RESUMO
There have been several research studies on efficient methods for analysis and classification of electromyography (EMG) signals and adoption of wavelet functions, which is a promising approach for determining the spectral distribution of the signal. This study compares distinct time-frequency analysis methods for investigating the EMG activity of the thigh and calf muscles during gait among non-diabetic subjects and diabetic neuropathic patients. It also attempts to verify, by adaptive optimal kernel and discrete wavelet transform, whether there are EMG alterations related to diabetic neuropathy in the lower limb muscles during gait. The results show that diabetics might not keep up with the mechanical demands of walking by changing muscle fibre recruitment strategies, as seen in the control group. Moreover, principal components analysis indicates more alterations in diabetic motor strategies, and we identify that diabetic subjects need other strategies with different muscle energy production and frequencies to carry out their daily activities.
Assuntos
Neuropatias Diabéticas/fisiopatologia , Marcha/fisiologia , Processamento de Sinais Assistido por Computador , Fenômenos Biomecânicos/fisiologia , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Análise de Componente PrincipalRESUMO
The aim was to investigate inter-tester and intra-tester reliability and parallel reliability between a visual assessment method and a method using a pachymeter for locating the mid-point of the patella in determining the medial/lateral patella orientation. Fifteen asymptomatic subjects were assessed and the mid-point of the patella was determined by both methods on two separate occasions two weeks apart. Inter-tester reliability was obtained by ANOVA and by intraclass correlation coefficient (ICC); intra-tester reliability was obtained by a paired t-test and ICC; and parallel reliability was obtained by Pearson's Correlation and ICC, for the measurement on the first and second evaluations. There was acceptable inter-tester agreement (p=0.490) and reliability for the visual inspection (ICC=0.747) and for the pachymeter (ICC=0.716) at the second evaluation. The inter-tester reliability in the first evaluation was unacceptable (visual ICC=0.604; pachymeter ICC=0.612). Although there was statistical similarity between measurements for the first and second evaluations for all testers, intra-tester reliability was not acceptable for both methods: visual (examiner 1 ICC=0.175; examiner 2 ICC=0.189; examiner 3 ICC=0.155) and pachymeter (examiner 1 ICC=0.214; examiner 2 ICC=0.246; examiner 3 ICC=0.069). Parallel reliability gave a perfect correlation at the first evaluation (r=0.828; p<0.001) and at the second (r=0.756; p<0.001) and reliability was between acceptable and very good (ICC=[0.748-0.813]). Both visual and pachymeter methods provide reliable and similar medial/lateral patella orientation and are reliable between different examiners, but the results between the two assessments at 2 weeks' interval demonstrated an unacceptable reliability.
Assuntos
Antropometria/métodos , Equipamentos e Provisões/estatística & dados numéricos , Articulação do Joelho/anatomia & histologia , Patela/anatomia & histologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Especialidade de Fisioterapia/métodos , Reprodutibilidade dos Testes , Adulto JovemRESUMO
BACKGROUND: The purpose of this study was to investigate the ankle range of motion during neuropathic gait and its influence on plantar pressure distribution in two phases during stance: at heel-strike and at push-off. METHODS: Thirty-one adults participated in this study (control group, n=16; diabetic neuropathic group, n=15). Dynamic ankle range of motion (electrogoniometer) and plantar pressures (PEDAR-X system) were acquired synchronously during walking. Plantar pressures were evaluated at rearfoot, midfoot and forefoot during the two phases of stance. General linear model repeated measures analysis of variance was applied to investigate relationships between groups, areas and stance phases. FINDINGS: Diabetic neuropathy patients walked using a smaller ankle range of motion in stance phase and smaller ankle flexion at heel-strike (P=0.0005). Peak pressure and pressure-time integral values were higher in the diabetic group in the midfoot at push-off phase when compared to heel-strike phase. On the other hand, the control group showed similar values of peak pressure in midfoot during both stance phases. INTERPRETATION: The ankle mobility reduction observed could be associated to altered plantar pressure distribution observed in neuropathic subjects. Results demonstrated that midfoot and forefoot play a different role in subjects with neuropathy by receiving higher loads at push-off phase that are probably due to smaller ankle flexion at stance phase. This may explain the higher loads in anterior areas of the foot observed in diabetic neuropathy subjects and confirm an inadequate foot rollover associated to the smaller ankle range of motion at the heel-strike phase.