Sensorimotor integration processing in Diabetic Retinopathy and Diabetic Peripheral Neuropathy

This study evaluated the direct link between visual perception and related motor output responses during an optic flow stimulation which induced a perception of forward movement, and during a driving task using a simulator. The experiments focussed on the evaluation of two different complications of diabetes, diabetic retinopathy and diabetic peripheral neuropathy (DPN), in order to evaluate the different contributions of both central and peripheral nervous factors in affecting the sensorimotor integration process in diabetes. Study I. The aim was to assess how optic flow processing contributes to the control of posture and whether it requires the predominant activation of cortical networks involved in motion perception or the intervention of subcortical loops. People with retinopathy and people who had undergone laser treatment showed a higher postural instability compared to control subjects. Differing retinal functionality produced different postural strategies. Based on these findings, postural control seems to be a process dependent on perceptual analysis via feed-forward cortical circuits. Study II. The aim was to assess whether diabetes was associated with alterations of visual gaze behaviour and/or neuromuscular impairment that might adversely affect driving performance. The potential for impaired driving performance with diabetes seems to be represented by diminished eye-steering coordination. While proprioception function seems to indicate the potential for improvement, a slower production of strength in the plantar flexor muscles seems not to influence accelerator pedal control during a driving simulation task in people with diabetes (with and without diabetic peripheral neuropathy). These results confirm the role of visual perception and eye movements in guiding human movements during dailylife activities. In particular, we demonstrated the detrimental effects of diabetes and the different contribution of diabetic retinopathy and diabetic peripheral neuropathy in affecting both central and peripheral components of the sensorimotor integration process.