Combined exercise and visual gaze training improves stepping accuracy in people with diabetic peripheral neuropathy

Publisher's version (útgefin grein)Introduction: Patients with diabetes and diabetic peripheral neuropathy (DPN) place their feet with less accuracy whilst walking, which may contribute to the increased falls-risk. This study examines the effects of a multi-faceted intervention on stepping accuracy, in patients with diabetes and DPN. Methods: Forty participants began the study, of which 29 completed both the pre and post-intervention tests, 8 patients with DPN, 11 patients with diabetes but no neuropathy (D) and 10 healthy controls (C). Accuracy of stepping was measured pre- and post-intervention as participants walked along an irregularly arranged stepping walkway. Participants attended a one-hour session, once a week, for sixteen weeks, involving high-load resistance exercise and visual-motor training. Results: Patients who took part in the intervention improved stepping accuracy (DPN: +45%; D: +36%) (p < 0.05). The diabetic non-intervention (D-NI) group did not display any significant differences in stepping accuracy pre- to post- the intervention period (−7%). Discussion: The improved stepping accuracy observed in patients with diabetes and DPN as a result of this novel intervention, may contribute towards reducing falls-risk. This multi-faceted intervention presents promise for improving the general mobility and safety of patients during walking and could be considered for inclusion as part of clinical treatment programmes.This work was supported by a Clinical Research Grant from the European Foundation for the Study of Diabetes (EFSD).Peer Reviewe

Electrophysiological Characterization of The Cerebellum in the Arterially Perfused Hindbrain and Upper Body of The Rat

In the present study, a non-pulsatile arterially perfused hindbrain and upper body rat preparation is described which is an extension of the brainstem preparation reported by Potts et al., (Brain Res Bull 53(1):59–67), 1. The modified in situ preparation allows study of cerebellar function whilst preserving the integrity of many of its interconnections with the brainstem, upper spinal cord and the peripheral nervous system of the head and forelimbs. Evoked mossy fibre, climbing fibre and parallel fibre field potentials and EMG activity elicited in forelimb biceps muscle by interpositus stimulation provided evidence that both cerebellar inputs and outputs remain operational in this preparation. Similarly, the spontaneous and evoked single unit activity of Purkinje cells, putative Golgi cells, molecular interneurones and cerebellar nuclear neurones was similar to activity patterns reported in vivo. The advantages of the preparation include the ability to record, without the complications of anaesthesia, stabile single unit activity for extended periods (3 h or more), from regions of the rat cerebellum that are difficult to access in vivo. The preparation should therefore be a useful adjunct to in vitro and in vivo studies of neural circuits underlying cerebellar contributions to movement control and motor learning

Visuomotor Cerebellum in Human and Nonhuman Primates

In this paper, we will review the anatomical components of the visuomotor cerebellum in human and, where possible, in non-human primates and discuss their function in relation to those of extracerebellar visuomotor regions with which they are connected. The floccular lobe, the dorsal paraflocculus, the oculomotor vermis, the uvula–nodulus, and the ansiform lobule are more or less independent components of the visuomotor cerebellum that are involved in different corticocerebellar and/or brain stem olivocerebellar loops. The floccular lobe and the oculomotor vermis share different mossy fiber inputs from the brain stem; the dorsal paraflocculus and the ansiform lobule receive corticopontine mossy fibers from postrolandic visual areas and the frontal eye fields, respectively. Of the visuomotor functions of the cerebellum, the vestibulo-ocular reflex is controlled by the floccular lobe; saccadic eye movements are controlled by the oculomotor vermis and ansiform lobule, while control of smooth pursuit involves all these cerebellar visuomotor regions. Functional imaging studies in humans further emphasize cerebellar involvement in visual reflexive eye movements and are discussed

Accelerator pedal control in diabetes: influence of ankle proprioception and muscle strength

Aims Diabetic peripheral neuropathy (DPN) influences neural sensitivity, nerve conduction velocity, proprioception and muscle strength. The aim of this work was to investigate whether the speed of strength generation (SSG) and/or proprioception function of the plantarflexor muscles in people with diabetes both with and without peripheral neuropathy would affect accelerator pedal control on a driving simulator. Methods Fifty-four active drivers, 15 with DPN (DPN, aged 66±6.0yrs), 25 with diabetes but no neuropathy (DM, aged 62±8.7yrs) and 14 controls without diabetes (C, aged 58±10yrs), undertook a maximum isometric muscle test of the plantarflexor muscles and a proprioception test of the right ankle joint using a dynamometer, in addition to a driving task using a driving simulator. We measured SSG (Nm/s), proprioception error values (degrees) and accelerator pedal position (degrees) from these tests, respectively. Results The DM and DPN groups showed significantly lower values for SSG with respect to C (DPN: 80.9±58.4; DM: 134.2±89.3; C: 233±135.4 Nm/s; p0.05), and the lowest value of accelerator pedal displacement during the driving test (DPN: 1.8±0.8; DM 3.1±0.6; C: 2.9±0.7 deg; p>0.05) with respect to DM and C groups. Conclusions Whilst not affecting people with diabetes without neuropathy, reduced ankle joint proprioception together with a slower production of plantarflexor muscle strength seems to influence accelerator pedal control during a driving simulation task in people DPN

Rehearsal by eye movement improves visuomotor performance in cerebellar patients

In order to assess the effect of rehearsal by eye movement alone on visuomotor performance, the eye movements and visually guided stepping of two cerebellar patients were monitored before and after a first and second batch of eye-movement rehearsals, in which patients made saccadic eye movements to the first 6 footfall targets (in a sequence of 18) whilst standing stationary at the start of the walkway. There was a marked improvement in oculomotor and locomotor performance following the second batch of eye-movement rehearsal. Both patients showed reduced occurrence of saccadic dysmetria, evident as a significant increase in the proportion of single to multi-saccadic eye movements (from 46 to 77% for DB and from 75 to 94% for TP). This was accompanied by increased regularity and accuracy of stepping in both patients, and decreased stance and double support phase durations (one patient only). Separate testing confirmed that these improvements in eye movements and stepping did not result from simple repetition of the task. This is the first demonstration of a technique – rehearsal by eye movement – that improves the visuomotor performance of cerebellar patients. It is compelling evidence for our proposal that during visually guided stepping the locomotor control system is dependent on assistance from the oculomotor control system