Made available in DSpace on 2014-06-11T19:22:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-11-13Bitstream added on 2014-06-13T18:08:38Z : No. of bitstreams: 1 camargo_mr_me_prud.pdf: 1247007 bytes, checksum: e62a69e293f9af935953a6b7044c49bb (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O Diabetes mellitus é uma enfermidade crônica que leva a alterações sensitivas e motoras. Tais alterações comprometem o equilíbrio e a deambulação predispondo seus portadores à ocorrência de quedas. Esta revisão teve por objetivo levantar, na literatura recente, estudos que visassem avaliar parâmetros da marcha e aspectos envolvidos com a deambulação. Para isso, foi realizada uma busca nas bases de dados MEDLINE, SciELO, LILACS e PEDro, cruzando as palavras-chaves: Neuropatias Diabéticas x Marcha; Diabetes Mellitus x Marcha e Pé Diabético x Marcha. Após passarem pelos critérios de seleção, foram obtidos 15 artigos, os quais foram sintetizados e discutidos, sendo, portanto, incluídos nesta revisão. Ficou claro que a neuropatia diabética leva a déficits na amplitude do passo, velocidade e cadência da marcha em superfícies planas, sem mudanças bruscas de direção ou paradas, e, déficits de equilíbrio e coordenação em aclives, declives e terrenos irregulares. Acarreta, também, aumento dos índices de pressão plantar e, devido à alteração de ativação do tríceps sural, dificuldade na fase de apoio terminal e prébalanço. Assim, o próximo contato inicial ocorrerá de maneira inadequada, com o antepé e sem absorção de choques. / Diabetes mellitus is a chronic disease that leads to sensory-motor changes. These changes affect balance and walking predisposing their patients to falls occurrence. This review aimed to investigate, in recent literature, assessing gait parameters and walking studies involved aspects. For this, a search was conducted in databases MEDLINE, SciELO, LILACS and PEDro, crossing the keywords: Diabetic neuropathies x Gait; Diabetes Mellitus x Gait and Diabetic Foot x Gait. After passing by selection criteria, it was remainder 15 articles, which were synthesized, discussed and is therefore included in this review. It was clear that diabetic neuropathy leads to deficits in the step amplitude, gait velocity and gait cadence on flat surfaces, without sudden changes of direction or stops, and balance and coordination deficits in slopes and uneven terrain. Diabetic neuropathies, provide, also increase plantar pressure rates due to the triceps sural activation change, difficulty in the terminal phase of support and pre-assessment. Thus, the next initial contact occurs in an inadequate way, with the forefoot and without absorption of shocks.

Orientador: Cristina Elena Prado Teles Fregonesi / Banca: Claudia Regina Sgobbi de Faria / Banca: José Angelo Barela / Resumo: O Diabetes mellitus é uma enfermidade crônica que leva a alterações sensitivas e motoras. Tais alterações comprometem o equilíbrio e a deambulação predispondo seus portadores à ocorrência de quedas. Esta revisão teve por objetivo levantar, na literatura recente, estudos que visassem avaliar parâmetros da marcha e aspectos envolvidos com a deambulação. Para isso, foi realizada uma busca nas bases de dados MEDLINE, SciELO, LILACS e PEDro, cruzando as palavras-chaves: Neuropatias Diabéticas x Marcha; Diabetes Mellitus x Marcha e Pé Diabético x Marcha. Após passarem pelos critérios de seleção, foram obtidos 15 artigos, os quais foram sintetizados e discutidos, sendo, portanto, incluídos nesta revisão. Ficou claro que a neuropatia diabética leva a déficits na amplitude do passo, velocidade e cadência da marcha em superfícies planas, sem mudanças bruscas de direção ou paradas, e, déficits de equilíbrio e coordenação em aclives, declives e terrenos irregulares. Acarreta, também, aumento dos índices de pressão plantar e, devido à alteração de ativação do tríceps sural, dificuldade na fase de apoio terminal e prébalanço. Assim, o próximo contato inicial ocorrerá de maneira inadequada, com o antepé e sem absorção de choques. / Abstract: Diabetes mellitus is a chronic disease that leads to sensory-motor changes. These changes affect balance and walking predisposing their patients to falls occurrence. This review aimed to investigate, in recent literature, assessing gait parameters and walking studies involved aspects. For this, a search was conducted in databases MEDLINE, SciELO, LILACS and PEDro, crossing the keywords: Diabetic neuropathies x Gait; Diabetes Mellitus x Gait and Diabetic Foot x Gait. After passing by selection criteria, it was remainder 15 articles, which were synthesized, discussed and is therefore included in this review. It was clear that diabetic neuropathy leads to deficits in the step amplitude, gait velocity and gait cadence on flat surfaces, without sudden changes of direction or stops, and balance and coordination deficits in slopes and uneven terrain. Diabetic neuropathies, provide, also increase plantar pressure rates due to the triceps sural activation change, difficulty in the terminal phase of support and pre-assessment. Thus, the next initial contact occurs in an inadequate way, with the forefoot and without absorption of shocks. / Mestre

Background: Diabetic foot neuropathy (DFN) is one of the most important complications of diabetes mellitus; its early diagnosis and intervention can prevent foot ulcers and the need for amputation. Thermometry, measuring the temperature of the feet, is a promising emerging modality for diabetic foot ulcer prevention. However, patient compliance with at-home monitoring is concerning. Delivering messages to remind patients to perform thermometry and foot care might be helpful to guarantee regular foot monitoring. This trial was designed to compare the incidence of diabetic foot ulcers (DFUs) between participants who receive thermometry alone and those who receive thermometry as well as mHealth (SMS and voice messaging) over a year-long study period. Methods/design: This is an evaluator-blinded, randomized, 12-month trial. Individuals with a diagnosis of type 2 diabetes mellitus, aged between 18-80 years, having a present dorsalis pedis pulse in both feet, are in risk group 2 or 3 using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Foot), have an operating cell phone or a caregiver with an operating cell phone, and have the ability to provide informed consent will be eligible to participate in the study. Recruitment will be performed in diabetes outpatient clinics at two Ministry of Health tertiary hospitals in Lima, Peru. Interventions: participants in both groups will receive education about foot care at the beginning of the study and they will be provided with a thermometry device (TempStat (TM)). TempStat (TM) is a tool that captures a thermal image of the feet, which, depending on the temperature of the feet, shows different colors. In this study, if a participant notes a single yellow image or variance between one foot and the contralateral foot, they will be prompted to notify a nurse to evaluate their activity within the previous 2 weeks and make appropriate recommendations. In addition to thermometry, participants in the intervention arm will receive an mHealth component in the form of SMS and voice messages as reminders to use the thermometry device, and instructions to promote foot care. Outcomes: the primary outcome is foot ulceration, evaluated by a trained nurse, occurring at any point during the study. Discussion: This study has two principal contributions towards the prevention of DFU. First, the introduction of messages to promote self-management of diabetes foot care as well as using reminders as a strategy to improve adherence to daily home-based measurements. Secondly, the implementation of a thermometry-based strategy complemented by SMS and voice messages in an LMIC setting, with wider implications for scalability.

published_or_final_version / abstract / Anatomy / Doctoral / Doctor of Philosophy

Thesis (M. Phil.)--University of Hong Kong, 2006. / Title proper from title frame. Also available in printed format.

Mode of access: World Wide Web. / Thesis (Ph. D.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references (leaves 116-154). / Electronic reproduction. / Also available by subscription via World Wide Web / xvii, 157 leaves, bound ill. 29 cm

Thesis (M.S.)--Indiana University, 2006. / Includes bibliographical references. Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.S.)--Indiana University, 2006. / Includes bibliographical references.

Includes bibliographical references and index.

Orientador: Cristina Elena Prado Teles Fregonesi / Banca: Dalva Minonroze Albuquerque Ferreira / Banca: Marli Aparecida Defani / Resumo: O objetivo do estudo foi verificar a estabilidade do ato de locomoção em diabéticos com neuropatia periférica, em três situações: marcha habitual com os olhos abertos; marcha com os olhos fechados e marcha com olhos abertos e diminuição da base de sustentação. Participaram do estudo 41 indivíduos, sendo 18 do grupo neuropata e 23 do grupo controle (GC). A avaliação da estabilidade foi realizada por meio de um baropodômetro associado ao software Footwalk Pro. Os dados obtidos foram: velocidade da marcha e porcentagens de tempo de duplo apoio e de apoio simples. Foram encontradas diferenças significantes nas três situações entre os grupos para a velocidade e tempo de apoio simples, com diminuição para o grupo neuropata (p<0,05), e tempo de duplo apoio, com aumento para esse grupo (p<0,05) em todas as condições. Para os dados de velocidade, tempo de duplo apoio e tempo de apoio simples, a condição de olho aberto foi diferente da condição de olho fechado (p=0,001) e da condição com diminuição da base de sustentação (p=0,001). Foi possível observar que nas três situações avaliadas, o grupo neuropata apresentou déficit na estabilidade do ato de locomoção e tal desempenho foi ainda mais comprometido nas duas situações que exigiam mais do controle postural. Tais modificações da marcha, decorrentes da complexidade imposta pelas diferentes condições, sugerem a inserção destas na avaliação e no tratamento dessa população / Abstract: The aim of this study was to verify the stability of the act of locomotion in diabetics with peripheral neuropathy in three situations: habitual gait with eyes opened, gait with eyes closed, and gait with eyes opened and reduced base of support. The study included 41 subjects: 18 of the neuropathic group and 23 in the control group. The stability was evaluated by baropodometry platform associated with the software Footwalk Pro. Data were obtained: gait speed and percentual of double stance time and single stance time. Significant differences were found in the three cases between the groups in the data of gait speed and single stance time, with a larger reduction for neuropathic group (p<0,05) and increased in double stance time in the neuropathic group (p<0,05) in all conditions. For data of gait speed measure, double stance time and single stance time, the condition eyes opened was different from eyes closed (p=0,001) and from the condition with reduced base of support (p=0,001). It was observed that in the three situations evaluated, the neuropathic group showed stability locomotion deficit and the performance was more injured in both situations that required more postural control. Such gait modifications, due to the complexity imposed by different conditions, suggest the inclusion of these in the evaluation and treatment of this population / Mestre