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Advanced Neurology Neuropathy-reduced balance and gait

hyperalgesia) or negative symptoms (e.g., loss of tactile be critical to reducing or reversing its effects, especially
sensation, proprioception, and temperature sensitivity). among individuals aged 65 and above.
4
Common complications of Pn are neuropathic pain and Therefore, the purpose of this study was to assess the
5,6
diabetic foot. The symptoms and/or complications differential effects of reduced foot sole sensitivity and
negatively affect the quality of life, daily activities, and slowed nerve conduction velocity on postural control and
7
independence. Older individuals with PN are at a higher functional gait. Our hypothesis posited that these two
8
risk of falling, with fall-related injuries such as fractures or factors would have varying effects on both postural control
9
traumatic brain injuries being a leading cause of hospital or and functional gait. In addition, we anticipated that the
nursing home admissions and associated medical costs. relationship between the dependent variables and reduced
10
Factors contributing to this heightened risk of falling foot sole sensitivity or slowed nerve conduction velocity
include the inability to detect and the delayed response to would differ significantly based on disease severity.
perturbations. 10
Postural control encompasses achieving, maintaining, 2. Methods
or restoring upright balance during different activities. 2.1. Participants
1
Maintaining postural control is important during quiet
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stance, functional gait, and in response to perturbations. Before participant recruitment, this study received
Individuals with PN have a decreased postural control approval (H20076) from the Institutional Review Board
capacity, defined by the average center of pressure (COP) of Georgia Southern University, ensuring compliance with
sway velocity and area, along with impaired functional the principles outlined in the Declaration of Helsinki.
gait, evidenced by a shortened 6-min walk distance Thirty-eight individuals from the local community were
(6MWD) and a longer timed-up-and-go duration (TUG). recruited and briefed about the testing procedures. The
12
Studies have shown increased postural sway in those inclusion criteria for participation were as follows: (i)
with PN 13-15 and there is an inverse relationship between attainment of at least 65 years old; (ii) capability to stand
sway magnitude and H-index from H-reflex tests. 16,17 In for at least 5 min; (iii) capacity to walk unassisted for at
addition, individuals with PN have been observed to walk least 6 min; (iv) absence of any history or evidence of
slower with greater variability. 12,18 central nervous system dysfunction; (v) absence of foot
sole ulcers; (vi) lack of a cardiac pacemaker implant; and
The pathological components of PN, namely, reduced (vii) negative response to all follow-up questions on the
foot sole sensitivity and reduced nerve conduction Physical Activity Readiness Questionnaire plus (PAR-Q+).
velocity, may affect postural control and functional gait
differently, depending on the stage of the disease, and 2.2. Testing protocol
as PN progresses, there is a notable decline in foot sole At the beginning of the testing session, participants
sensitivity and nerve conduction velocity. The neural completed the necessary forms and assessments, including
19
pathway governing stance and walking comprises five obtaining informed consent, gathering medical history,
components: sensory reception, signal ascent to the and administering the PAR-Q+. Anthropometric data
central nervous system, information processing, signal (i.e., age, sex, height, and body mass) were also collected.
descent to muscles, and signal translation to the alpha Subsequently, assessments for foot sole sensitivity,
motor neuron. PN PN predominantly affects feedback Hoffmann reflex, postural control, and functional gait
control at the sensory reception level due to reduced were tested.
foot sole sensitivity, leading to insensitivity to postural
perturbations. It also impacts signal descent through Foot sole sensitivity was assessed using a 5.07-
1,20
demyelination, resulting in slower nerve conduction gauge Semmes-Weinstein monofilament (North Coast
velocity, thereby influencing reaction speed to detected Medical, Inc., United States of America [USA]) following
23
perturbations and the ability to complete functional established protocols. Testing sites included the hallux,
21
gait tests. These PN pathological effects have been bases of the first and fifth metatarsals, midsole, and heel.
22
investigated, either isolated or in combination, and it has Each site was randomly tested 3 times. Two or more
been determined that individuals with PN have decreased positive identifications of the touch by the monofilament
postural control and impaired functional gait. However, were scored as “1,” otherwise “0” was assigned to the site.
there is a gap in the literature regarding how each This method has demonstrated reliability within this
23
component of PN uniquely affects postural control and population.
functional gait. A better understanding of the potential The Hoffmann reflex test was conducted with the
effects of PN on postural control and functional gait may participant standing. A surface electromyography (EMG)

Volume 3 Issue 2 (2024) 2 doi: 10.36922/an.2900