Diabetes Metab J.  2018 Feb;42(1):82-86. 10.4093/dmj.2018.42.1.82.

Single Sensor Gait Analysis to Detect Diabetic Peripheral Neuropathy: A Proof of Principle Study

• Esser P
• Collett J
• Maynard K
• Steins D
• Hillier A
• Buckingham J
• Tan GD
• King L
• Dawes H

• KMID: 2409189
• DOI: http://doi.org/10.4093/dmj.2018.42.1.82

Abstract

This study explored the potential utility of gait analysis using a single sensor unit (inertial measurement unit [IMU]) as a simple tool to detect peripheral neuropathy in people with diabetes. Seventeen people (14 men) aged 63±9 years (mean±SD) with diabetic peripheral neuropathy performed a 10-m walk test instrumented with an IMU on the lower back. Compared to a reference healthy control data set (matched by gender, age, and body mass index) both spatiotemporal and gait control variables were different between groups, with walking speed, step time, and SDa (gait control parameter) demonstrating good discriminatory power (receiver operating characteristic area under the curve >0.8). These results provide a proof of principle of this relatively simple approach which, when applied in clinical practice, can detect a signal from those with known diabetes peripheral neuropathy. The technology has the potential to be used both routinely in the clinic and for tele-health applications. Further research should focus on investigating its efficacy as an early indicator of or effectiveness of the management of peripheral neuropathy. This could support the development of interventions to prevent complications such as foot ulceration or Charcot's foot.

Keyword

Accelerometry; Diabetes complications; Diabetic neuropathies; Gait

MeSH Terms

Accelerometry
Dataset
Diabetes Complications
Diabetic Neuropathies
Foot
Foot Ulcer
Gait*
Peripheral Nervous System Diseases*
Walking

Reference

1. Hoffman EM, Staff NP, Robb JM, St Sauver JL, Dyck PJ, Klein CJ. Impairments and comorbidities of polyneuropathy revealed by population-based analyses. Neurology. 2015; 84:1644–1651. PMID: 25832668.

2. Callaghan B, Kerber K, Langa KM, Banerjee M, Rodgers A, McCammon R, Burke J, Feldman E. Longitudinal patient-oriented outcomes in neuropathy: importance of early detection and falls. Neurology. 2015; 85:71–79. PMID: 26019191.

3. Tesfaye S. Recent advances in the management of diabetic distal symmetrical polyneuropathy. J Diabetes Investig. 2011; 2:33–42.

4. Mustapa A, Justine M, Mohd Mustafah N, Jamil N, Manaf H. Postural control and gait performance in the diabetic peripheral neuropathy: a systematic review. Biomed Res Int. 2016; 2016:9305025. PMID: 27525281.

5. Hazari A, Maiya AG, Shivashankara KN, Agouris I, Monteiro A, Jadhav R, Kumar S, Shashi Kumar CG, Mayya SS. Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis. Springerplus. 2016; 5:1819. PMID: 27812455.

6. Toro B, Nester CJ, Farren PC. The status of gait assessment among physiotherapists in the United Kingdom. Arch Phys Med Rehabil. 2003; 84:1878–1884. PMID: 14669198.

7. Steins D, Sheret I, Dawes H, Esser P, Collett J. A smart device inertial-sensing method for gait analysis. J Biomech. 2014; 47:3780–3785. PMID: 25305689.

8. Esser P, Dawes H, Collett J, Howells K. IMU: inertial sensing of vertical CoM movement. J Biomech. 2009; 42:1578–1581. PMID: 19442978.

9. Collett J, Esser P, Khalil H, Busse M, Quinn L, DeBono K, Rosser A, Nemeth AH, Dawes H. Insights into gait disorders: walking variability using phase plot analysis, Huntington's disease. Gait Posture. 2014; 40:694–700. PMID: 25172806.

10. Esser P, Dawes H, Collett J, Howells K. Insights into gait disorders: walking variability using phase plot analysis, Parkinson's disease. Gait Posture. 2013; 38:648–652. PMID: 23510514.

11. Hauser RA. Early pharmacologic treatment in Parkinson;s disease. Am J Manag Care. 2010; 16(Suppl Implications):S100–S107. PMID: 20297870.

12. Kremens D, Hauser RA, Dorsey ER. An update on Parkinson's disease: improving patient outcomes. Am J Med. 2014; 127:S3.

13. Schaper NC, Van Netten JJ, Apelqvist J, Lipsky BA, Bakker K;. IWGDF). Prevention and management of foot problems in diabetes: a summary guidance for daily practice 2015, based on the IWGDF guidance documents. Diabetes Res Clin Pract. 2017; 124:84–92. PMID: 28119194.

14. Rosano C, Studenski SA, Aizenstein HJ, Boudreau RM, Longstreth WT Jr, Newman AB. Slower gait, slower information processing and smaller prefrontal area in older adults. Age Ageing. 2012; 41:58–64. PMID: 21965414.

15. Aboutorabi A, Arazpour M, Bahramizadeh M, Hutchins SW, Fadayevatan R. The effect of aging on gait parameters in able-bodied older subjects: a literature review. Aging Clin Exp Res. 2016; 28:393–405. PMID: 26210370.

16. Beavers KM, Beavers DP, Houston DK, Harris TB, Hue TF, Koster A, Newman AB, Simonsick EM, Studenski SA, Nicklas BJ, Kritchevsky SB. Associations between body composition and gait-speed decline: results from the Health, Aging, and Body Composition study. Am J Clin Nutr. 2013; 97:552–560. PMID: 23364001.

17. Esser P, Dawes H, Collett J, Feltham MG, Howells K. Assessment of spatio-temporal gait parameters using inertial measurement units in neurological populations. Gait Posture. 2011; 34:558–560. PMID: 21764583.

18. Esser P, Dawes H, Collett J, Feltham MG, Howells K. Validity and inter-rater reliability of inertial gait measurements in Parkinson's disease: a pilot study. J Neurosci Methods. 2012; 205:177–181. PMID: 22269595.

19. Rota V, Perucca L, Simone A, Tesio L. Walk ratio (step length/cadence) as a summary index of neuromotor control of gait: application to multiple sclerosis. Int J Rehabil Res. 2011; 34:265–269. PMID: 21629125.

20. Nazhel B, Yetkin I, Irkec C, Kocer B. Sympathetic skin response in diabetic neuropathy. Electromyogr Clin Neurophysiol. 2002; 42:181–185. PMID: 11977432.

21. Castell MV, Sanchez M, Julian R, Queipo R, Martin S, Otero A. Frailty prevalence and slow walking speed in persons age 65 and older: implications for primary care. BMC Fam Pract. 2013; 14:86. PMID: 23782891.

22. Awotidebe TO, Ativie RN, Oke KI, Akindele MO, Adedoyin RA, Olaogun MO, Olubayode TE, Kolawole BA. Relationships among exercise capacity, dynamic balance and gait characteristics of Nigerian patients with type-2 diabetes: an indication for fall prevention. J Exerc Rehabil. 2016; 12:581–588. PMID: 28119881.

23. Khalaf K, Al-Angari HM, Khandoker AH, Lee S, Almahmeed W, Al Safar HS, Jelinek HF. Gait alterations in the UAE population with and without diabetic complications using both traditional and entropy measures. Gait Posture. 2017; 58:72–77. PMID: 28756345.

24. Brown S, Boulton A, Bowling F, Reeves N. Benefits, challenges, and potential utility of a gait database for diabetes patients. J Diabetes Sci Technol. 2016; 10:1065–1072. PMID: 27022098.