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Gait alterations in the UAE population with and without diabetic complications using both traditional and entropy measures
±Û¾´ÀÌ : °ü¸®ÀÚ ³¯Â¥ : 2017-09-18 (¿ù) 18:02 Á¶È¸ : 1984
Á¶Èñ°æ_Gait alterations in the UAE population with and without diabetic complications using both traditional and entropy measures.pdf (440.4K), Down : 0, 2017-09-18 18:02:07

<Gait alterations in the UAE population with and without diabetic complications using both traditional and entropy measures>

 

Kinda Khalaf, Haitham M. Al-Angari, Ahsan H. Khandoker, Sungmun Lee, Wael Almahmeed, Habiba S. Al Safar, Herbert F. Jelinek

Gait & Posture 58 (2017) 7277

1. Introduction

´ç´¢º´ ȯÀÚµéÀÇ ¼Õ»óµÈ º¸ÇàÀº ´Ù¸éÀûÀ̸ç, ÀüÇüÀûÀ¸·Î central nervous system dysfunction »Ó¸¸ ¾Æ´Ï¶ó sensory impairment, lower-extremity strength, mobility, fore-producing capacityÀÇ °¨¼ÒÀÇ º¹ÇÕ »óÈ£ ÀÛ¿ëÀ¸·Î ±âÀÎÇÏ´Ù. ´ç´¢º´°ú °ü·ÃµÈ º¸Çà º¯È­¿¡ °üÇÑ ¹®ÇåÀº dzºÎÇÏÁö¸¸, ´Ù¾çÇÑ Á¾·ùÀÇ neuropathy¿Í °ü·ÃÇÏ¿© µ¿Àû º¸Çà º¯È­ÀÇ ¿ªÇÒ°ú Á¤µµ¸¦ ¼ö·®È­ÇÏ´Â °ÍÀº ¿©ÀüÈ÷ ºÒºÐ¸íÇÏ´Ù. ÀÓ»óÀû °üÁ¡¿¡¼­ º¼ ¶§, ¹ß ±Ë¾çÀÇ À§Ç輺ÀÌ ÀÖ´Â ´ç´¢º´ ȯÀÚÀÇ ÀϹÝÀûÀÎ ÀÓ»ó Æò°¡´Â ÇöÀç ½Ã°¢Àû Æò°¡¸¦ ±â¹ÝÀ¸·Î Çϸç, Á¤·®È­µÈ biomechanical-based ÆĶó¹ÌÅÍ¿¡´Â ÀÇÁ¸ÇÏÁö ¾Ê°í ÀÖ´Ù.

Àΰ£ÀÇ º¸ÇàÀº º¹ÀâÇϸç, ÀϹÝÀûÀ¸·Î nonlinearity, non-stationarity, asymmetry, & multiscale variabilityÇÏ´Ù. Nonlinear dynamics ºÐ¾ß¿¡¼­ entropy´Â irregularity¸¦ Á¤·®È­ÇÏ´Â ÃøÁ¤ ½Ã½ºÅÛÀÌ´Ù. ½ÅÈ£°¡ ´õ ¿¹Ãø °¡´ÉÇÒ¼ö·Ï entropy °ªÀÌ ³·¾ÆÁø´Ù. Á¤»óÀûÀÎ »ýü ½ÅÈ£´Â ³ôÀº entropy °ªÀ» º¸¿© ÁÖ¸ç, ÀÌ´Â complexity¿Í unpredictability¸¦ ÀǹÌÇÑ´Ù.

º» ¿¬±¸ÀÇ ¸ñÀûÀº °í½ÄÀûÀÎ º¸Çà ÃøÁ¤ (gait speed, step length & width, peak plantar pressure (PPP) magnitude & location)À» »ç¿ëÇÒ »Ó¸¸ ¾Æ´Ï¶ó nonlinear dynamic measureÀÎ SamEn (hereafter, Gait entropy: GaitEn)¸¦ »ç¿ëÇÏ¿© ´Ù¾çÇÑ À¯ÇüÀÇ ´ç´¢ ÇÕº´Áõ(diabetic peripheral neuropathy(DPN), nephropathy, & retinopathy)°ú °ü·ÃÇÏ¿© º¸ÇàÀÇ º¯È­¸¦ ¿¬±¸ÇÏ°íÀÚ ÇÏ¿´´Ù.

2. Material and Methods

2.1. Subjects

< Inclusion criteria >

-18¼¼ ÀÌ»óÀÇ ´ç´¢ ÇÕº´ÁõÀÌ Àְųª ¾ø´Â ´ç´¢º´ ȯÀÚ

-º¸Çà °¡´ÉÇÑ »ç¶÷

-±Ë¾çÀÇ º´·ÂÀÌ ¾ø°í, ÇöÀç ±Ë¾çÀÌ ¾ø´Â »ç¶÷

-Á¤Çü¿Ü°úÀû ¹®Á¦, ÇÏÁö ¼ö¼ú ¹× ½ÉÇ÷°ü ÁúȯÀÇ º´·ÂÀÌ ¾ø´Â »ç¶÷

-ÃÑ211¸í (¿©¼º 136¸í, ³²¼º 75¸í)

 

8°³ÀÇ ±ºÀ¸·Î ºÐ·ù

1) ALL-C group: retinopathy+nephropathy+DPN

2) RNp: retinopathy+nephropathy

3) NNp: DPN+ nephropathy

4) RN : retinopathy+DPN

5) DPN: DPN

6) R: retinopathy

7) Np: nephropathy

8) control group (CONT): none of the three complications

 

2.2. Data collection and processing

- ȯÀÚµéÀº gait assessment system (Walkway, Tekscan Inc., MA)¿¡¼­ Á¤»óÀûÀÎ ¼Óµµ·Î µÎ Â÷·Ê °É¾ú´Ù.

- Walkway ½Ã½ºÅÛÀº ÃÊ´ç 30 ÇÁ·¹ÀÓ ¼Óµµ·Î step´ç plantar pressureÀÇ °ø°£Àû ºÐÆ÷¸¦ º¸¿©ÁÖ¾ú´Ù.

- heel°ú forefootÀÇ PPPÀÇ Å©±â¿Í Ç¥ÁØÈ­µÈ (x, y) À§Ä¡¸¦ ÃßÃâÇϱâ À§ÇÏ¿© ³»ºÎ Matlab code¸¦ »ç¿ëÇÏ¿´´Ù.


2.3. Gait computation

Gait cycleÀÇ stance phase µ¿¾ÈÀÇ ¿À¸¥¹ß°ú ¿Þ¹ßÀÇ pressure wave formÀ» ºÐ¸®ÇÏ°í ¸ð¾Æ ¿¬¼Ó ÆÄÇüÀ» Çü¼ºÇϵµ·Ï ±¸¼ºÇÏ¿´´Ù. ¿À¸¥ÂÊ°ú ¿ÞÂÊ waveform °£ÀÇ GaitEn Â÷ÀÌ¿¡ ´ëÇÏ¿© °è»êµÇ¾ú´Ù.






3. Results

- PPP in the heel region: CONT ±×·ì¿¡¼­ DPN ±×·ì°ú ºñ±³ ½Ã À¯ÀÇÇÏ°Ô Áõ°¡ÇÔ.

- PPP in the forefoot region: CONT ±×·ì°ú DPN ±×·ì°£ À¯ÀÇÇÑ Â÷ÀÌ ¾øÀ½.

- Gait velocity: CONT ±×·ì¿¡¼­ Np¸¦ Á¦¿ÜÇÑ ´Ù¸¥ ¸ðµç ±×·ì°ú ºñ±³ ½Ã À¯ÀÇÇÏ°Ô Áõ°¡ÇÔ.

- Step length: CONT ±×·ì¿¡¼­ NNp & Np¸¦ Á¦¿ÜÇÑ ´Ù¸¥ ¸ðµç ±×·ì¿¡¼­ À¯ÀÇÇÏ°Ô Áõ°¡ÇÔ.

- Step width: CONT ±×·ì°ú ´Ù¸¥ ±×·ì°£ À¯ÀÇÇÑ Â÷ÀÌ ¾øÀ½.

- GaitEn: DPN ±×·ì¿¡¼­ CONT ±×·ì°ú ºñ±³ ½Ã À¯ÀÇÇÏ°Ô °¨¼Ò. neuropathy¿Í retinopathy ¶Ç´Â nephropathy°¡ µ¿¹ÝµÉ ¶§¿¡µµ °¨¼ÒµÈ gait entropy °üÂûµÊ.

- Correlation analysis: CONT ±×·ì¿¡¼­ forefoot¿¡¼­ÀÇ PPP¿Í gait velocity¿Í step length »çÀÌÀÇ À¯ÀÇÇÑ »ó°ü°ü°è °üÂûµÊ. ÇÏÁö¸¸ ÇÕº´ÁõÀÌ ÀÖ´Â ´Ù¸¥ ¸ðµç ±×·ì¿¡¼­´Â À¯ÀÇÇÑ »ó°ü°ü°è °üÂûµÇÁö ¾ÊÀ½. ±× ¾î¶² ȯÀÚ ±×·ì¿¡¼­µµ GaitEn°ú spatiotemporal ÆĶó¹ÌÅÍ »çÀÌ¿¡ À¯ÀÇÇÑ »ó°ü°ü°è´Â °üÂûµÇÁö ¾ÊÀ½.

 

4. Conclusion

- º» ¿¬±¸´Â ÀÓ»óÀûÀ¸·Î °¨ÁöÇÒ ¼ö ÀÖ´Â neuropathy¿Í ´ç´¢ ÇÕº´Áõ ¹ßº´ Àü º¸Çà ÀÌ»ó ¡ÈÄÀÇ À§Ç輺À» ¿¹ÃøÇÒ ¼ö ÀÖ´Â biomechanical marker¸¦ ÅëÇÏ¿© ´ç´¢ ÇÕº´ÁõÀÌ º¸Çà¿¡ ¿µÇâÀ» ¹ÌÄ¡´Â ¿µÇâ¿¡ ´ëÇÏ¿© ¿¬±¸Çß´Ù.

- Spatiotemporal º¸Çà ÆĶó¹ÌÅÍÀÇ ¾çÀû °¨¼Ò´Â proprioceptive ½Ã½ºÅÛÀÇ º¸»ó ¸ÞÄ¿´ÏÁò ÀûÀÀ¿¡ µû¸¥ Á¶½É½º·¯¿î º¸Çà ÆÐÅÏÀ» ¹Ý¿µÇÑ´Ù. Áï, º¸Çà º¯È­´Â ¸»ÃÊ °¨°¢ Á¤º¸ÀÇ °¨¼Ò¿Í ÁßÃß ½Å°æ°è·ÎÀÇ È®Àå ¶§¹®¸¸ÀÌ ¾Æ´Ï¶ó º¸Çà complexity¸¦ ±ÔÁ¦ÇÏ°í Á¶ÀýÇϱâ À§ÇÏ¿© attention ¿ä±¸µµÀÇ Áõ°¡ ¶§¹®ÀÎ °ÍÀÌ´Ù.

- ´Ù¸¥ ±×·ì°ú ºñ±³ÇÏ¿© CONT±×·ìÀÇ GaitEnÀÇ ³ôÀº °ªÀº Á¤»óÀûÀÎ º¸Çà Áֱ⠵¿¾È ¹ß¹Ù´Ú ¾Ð·Â¿¡ ´õ ¸¹Àº ºÒ±ÔÄ¢¼ºÀÌ ÀÖÀ½À» ³ªÅ¸³½´Ù. »Ó¸¸ ¾Æ´Ï¶ó, º» ¿¬±¸¿¡¼­ GaitEn ÃøÁ¤ÀÌ ´Ù¸¥ spatiotemporal ÆĶó¹ÌÅÍ¿Í ÀüÇô »ó°ü°ü°è¸¦ º¸ÀÌÁö ¾Ê¾Ò´Âµ¥ ÀÌ´Â GaitEn´Â ´ç´¢ ÇÕº´ÁõÀ¸·Î ÀÎÇÑ º¸ÇàÀ» Á¶ÀýÇϱâ À§ÇÑ ½Å°æ°èÀÇ ³»ÀçÀû ÀûÀÀÀ» Ç¥ÇöÇÒ ¼ö ÀÖ´Ù°í ¸»ÇÒ ¼ö ÀÖ´Ù.


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