title: Diabetic peripheral neuropathy compromises balance during daily activities.
abstract: OBJECTIVE
  Patients with diabetes with peripheral neuropathy have a well-recognized increased risk of falls that may result in hospitalization. Therefore this study aimed to assess balance during the dynamic daily activities of walking on level ground and stair negotiation, where falls are most likely to occur.
  
  
  METHODS
  Gait analysis during level walking and stair negotiation was performed in 22 patients with diabetic neuropathy (DPN), 39 patients with diabetes without neuropathy (D), and 28 nondiabetic control subjects (C) using a motion analysis system and embedded force plates in a staircase and level walkway. Balance was assessed by measuring the separation between the body center of mass and center of pressure during level walking, stair ascent, and stair descent.
  
  
  RESULTS
  DPN patients demonstrated greater (P < 0.05) maximum and range of separations of their center of mass from their center of pressure in the medial-lateral plane during stair descent, stair ascent, and level walking compared with the C group, as well as increased (P < 0.05) mean separation during level walking and stair ascent. The same group also demonstrated greater (P < 0.05) maximum anterior separations (toward the staircase) during stair ascent. No differences were observed in D patients.
  
  
  CONCLUSIONS
  Greater separations of the center of mass from the center of pressure present a greater challenge to balance. Therefore, the higher medial-lateral separations found in patients with DPN will require greater muscular demands to control upright posture. This may contribute to explaining why patients with DPN are more likely to fall, with the higher separations placing them at a higher risk of experiencing a sideways fall than nondiabetic control subjects.
authors.affiliation: School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, U.K. s.brown@mmu.ac.uk.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Brown
authors.affiliation: School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, U.K.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Handsaker
authors.affiliation: Faculty of Medical and Human Sciences, University of Manchester, Manchester, U.K.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Bowling
authors.affiliation: Faculty of Medical and Human Sciences, University of Manchester, Manchester, U.K.
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
authors.affiliation: School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, U.K.
authors.forename: Neil D
authors.initials: ND
authors.lastname: Reeves
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D016022:Case-Control Studies; D003929:Diabetic Neuropathies / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D016138:Walking / Q000502:physiology