Evaluation of Knee Proprioception and Kinesthesia in Patients with Type 2 Diabetes Mellitus
DOI:
https://doi.org/10.34058/njmr.v17i1.95Keywords:
Diabetes type 2, Neuropathy, Proprioception, Kinesthesia, Continuous Passive MotionAbstract
Background: Diabetes is a highly significant public health problem inIran with a prevalence of 5 to 8%. Proprioception plays an important role in the orientation and limb movement in space. Diabetic neuropathy decreases sensory function and causes gait instabilities.
Objective: The present study evaluated knee proprioception and kinesthesia in patients with type 2 diabetes with and without neuropathy and compared the results with those of healthy people.
 Methods: The subjects were ten type 2 diabetes mellitus patients with diabetes type 2 associated with neuropathy, ten patients with diabetes without neuropathy and ten healthy people as the control group. Data were collected in a physical examination and using a questionnaire. Special tests included manual muscle testing of the knee musculature, Achilles and patellar reflexes, and knee proprioception and kinesthesia. Data were analyzed using one-way ANOVA and the Tukey test.
Results: the results show that knee proprioception and kinesthesia were significantly decreased in patients with diabetes mellitus type 2 in comparison with healthy people and there was a greater decline in patients with diabetes associated with neuropathy than in patients with diabetes without neuropathy. Also, knee musculature strength was significantly lower in patients with diabetes in comparison with healthy people and the attenuation was greater in neuropathic patients than in non-neuropathic ones.
 Conclusions: Patients with diabetes type 2 especially those with neuropathy suffer from proprioception deficits. Proprioception training may prevent secondary problems occurring as a result of proprioception impairment in patients with diabetes type2.
References
ANDERSEN, H. & JAKOBSEN, J. 1997. A comparative study of isokinetic dynamometry and manual muscle testing of ankle dorsal and plantar flexors and knee extensors and flexors. European neurology, 37, 239-242.
ANDERSEN, H., NIELSEN, S., MOGENSEN, C. E. & JAKOBSEN, J. 2004. Muscle strength in type 2 diabetes. Diabetes, 53, 1543-1548.
ANDERSEN, H., STÃ…LBERG, E., GJERSTAD, M. D. & JAKOBSEN, J. 1998. Association of muscle strength and electrophysiological measures of reinnervation in diabetic neuropathy. Muscle & nerve, 21, 1647-1654.
BLOEM, B., ALLUM, J., CARPENTER, M. & HONEGGER, F. 2000. Is lower leg proprioception essential for triggering human automatic postural responses? Experimental Brain Research, 130, 375-391.
BOYLE, J. P., HONEYCUTT, A. A., NARAYAN, K. V., HOERGER, T. J., GEISS, L. S., CHEN, H. & THOMPSON, T. J. 2001. Projection of Diabetes Burden Through 2050 Impact of changing demography and disease prevalence in the US. Diabetes care, 24, 1936-1940.
FRIJNS, C., LAMAN, D., VAN DUIJN, M. & VAN DUIJN, H. 1997. Normal values of patellar and ankle tendon reflex latencies. Clinical neurology and neurosurgery, 99, 31-36.
HIJMANS, J. M., GEERTZEN, J., ZIJLSTRA, W., HOF, A. L. & POSTEMA, K. 2008. Effects of vibrating insoles on standing balance in diabetic neuropathy. Orthotic Interventions to Improve Standing Balance in Somatosensory Loss, 45, 1442-1450.
HORAK, F. B., DICKSTEIN, R. & PETERKA, R. J. 2002. Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance. Somatosensory & motor research, 19, 316-326.
REGENSTEINER G.J. (1st ed.) 2009. Diabetes and exercise, boston: Humana Press.
KANDELL, E. (3rd ed.) 2000. Electrodiagnostic medicine, New York: McGraw-Hill.
KATOULIS, E. C., EBDON-PARRY, M., LANSHAMMAR, H., VILEIKYTE, L., KULKARNI, J. & BOULTON, A. J. 1997. Gait abnormalities in diabetic neuropathy. Diabetes care, 20, 1904-1907.
KAVOUNOUDIAS, A., ROLL, R. & ROLL, J.-P. 2001. Foot sole and ankle muscle inputs contribute jointly to human erect posture regulation. The Journal of physiology, 532, 869-878.
NASHNER L.M. 1976. Adapting reflexes controlling the human posture. Exp Brain Res 26, 59-72.
LARIJANI, B. & ZAHEDI, F. 2002. Epidemiology of diabetes mellitus in Iran. Iranian journal of diabetes and lipid disorders.
LEVANGIE P.K., N. C. C. (4th ed.) 2001. Joint structure and function, Delhi: Jaypee Brothers.
MAGEE, D. (ed.) 1997. Orthopedic Physical Assessment, Philadelphia: Saunders.
MAURER, C., MERGNER, T. & PETERKA, R. 2006. Multisensory control of human upright stance. Experimental Brain Research, 171, 231-250.
RICHARDSON, J. K. & HURVITZ, E. A. 1995. Peripheral neuropathy: a true risk factor for falls. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 50, M211-M215.
SHEPARD, N. T., TELIAN, S. A. & SMITH-WHEELOCK, M. 1990. Habituation and balance retraining therapy: a retrospective review. Neurologic Clinics.
SIMONEAU, G. G., ULBRECHT, J. S., DERR, J. A., BECKER, M. B. & CAVANAGH, P. R. 1994. Postural instability in patients with diabetic sensory neuropathy. Diabetes care, 17, 1411-1421.
STROTMEYER, E. S., CAULEY, J. A., SCHWARTZ, A. V., NEVITT, M. C., RESNICK, H. E., BAUER, D. C., TYLAVSKY, F. A., DE REKENEIRE, N., HARRIS, T. B. & NEWMAN, A. B. 2005. Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging, and body composition study. Archives of Internal Medicine, 165, 1612.
UCCIOLI, L., GIACOMINI, P. G., MONTICONE, G., MAGRINI, A., DUROLA, L., BRUNO, E., PARISI, L., DI GIROLAMO, S. & MENZINGER, G. 1995. Body sway in diabetic neuropathy. Diabetes care, 18, 339-344.
VOLPATO, S., LEVEILLE, S. G., BLAUM, C., FRIED, L. P. & GURALNIK, J. M. 2005. Risk factors for falls in older disabled women with diabetes: the women's health and aging study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60, 1539-1545.
VOORHEES, R. 1990. Dynamic posturography findings in central nervous system disorders. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery, 103, 96.
YOUNG, M., BOULTON, A., MACLEOD, A., WILLIAMS, D. & SONKSEN, P. 1993. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia, 36, 150-154.
