interventions improve gait in peripheral neuropathy

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From Journal of American Geriatric Society. 2004 Apr;52(4):510-5.

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Interventions improve gait regularity in patients with peripheral

neuropathy while walking on an irregular surface under low light.

JK, Thies SB, DeMott TK, Ashton- JA.

Department of Physical Medicine and Rehabilitation, University of

Michigan, Ann Arbor, Michigan.

Objectives: To determine which, if any, of three inexpensive

interventions improve gait regularity in patients with peripheral

neuropathy (PN) while walking on an irregular surface under low-light

conditions.

Design: Observational.

Setting: University of Michigan Biomechanics Research Laboratory.

Participants: Forty-two patients with PN (20 women), mean age+/-standard

deviation=64.5+/-9.7.

Interventions: A straight cane, touch of a vertical surface, or

semirigid ankle orthoses.

Measurements: Step-width variability and range, step-time variability,

and speed.

Results: Subjects demonstrated significantly less step-width variability

(mean=41.0+/-1.5, 36.9+/-1.6, 37.2+/-1.3, and 35.9+/-1.5 mm for

baseline, cane, orthoses, and vertical surface, respectively; P<.0001)

and range (182.7+/-7.4, 163.7+/-8.3, 164.3+/-7.4, 154.3+/-6.9 mm for

baseline, cane, orthoses and vertical surface, respectively; P=.0006)

with each of the interventions than under baseline conditions. Step-time

variability significantly decreased with use of the orthoses and

vertical surface but not the cane (P=.0001). Use of a cane, but not

orthoses or vertical surface, was associated with decreased speed

(0.79+/-0.03, 0.73+/-0.03, 0.79+/-0.03, 0.80+/-0.03 m/s for baseline,

cane, orthoses, and vertical surface, respectively; P=.0001).

Conclusion: Older patients with PN demonstrate improved spatial and

temporal measures of gait regularity with the use of a cane, ankle

orthoses, or touch of a vertical surface while walking under challenging

conditions. The decreased speed and stigma associated with the cane and

uncertain availability of a vertical surface suggest that the ankle

orthoses may be the most practical intervention.