Citation

Zurales K, Demott TK, Kim H, Allet L, Ashton-Miller JA, Richardson JK. Am. J. Phys. Med. Rehabil. 2015; 95(2): 83-90.

Affiliation

From the Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Michigan (KZ, TKD, JKR); Department of Physiotherapy, University of Applied Sciences of Western Switzerland, Geneva, Switzerland (LA); and Department of Mechanical Engineering, Biomechanics Research Laboratory, University of Michigan, Ann Arbor, Michigan (HK, JAA-M).

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/PHM.0000000000000324

PMID

26053187

Abstract

OBJECTIVE: The 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.

DESIGN: Twenty-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.

RESULTS: Seventeen 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-r = 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.

CONCLUSION: SW: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.

Language: en