Trina K. DeMott

Falls and gait characteristics among older persons with peripheral neuropathy

DeMott TK, Richardson JK, Thies SB, Ashton-Miller JA: Falls and gait characteristics among older persons with peripheral neuropathy. Am J Phys Med Rehabil 2007;86:125–132. Objective:To prospectively determine the frequency and circumstances of falls in older persons with peripheral neuropathy and to identify gait characteristics on smooth and irregular surfaces associated with falls in this same population. Design:This was a descriptive and observational study of a prospective group cohort. Spatial and temporal gait measures on smooth and irregular surfaces, as well as basic demographic and clinical data, were obtained in 20 older persons with peripheral neuropathy. Falls and fall-related injuries were then prospectively determined for 1 yr. Results:Thirteen of 20 (65%) subjects fell, and 6 of 20 (30%) subjects sustained a fall-related injury during the year of observation. Of the 76 reported falls, 69 (90.8%) were associated with a surface abnormality (irregular or slick). Gait measures on the smooth surface did not distinguish between fall groups. On the irregular surface, however, step-time variability tended to be higher for those subjects who fell than for those who did not (89 ± 29 vs. 64 ± 26 msecs, respectively; P = 0.077) and for those who were injured from a fall compared with those who were not injured (101 ± 21 vs. 71 ± 29 msecs, respectively; P = 0.038). Conclusions:Older patients with peripheral neuropathy have a high rate of falls, and these falls are often associated with walking on irregular surfaces. Gait analysis on an irregular surface may be superior to that on a smooth surface for detecting fall risk in this patient population.

A Comparison of Gait Characteristics Between Older Women with and Without Peripheral Neuropathy in Standard and Challenging Environments

Objectives: To compare gait patterns in older women with and without peripheral neuropathy (PN) in standard (smooth surface, normal lighting) and challenging environments (CE) (irregular surface, low lighting).

Interventions improve gait regularity in patients with peripheral neuropathy while walking on an irregular surface under low light

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.

A comparison of gait characteristics between older women with and without peripheral neuropathy on smooth and unlevel surfaces

Objectives: To compare gait patterns in older women with and without peripheral neuropathy (PN) in standard (smooth surface, normal lighting) and challenging environments (CE) (irregular surface, low lighting).

Hip strength: Ankle proprioceptive threshold ratio predicts falls and injury in diabetic neuropathy

Introduction: We determined lower limb neuromuscular capacities associated with falls and fall‐related injuries in older people with declining peripheral nerve function. Methods: Thirty‐two subjects (67.4 ± 13.4 years; 19 with type 2 diabetes), representing a spectrum of peripheral neurologic function, were evaluated with frontal plane proprioceptive thresholds at the ankle, frontal plane motor function at the ankle and hip, and prospective follow‐up for 1 year. Results: Falls and fall‐related injuries were reported by 20 (62.5%) and 14 (43.8%) subjects, respectively. The ratio of hip adductor rate of torque development to ankle proprioceptive threshold (HipSTR/AnkPRO) predicted falls (pseudo‐R2 = .726) and injury (pseudo‐R2 = .382). No other variable maintained significance in the presence of HipSTR/AnkPRO. Conclusions: Fall and injury risk in the population studied is related inversely to HipSTR/AnkPRO. Increasing rapidly available hip strength in patients with neuropathic ankle sensory impairment may decrease risk of falls and related injuries. Muscle Nerve 50: 437–442, 2014

Gait Efficiency on an Uneven Surface Is Associated with Falls and Injury in Older Subjects with a Spectrum of Lower Limb Neuromuscular Function: A Prospective Study.

ObjectiveThe objective of this study was to determine which gait measures on smooth and uneven surfaces predict falls and fall-related injuries in older subjects with diabetic peripheral neuropathy. DesignTwenty-seven subjects (12 women) with a spectrum of peripheral nerve function ranging from normal to moderately severe diabetic peripheral neuropathy walked on smooth and uneven surfaces, with gait parameters determined by optoelectronic kinematic techniques. Falls and injuries were then determined prospectively over the following year. ResultsSeventeen subjects (62.9%) fell and 12 (44.4%) sustained a fall-related injury. As compared with nonfallers, the subject group reporting any fall, as well as the subject group reporting fall-related injury, demonstrated decreased speed, greater step width (SW), shorter step length (SL), and greater SW-to-SL ratio (SW:SL) on both surfaces. Uneven surface SW:SL was the strongest predictor of falls (pseudo-r2 = 0.65; P = 0.012) and remained so with inclusion of other relevant variables into the model. Post hoc analysis comparing injured with noninjured fallers showed no difference in any gait parameter. ConclusionSW:SL on an uneven surface is the strongest predictor of falls and injuries in older subjects with a spectrum of peripheral neurologic function. Given the relationship between SW:SL and efficiency, older neuropathic patients at increased fall risk appear to sacrifice efficiency for stability on uneven surfaces. To Claim CME Credits:Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives:Uponcompletion of this article, thereader should be able to: (1) Identify health-related outcomes associated with walking for exercise in older populations; (2) Describe the gait pattern, most strongly associated with falls and injuries in the older population with diabetic peripheral neuropathy (DPN); and (3) Incorporate the assessment and treatment of gait abnormalities known to increase fall risk in older patient with DPN into the patients care plan. Level:Advanced Accreditation:The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Accuracy of Clinical Techniques for Evaluating Lower Limb Sensorimotor Functions Associated With Increased Fall Risk

In prior work, laboratory‐based measures of hip motor function and ankle proprioceptive precision were critical to maintaining unipedal stance and fall/fall‐related injury risk. However, the optimal clinical evaluation techniques for predicting these measures are unknown.

The relationship between frontal plane gait variability and ankle range of motion in middle-aged and older persons with neuropathy.

Carter SE, Richardson JK, Thies S, DeMott T, Ashton-Miller JA: The relationship between frontal plane gait variability and ankle range of motion in middle-aged and older persons with neuropathy. Am J Phys Med Rehabil 2009;88:210-215. Objective:To explore the relationship between frontal plane ankle range of motion (ROM) and frontal plane control during gait, as determined by step-width variability and step-width range, among middle-aged and older persons with peripheral neuropathy (PN). Design:Observational study of 39 adults (mean age ± standard deviation = 64.7 ± 9.5 yrs) with PN. Demographic and clinical data, including measures of ankle ROM and PN severity, and spatiotemporal gait measures were obtained. Correlation and multivariate analyses were used to identify relationships between measures of ankle ROM and frontal plane gait variability. Results:Significant negative correlations were identified between frontal plane ankle ROM (inversion + eversion), and step-width variability (r = −0.344; P = 0.032) and step-width range (r = −0.386, P = 0.015). Multivariate analyses showed that the relationship between ankle ROM and step-width variability weakened in the presence of PN severity, with ROM and PN severity both demonstrating trends toward independent associations with step-width variability (P = 0.086 and 0.083, respectively; adjusted r2 = 0.145). However, ankle ROM demonstrated a stronger association with step-width range than did PN severity (P = 0.043 and 0.098, respectively; adjusted r2 = 0.169). Conclusions:Increased frontal plane ankle ROM is associated with decreased variability in frontal plane foot placement during gait among middle-aged and older persons with PN, a population at high risk for falls.

Poster 118 Is a Clinical Measure of Upper Limb Reaction Time Predictive of Lower Limb Neuromuscular Function

although a C5 radiculopathy could not be ruled out. Magnetic resonance imaging of the cervical spine showed mild spondylosis and mild neuroforaminal narrowing at the C3-4, C5-6, and C6-7 levels. Setting: A Veterans Affairs hospital. Results: Eleven months later, the patient’s right shoulder pain, weakness, and atrophy resolved. Discussion: Although the electromyographic findings could be suggestive of a cervical radiculopathy, the cervical MRI showed mild neuroforaminal narrowing, and it is unlikely that this finding could account for the degree of atrophy in this patient. We discuss further the diagnostic dilemma in patients with clinical evidence of Parsonage-Turner syndrome and the differential diagnosis that should be considered. Conclusions: The true etiology of our patient’s symptoms still remains equivocal, but we suggest that the diagnosis of ParsonageTurner syndrome should be considered in patients with postoperative shoulder pain when there is acute onset of pain followed by atrophy with evidence of active denervation and reinnervation on electromyography and poor anatomic correlation for radiculopathy on imaging. Brachial neuritis is a known cause for postsurgical shoulder pain, and this is the first case report to our knowledge that documents its occurrence after carotid endarterectomy.