Interventions Improve Gait Regularity in Patients with Peripheral Neuropathy While Walking on an Irregular Surface Under Low Light

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Abstract
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