Hypotheses explaining why diabetic neuropathy causes postural instability

Cedrick Bonnet
CESPA, University of Connecticut

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     Last modified: February 28, 2007

Abstract
Hypotheses explaining why diabetic neuropathy causes postural instability

Cedrick T. Bonnet1, Claudia Carello1, and Michael T. Turvey1


1 CESPA, University of Connecticut, USA.


Diabetes mellitus is a metabolic disorder that is considered to be epidemic in modern societies given the increase in the number of diabetic patients every year. Diabetes can lead to neuropathy (damage to sensory and motor nerves) with complications for the person?s physical and psychological life that also entail economic burdens for Health Care Systems. A notable complication, mentioned in the literature, is postural instability. An instable person can fall and have related complications and, perhaps most importantly, can loose their independence. There are now more than 30 research publications directed at the relation between postural control and diabetes since the first experimental investigation was conducted in 1982 (Mimori et al.). In those 25 years, all experiments have shown that diabetes per se is not the cause of instability. The question posed therefore is what factors lead to instability in neuropathy is/are? Hypotheses ? whether already tested or only evoked in the literature ? are discussed in this poster.
Symmetrical (left-right) peripheral sensory neuropathy has been proposed to be the cause of instability. This hypothesis, in fact, comprises three component hypotheses, all of which are evaluated. Is the neuropathy only symmetrical is, only peripheral (i.e. not affecting the central nervous system), or only sensory (i.e. not involving the motor system)? Additional hypotheses are also considered, along with their supportive arguments: electrophysiological (e.g., different dysfunctions at the nerve conduction level), perceptual (e.g., detection of vibration or motion at the peripheral level), information processing (changes in the information and/or postural strategy used for postural control), biomechanical (the consequences of neuropathy for the dynamics of postural motion), and autonomic (issues at the heart rate level). We further consider methodological problems or confounding variables that might also explain why amplification of postural sway is symptomatic of diabetic patients with neuropathy. Finally, the ecological approach to perception-action is discussed. This framework has not yet been brought to bear, experimentally or theoretically, on this particular instance of impaired postural control. Suggestions are offered for how this approach might be applied to the results already found in the literature.

References

Mimori, Y., Nakanyra, S., Kameyama, M., Sako, Y, Yamao, S., & Miyoshi, T. (1982). Statokinesigram of patients with diabetic neuropathy. In G. Y. Horiuchi & A. Kogurek (Eds.), Diabetic neuropathy: Proceedings of the international symposium in diabetic neuropathy (pp. 168-172). New York, Excerpta Medica.

***Acknowledgements. This research is supported by the Provost grant.***