | 3 (6.2%) | 21 (100%) | NA |
Mean ± Standard deviation | Mean ± Standard deviation | ||
Quadriceps strength (Kg) | 40.1 ± 18.6 | 58.2 ± 21.6 | 0.0007 |
Physical activity score (met/min/week) | 2239 ± 2315 | 3654 ± 2328 | 0.02 |
Ankle brachial index | 1.00 ± 0.15 | 0.99 ± 0.03 | - |
Gain to rotation in the dark at 0.16 Hz | 0.47 ± 0.15 | 0.49 ± 0.13 | 0.59 |
Gain to rotation in the dark at 1.28 Hz | 0.96 ± 0.12 | 0.98 ± 0.08 | 0.48 |
Static Visual Vertical (°) | −0.37°± 0.83° | −0.02° ± 0.06° | 0.058 |
Dynamic Visual Vertical (absolute average) | 4.2°± 1.48° | 4.3° ± 0.86° | 0.77 |
Length of Sway | Estimate | Standard Error | Wald Statistic | p-Value |
---|---|---|---|---|
Intercept | 5.017 | 0.415 | 146.208 | < 0.001 |
Vestibulo-ocular reflex at 1.28 Hz | 0.558 | 0.324 | 2.954 | 0.086 |
Dynamic Visual Vertical (°) | −0.035 | 0.026 | 1.782 | 0.182 |
Body Mass Index > 30 kg/m2 | −0.089 | 0.035 | 6.272 | 0.012 * |
Sex | −0.094 | 0.036 | 6.978 | 0.008 * |
Area of Sway | ||||
Intercept | 3.869 | 1.032 | 14.052 | <0.001 |
Vestibulo-ocular reflex at 1.28 Hz | 1.630 | 0.754 | 4.674 | 0.031 * |
Dynamic Visual Vertical (°) | −0.108 | 0.063 | 2.926 | 0.087 |
Quadriceps strength | 0.009 | 0.003 | 6.564 | 0.010 * |
Body Mass Index > 30 kg/m2 | −0.165 | 0.076 | 4.662 | 0.031 * |
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Villaseñor-Moreno, J.C.; Aranda-Moreno, C.; Figueroa-Padilla, I.; Giraldez-Fernández, M.E.; Gresty, M.A.; Jáuregui-Renaud, K. Individual Cofactors and Multisensory Contributions to the Postural Sway of Adults with Diabetes. Brain Sci. 2022, 12, 1489. https://doi.org/10.3390/brainsci12111489
Villaseñor-Moreno JC, Aranda-Moreno C, Figueroa-Padilla I, Giraldez-Fernández ME, Gresty MA, Jáuregui-Renaud K. Individual Cofactors and Multisensory Contributions to the Postural Sway of Adults with Diabetes. Brain Sciences. 2022; 12(11):1489. https://doi.org/10.3390/brainsci12111489
Chicago/Turabian StyleVillaseñor-Moreno, Julio César, Catalina Aranda-Moreno, Ignacio Figueroa-Padilla, María Esther Giraldez-Fernández, Michael A. Gresty, and Kathrine Jáuregui-Renaud. 2022. "Individual Cofactors and Multisensory Contributions to the Postural Sway of Adults with Diabetes" Brain Sciences 12, no. 11: 1489. https://doi.org/10.3390/brainsci12111489
APA StyleVillaseñor-Moreno, J. C., Aranda-Moreno, C., Figueroa-Padilla, I., Giraldez-Fernández, M. E., Gresty, M. A., & Jáuregui-Renaud, K. (2022). Individual Cofactors and Multisensory Contributions to the Postural Sway of Adults with Diabetes. Brain Sciences, 12(11), 1489. https://doi.org/10.3390/brainsci12111489