Head and Trunk Control While Walking in Older Adults with Diabetes: Effects of Balance Confidence

Investigations of gait in older adults with diabetes mellitus (DM) have been primarily focused on lower limb biomechanical parameters. Yet, the upper body accounts for two thirds of the body's mass, and head and trunk control are critical for balance. The authors examined head and trunk control during self-selected comfortable, fast, and dual-task walking and the relationship between balance confidence and potential head-trunk stiffening strategies in older adults with DM without diagnosed diabetic peripheral neuropathy (DPN). Twelve older adults with DM without diagnosed DPN (DM group) and 12 without DM (no-DM group) were recruited. Walking speed, peak-to-peak head and trunk roll displacement, head and trunk roll velocity, and head-trunk correlation were measured while walking at a self-selected comfortable or fastest possible speed with or without a secondary cognitive task. The Activities-specific Balance Confidence scale measured balance confidence. Subtle group differences in axial segmental control (lower trunk roll velocity; higher head-trunk correlation) were apparent in older adults with DM even in the absence of DPN. Balance confidence was 19% lower in the DM group than in the no-DM group, and partially explained (34%) the group difference in head-trunk stiffening. These results emphasize the need for proactive monitoring of postural control and balance confidence before the onset of DPN.