OAR@UM Collection:

The effect of exercise on the gait biomechanics of the neuro-ischemic diabetic foot with peripheral neuropathy

2018-09-28T01:47:56Z

Title: The effect of exercise on the gait biomechanics of the neuro-ischemic diabetic foot with peripheral neuropathy Abstract: The aim of the study was to investigate the effect of a six-week exercise program on the kinetics and kinematics during gait in people diagnosed with ischemia and diabetic peripheral neuropathy. The peak plantar pressures, pressure-time integral, lower limb joint angles in the sagittal plane and ground reaction forces were tested before and after the exercise program. Research in this area is lacking, providing only small scale studies with mixed results and decreased significance. The researcher aimed to add to the body of knowledge and provide further insight into the possible use of exercise to prevent and manage the complications of diabetic peripheral neuropathy such as the development of pressure ulcers. Methodology: Twelve participants were chosen for this pilot study, and were asked to carry out a specialised exercise program for six weeks, twice weekly. The kinematics and ground reaction forces were tested using 3D motion analysis (Vicon) and force plates (AMTI) and plantar pressures and pressure-time integral were tested via the TekScan HR mat. The patients acted as their own control, comparing pre- and post- intervention results. Results showed a statistically significant decrease in plantar pressures in all areas and in the pressuretime integral at the forefoot. Hip flexion at toe-off and knee extension at heel strike showed a statistically significant improvement. All other areas showed a slight improvement but were not statistically significant, thus failing to reject the null hypothesis. Conclusion: Although improvements were seen, this pilot study requires further research to support the findings in this study and possibly implement these findings in clinical practice in the future. Description: M.SC.CLINICAL BIOMECHANICS

A comparison of standard wound care vs. standard wound care with adjunct hyperbaric oxygen therapy in diabetic arterial ulceration

2018-04-25T06:35:02Z

Title: A comparison of standard wound care vs. standard wound care with adjunct hyperbaric oxygen therapy in diabetic arterial ulceration Abstract: Background: As the incidence of diabetes increases so does the prevalence of diabetic arterial ulcerations, which if not treated promptly, may lead to loss of morbidity posing a great burden on the patient’s quality of life and the health care system. Diverse treatment modalities and protocols for arterial ulcerations are available, however further studies should be conducted to compare and evaluate the clinical efficacy of such treatments. Aim: The aim of this study was to compare Standard Wound Care versus Standard Wound Care with Adjunct Hyperbaric Oxygen Therapy in the treatment of diabetic arterial foot ulceration. Research Design and Method: A quasi-experimental, matched-control clinical trial was conducted at the Tissue Viability Unit and at the Hyperbaric Oxygen Therapy Unit. Twenty-six participants living with Type 2 Diabetes and presenting with a newly diagnosed arterial foot ulcer were recruited. Subjects were divided into 2 groups. Group A underwent Standard Wound Care with adjunct Hyperbaric Oxygen Therapy and Group B underwent Standard Wound Care only. Following application of treatment, participants were reviewed every week for a period of four weeks and their ulcers were measured for their surface area and depth to assess any change in wound size. Results: Both Standard Wound Care with adjunct Hyperbaric Oxygen Therapy and Standard Wound Care only were effective in reducing the surface area and depth of ulcer (p=0.00). Nonetheless, SWC with adjunctive HBOT was 3.57 times better in reducing the surface area (p=0.000) of the ulcer and 4.61 times in reducing the depth of the ulcer (p=0.000) when compared to SWC only. Conclusion: Standard Wound Care with adjunctive Hyperbaric Oxygen Therapy, could be considered as a more practical and effective modality when treating diabetic arterial foot ulcerations, owing to its advantages in reducing the surface area and depth of ulcers in comparison to Standard Wound Care only. Provision of optimal wound care, would promote wound healing, bringing about significant reductions in the number of amputations which will eventually improve the patients’ quality of life and reduce both morbidity and mortality in this high-risk population. Description: B.SC.(HONS)PODIATRY

The effect of Type 2 Diabetes Mellitus on plantar pressure and contact area within the Maltese population

2018-03-29T13:32:13Z

Title: The effect of Type 2 Diabetes Mellitus on plantar pressure and contact area within the Maltese population Abstract: Aim : The aim of this study was to determine whether plantar pressure and contact area in participants living with Type 2 Diabetes are affected by the duration of Type 2 Diabetes Mellitus. Research Design and Method : The study employed a non-experimental quantitative matched subject design. A group of 36 participants were recruited and divided into three groups (Group 1: 0-5 years, Group 2: 6- 10 years, Group 3: 11-15 years) matched for age, gender, weight and duration of diabetes. Foot pressure mapping utilizing the 2-step protocol was employed to obtain the mean peak plantar pressure, mean pressure-time integral and mean contact area for the hallux, 1st metatarsophalangeal joint region, 2nd - 4th metatarsophalangeal joint region, 5th metatarsophalangeal joint region and heel for both feet. Results : The results indicate that there was a significant difference in mean peak plantar pressure between the three groups under the left (p=0.012) and right 2nd - 4th metatarsophalangeal joint (MPJ) region of interest (ROI) (p=0.022) and left heel (p=0.049), as well as a significant difference in mean pressure-time integral under the left 2nd - 4th MPJ ROI (p=0.021) and right heel (p=0.048). There was also a significant difference between Group 1 and Group 2 (p=0.044) for left 2nd – 4th MPJ ROI and (p=0.028) right left 2nd – 4th MPJ ROI and between Group 1 and Group 3 (p=0.016) for mean peak plantar pressure of the left 2nd – 4th MPJ ROI. No significant difference was found in contact area for both left (p=0.893) and right feet (p=0.800) between the three groups. Conclusion As the duration of diabetes increases, peak plantar pressure increases significantly under the left and right 2nd - 4th metatarsophalangeal joint region of interest. The highest peak plantar pressure at the right 2nd - 4th metatarsophalangeal joint region of interest was 348.93 kPa which is very near to the threshold peak plantar pressures quoted in other research. These findings demonstrate that podiatrists should be encouraged to make more use of pressure mapping technology as part of their clinical treatment plan in patients living with Type 2 Diabetes Mellitus without any complications or deformities. Description: B.SC.(HONS)PODIATRY

The influence of peripheral arterial disease on lower limb surface myoelectric signals in patients living with Type II Diabetes Mellitus

2018-06-20T07:41:52Z

Title: The influence of peripheral arterial disease on lower limb surface myoelectric signals in patients living with Type II Diabetes Mellitus Abstract: Aim: The aim of this study was to evaluate whether there are any significant differences in muscle activity between individuals living with type II diabetes mellitus (DM) and individuals living with type II DM and peripheral arterial disease (PAD), during gait, at a self-selected speed and at various gait transition speeds. The influence of different stages of PAD on muscle activity during gait was also assessed with the use of surface electromyography. Research Design and Method: A prospective, comparative, non-experimental study was conducted. Ninety participants were divided into three groups namely Group A (thirty participants living with type II DM), Group B(i) (thirty participants living with type II DM and mild PAD) and Group B(ii) (thirty participants living with type II DM and severe PAD). Surface electrode sensors were placed according to SENIAM guidelines, on six lower limb muscles on both limbs, namely, rectus femoris, biceps femoris, tibialis anterior, medial head of gastrocnemius, peroneus longus and extensor hallucis longus. Muscle activity was recorded using a 16-channel Trigno™ Wireless System by Delsys®, where participants were instructed to walk at a self-selected speed on a 10-m walkway. This procedure was repeated at 5% and 10% above the step frequency using a digital metronome. The raw data was transferred to Delsys EMGworks® Analysis software to be processed and analysed. Averaged Burst RMS was used to analyse the amplitude (mV) and the duration of muscle activation (s) of each signal. Results: There was a significant increase in muscle amplitude and duration of activation in the presence of lower limb ischaemia during gait at a self-selected speed and at 5% and 10% above the baseline step frequency. The largest significant difference (p = < 0.05) in EMG amplitude and duration of activation when looking at the six muscles in general was found between participants living with Type II DM [Group A] and participants living with Type II DM and severe PAD [Group B(ii)]. No significant difference was found between baseline step frequency, 5% above the baseline step frequency (Speed 2) and 10% above the baseline step frequency (Speed 3) in the mean EMG muscle amplitude and duration of activation in all six muscles tested. Conclusion: The findings in this study show that there was an increase in muscle EMG amplitude and duration of activation in individuals living with PAD during gait. This indicates that there are musculoskeletal and biomechanical changes in the lower limb musculature with increasing severity of PAD. Higher muscle exertion demands are required during gait to produce the desired action which may result in earlier fatigue. Electromyographic tests in the clinical setting would be beneficial for detecting muscle dysfunction objectively and noninvasively, even during early stages of the disease, thus reducing the risk of lower limb complications associated with type II DM and PAD. Description: M.SC.CLINICAL BIOMECHANICS