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Postural Threat and Balance Control in Diabetic Neuropathy: Evidence from Anticipatory Postural Adjustments
Shirin Rahimzadeh1, Amin Behdarvandan1,2, Mehrnoosh Zakerkish3,4
1Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Background:
Postural threat can influence both emotional and motor responses, particularly in individuals with diabetic peripheral neuropathy (DPN), who exhibit impaired balance and increased fall risk. This study examined the effects of postural threat on anticipatory postural adjustments (APAs) and anxiety in people with DPN compared with healthy controls.
Methods:
This quasi-experimental study included twenty-five participants with DPN and twenty-five healthy controls. All participants completed the rise-on-toes task under two conditions: threat and no-threat. Center of pressure (COP) and electromyographic (EMG) signals were collected using a force platform and wireless EMG system. Anxiety was measured before and during each condition. Nonparametric Mann-Whitney and Wilcoxon tests with false discovery rate (FDR) correction were used, and effect sizes ® were calculated for significant comparisons.
Results:
Individuals with DPN showed greater anxiety P<0.001, r=0.75) and delayed APA onset (P<0.001, r=0.62) compared with healthy controls. Both groups exhibited higher anxiety and larger, faster COP and EMG responses under threat (P<0.001, r=0.50-0.70), but the magnitude of these adjustments was smaller in the DPN group.
Conclusion:
Postural threat increased emotional arousal and APA magnitude in both groups, though individuals with DPN demonstrated attenuated adaptive modulation. These findings suggest that incorporating psychological and sensorimotor balance training may enhance stability and reduce fall risk in this population.
