Application of surface EMG in diabetic disease

Summary: English The World Health Organization warns that, in 2000, as many as 33 million Europeans suffered from diabetes, approximately 15% will likely develop foot ulcers, and approximately 15% to 20% of these patients will face lower-extremity amputation. In 2004, an estimated 3.4 million people died from consequences of high blood sugar. Diabetic neuropathy is the most common chronic complication associated with diabetes mellitus, affecting 20–50% of diabetic patients 10 years after their diagnosis. Peripheral neuropathy and peripheral arterial disease are the most common and invalidating diabetes’s complications, involved in the pathogenesis of diabetic foot. They account for the leading cause of non-traumatic lower limb amputations. It results from two factors. The first one is a reduced blow of blood in the inferior limbs, caused from the presence of obliterating peripheral arteriopathy disease. The second is the progressive laceration of nervous fibers (neuropathy) that cause a reduction of the sensitivity (also to the pain) and of the ability of movement, and that helps the appearance of lesions. Together with diabetes falls in older adults are a big public health concern and have provided much of the motivation for research into age-related changes in human gait. Tripping during walking is the predominant cause of falls not only in the elderly but also in the neuropathic subjects. Trips can occur during walking on a level ground, but also during crossing visible obstacle, stair ascending and descending. The social and economic weight of the diabetic foot and the tragic consequences that brings with it can be reduced through a prompt diagnosis and treatment from the very beginning. The aim of this thesis, was to evaluate differences in gait parameters, in performing stair ascending and descending task and evaluation of muscle fatigue during treadmill protocol in diabetes subjects with and without complications, in order to provide a further tool for early diagnosis which allows clinicians to change, if is necessary, or only to control, as soon as possible, the follow-up of patients according to their specific characteristics

A multi-scale framework for the prevention of plantar ulcers in diabetic subjects: a multidisciplinary approach combining gait analysis, musculkoskeletal and finite element foot modelling.

This study aims to evaluate the accuracy of a multiscale workflow applicable in clinical practice aiming to prevent ulceration by detecting excessive external and internal stresses preceding overloading and breakdown in diabetic subjects

The rugby side-on tackle: on-field comparison between young and senior international \ue9lite athletes for technique enhancement and injury prevention.

The aim of the present study is to investigate the tackling technique in international \ue9lite young and senior athletes, to highlight differences both in technique effectiveness and ACL injury risk

Current practices in clinical gait analysis in Europe:A comprehensive survey-based study from the European society for movement analysis in adults and children (ESMAC) standard initiative

BACKGROUND: Clinical gait analysis (CGA) is a systematic approach to comprehensively evaluate gait patterns, quantify impairments, plan targeted interventions, and evaluate the impact of interventions. However, international standards for CGA are currently lacking, resulting in various national initiatives. Standards are important to ensure safe and effective healthcare practices and to enable evidence-based clinical decision-making, facilitating interoperability, and reimbursement under national healthcare policies. Collaborative clinical and research work between European countries would benefit from common standards.RESEARCH OBJECTIVE: This study aimed to review the current laboratory practices for CGA in Europe.METHODS: A comprehensive survey was conducted by the European Society for Movement Analysis in Adults and Children (ESMAC), in close collaboration with the European national societies. The survey involved 97 gait laboratories across 16 countries. The survey assessed several aspects related to CGA, including equipment used, data collection, processing, and reporting methods.RESULTS: There was a consensus between laboratories concerning the data collected during CGA. The Conventional Gait Model (CGM) was the most used biomechanical model for calculating kinematics and kinetics. Respondents also reported the use of video recording, 3D motion capture systems, force plates, and surface electromyography. While there was a consensus on the reporting of CGA data, variations were reported in training, documentation, data preprocessing and equipment maintenance practices.SIGNIFICANCE: The findings of this study will serve as a foundation for the development of standardized guidelines for CGA in Europe.</p

SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference

Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field

Application of surface EMG in diabetic disease

Summary: English The World Health Organization warns that, in 2000, as many as 33 million Europeans suffered from diabetes, approximately 15% will likely develop foot ulcers, and approximately 15% to 20% of these patients will face lower-extremity amputation. In 2004, an estimated 3.4 million people died from consequences of high blood sugar. Diabetic neuropathy is the most common chronic complication associated with diabetes mellitus, affecting 20–50% of diabetic patients 10 years after their diagnosis. Peripheral neuropathy and peripheral arterial disease are the most common and invalidating diabetes’s complications, involved in the pathogenesis of diabetic foot. They account for the leading cause of non-traumatic lower limb amputations. It results from two factors. The first one is a reduced blow of blood in the inferior limbs, caused from the presence of obliterating peripheral arteriopathy disease. The second is the progressive laceration of nervous fibers (neuropathy) that cause a reduction of the sensitivity (also to the pain) and of the ability of movement, and that helps the appearance of lesions. Together with diabetes falls in older adults are a big public health concern and have provided much of the motivation for research into age-related changes in human gait. Tripping during walking is the predominant cause of falls not only in the elderly but also in the neuropathic subjects. Trips can occur during walking on a level ground, but also during crossing visible obstacle, stair ascending and descending. The social and economic weight of the diabetic foot and the tragic consequences that brings with it can be reduced through a prompt diagnosis and treatment from the very beginning. The aim of this thesis, was to evaluate differences in gait parameters, in performing stair ascending and descending task and evaluation of muscle fatigue during treadmill protocol in diabetes subjects with and without complications, in order to provide a further tool for early diagnosis which allows clinicians to change, if is necessary, or only to control, as soon as possible, the follow-up of patients according to their specific characteristics.Summary: Italian L'Organizzazione Mondiale della Sanità avverte che, nel 2000, ben 33 milioni di europei hanno sofferto di diabete, circa il 15% probabilmente svilupperà ulcere del piede, e circa il 15-20% di questi pazienti si troveranno ad affrontare l'amputazione degli arti inferiori. Nel 2004 5.2 milioni di persone sono morte a causa degli elevati livelli di zucchero nel sangue. La neuropatia periferica è la complicanza diabetica cronica più frequente e colpisce dal 20 al 50% dei pazienti diabetici a distanza di 10 anni dalla diagnosi. Neuropatia e vasculopatia periferica sono le complicanze del diabete più comuni e invalidanti, e le maggiori responsabili della patogenesi del piede diabetico. Insieme rappresentano la principale causa di amputazioni non traumatiche degli arti inferiori. La vasculopatia periferica causa un ridotto apporto di sangue agli arti inferiori, mentre la neuropatia periferica si manifesta attraverso la lacerazione progressiva delle fibre nervose che causa una riduzione della sensibilità (anche al dolore) e della capacità di movimento, che provoca di conseguenza la comparsa di lesioni. Insieme al diabete, le cadute nella popolazione anziana sono una grande preoccupazione per la sanità pubblica e sono state la spinta motivazionale per la maggior parte delle ricerche svolte nell’ambito delle alterazioni del cammino nell’uomo. Inciampare durante il cammino è la causa predominante delle cadute, non solo negli anziani, ma anche nei soggetti neuropatici e può accadere non solo durante il cammino su un terreno pianeggiante, ma anche su terreni sconnessi o durante la salita e la discesa di una scala. Il peso sociale ed economico del piede diabetico, assieme alla drammatiche conseguenze che porta con sè possono essere ridotti attraverso una diagnosi tempestiva e un trattamento immediato preferibilmente antecedente alla diagnosi clinica. L'obiettivo primario di questa tesi, è stato quello di valutare la presenza di alterazioni nelle attivazioni muscolari in soggetti diabetici con e senza complicanze durante l’esecuzione di diversi task motori con il fine ultimo di valutare se questo tipo di acquisizioni fossero in grado di fornire ai clinici un ulteriore strumento per la diagnosi precoce che consenta loro di modificare, se necessario, o semplicemente di valutare l’efficacia del follow-up dei pazienti in base alle loro caratteristiche specifiche

The Effect of Custom Insoles on Muscle Activity in Diabetic Individuals with Neuropathy

Foot ulcers are amongst the most serious complications of diabetes. Guidelines recommend that people with diabetes wear appropriate footwear or insoles to reduce repetitive stresses. Excessive plantar pressure has been recognized as the major risk factor for plantar ulcers in diabetic individuals; custom insoles are indicated as the gold standard treatment to unload the foot structure. The aim of this study was to investigate the effect of custom insoles on biomechanical and neuromuscular functions in diabetic neuropathic individuals. Ten diabetic subjects walked with and without custom insoles at their preferred speed; ten controls were assessed for comparison. Data were captured through seven video cameras, plantar pressure insoles, and surface electromyography. The electrical activity of Rectus Femoris, Tibialis Anterior, Medius Gluteus and Gastrocnemius Lateralis were acquired bilaterally. The plantar pressure and surface electromyographic variables were determined, while videos were used to detect the gait cycle. The following comparisons were made across the variables through the non-parametric SPM1D test (p &lt; 0.05): condition with vs. without insoles vs. controls. Custom insoles provided a reduction in plantar pressure through contact surface redistribution in association with a reduced electromyographic activity. Our results suggest optimizing the prevention approach by including personalized foot and ankle exercises

The Effect of Custom Insoles on Muscle Activity in Diabetic Individuals with Neuropathy

Foot ulcers are amongst the most serious complications of diabetes. Guidelines recommend that people with diabetes wear appropriate footwear or insoles to reduce repetitive stresses. Excessive plantar pressure has been recognized as the major risk factor for plantar ulcers in diabetic individuals; custom insoles are indicated as the gold standard treatment to unload the foot structure. The aim of this study was to investigate the effect of custom insoles on biomechanical and neuromuscular functions in diabetic neuropathic individuals. Ten diabetic subjects walked with and without custom insoles at their preferred speed; ten controls were assessed for comparison. Data were captured through seven video cameras, plantar pressure insoles, and surface electromyography. The electrical activity of Rectus Femoris, Tibialis Anterior, Medius Gluteus and Gastrocnemius Lateralis were acquired bilaterally. The plantar pressure and surface electromyographic variables were determined, while videos were used to detect the gait cycle. The following comparisons were made across the variables through the non-parametric SPM1D test (p < 0.05): condition with vs. without insoles vs. controls. Custom insoles provided a reduction in plantar pressure through contact surface redistribution in association with a reduced electromyographic activity. Our results suggest optimizing the prevention approach by including personalized foot and ankle exercises