Postural Control with and without Secondary Tasks during Stair Ascent in Older Adults with Type two Diabetes

Abstract

Background: Community-dwelling older adults rate ascending and descending stairs among the top five most difficult daily tasks, likely a result of bodily deterioration due to normal aging. Type 2 diabetes mellitus (DM2) is a chronic prevalent condition and when combined with the normal aging process results in more significant deterioration throughout the sensorimotor and musculoskeletal systems, significantly affecting balance control. The purpose of this study was to investigate postural control differences during stair ascent between people with DM2 and an age-matched control group under three conditions: without additional challenge, with a cognitive challenge, and with a motor challenge, and to investigate which measure of centre of mass (CoM) –body or trunk– is more sensitive to changes in postural control during stair ascent. Methods: Fifteen older adults (¬≥ 65 years) with DM2 and fifteen healthy age-matched controls were recruited. Data were collected by an OPTOTRAK motion capture system as participants climbed a four-step staircase without hand support at a self-selected pace. Cognitive and motor tasks were added to assess their ability to multitask. The cognitive task involved serial subtraction by three’s and the motor task involved carrying an empty laundry basket. Outcome measures included: body and trunk measures of CoM (RMS, RMS velocity, and peak-to-peak displacement), RMS of centre of pressure, head and trunk stiffening, and gait velocity. Results: In both groups, gait velocity during stair ascent decreased during the basket and cognitive conditions when compared to the control condition. The trunk peak-to-peak CoM measure was more sensitive than the body CoM to changes measure under the cognitive condition, with no between-group differences identified. Conclusion: The ability of individuals with and without DM2 to maintain postural control during stair ascent with the addition of the secondary task may be attributed to a slower gait velocity. When a cognitive task was added to stair ascent, the measure of trunk CoM displacement was more sensitive to changes when compared to the measure of body CoM displacement, indicating that individuals with DM2 did not change their use of postural control strategies when compared to the healthy control participants.