Peripheral neuropathy, sensorimotor function and balance

我们已经证明，全身性外周多发性神经病(PN)是跌倒的一个强大的危险因素，受影响的老年人跌倒的可能性是没有PN的匹配对照组的15倍。此外，PN很常见，影响到15%到20%的美国老年人。我们已经确定并量化了PN受试者的远端感觉(踝关节内翻/外翻本体感觉阈值增加)和运动(踝关节力量发育速度降低)功能的损害，这些损害是他们姿势不稳定的基础，尤其是在额面。这项拟议的工作将通过两项随机对照研究，探索对感觉(IDS1)和运动(IDS2)损害进行补偿的干预措施。在入侵检测系统中，1240名患有PN的老年患者将随机接受四种干预措施中的一种，即组装一个改善足底皮肤感觉的鹅卵石矫形器、一个标准的直拐杖、触摸肩膀高度的垂直表面和一个与健康有关的视频(对照组)。结果将包括踝关节内翻/外翻本体感觉阈值、舒适的步速、在具有挑战性的步行任务中的错误(表面不规则、光线较弱)和单足站立时间。在入侵检测系统中，2120名患有PN的老年人将被随机分为12周的平衡和强化计划，这些计划是专门为PN患者设计的，或者是对照运动方案。结果将是踝关节内翻和内翻的最大自愿力量，舒适的步态速度和行走任务中的错误次数，从侧倾测试中恢复的能力或脚踝力量发展和单足站立时间。这项工作的结果将指导未来一项旨在预防社区PN患者跌倒的干预性研究。

We have demonstrated that a generalized peripheral polyneuropathy (PN) is a powerful risk factor for falls, with affected older persons being 15 times more likely to fall than matched controls without PN. Furthermore PN is common, affecting between 15 and 20% of older Americans. We have identified and quantified impairments in distal sensory (increased ankle inversion/eversion proprioceptive thresholds) and motor (decreased ankle rate of strength development) function in PN subjects that underlie their postural instability, particularly in the frontal plane. The proposed work will explore interventions to compensate for the sensory (IDS 1) and motor (IDS 2) impairments we have identified by means of two randomized and controlled studies. In IDS 1, 240 older adults with PN will be randomized to receive one of four interventions, a pebbled orthotic assembled to improve plantar cutaneous sensation, a standard straight cane, touch of a vertical surface at shoulder height and a health- related video (control group). Outcomes will include ankle inversion/eversion proprioceptive thresholds, comfortable gait speed and errors on a challenging walking task (irregular surface, low light) and unipedal stance time. In IDS 2 120 older adults with PN will be randomized to a 12 week balance and strengthening program designed specifically for patients with PN or a control exercise regimen. Outcomes will be maximum voluntary strength of the ankle invertors and invertors, comfortable gait speed and number of errors on the walking task, ability to recovery from a lateral leans test rate or ankle strength development and unipedal stance time. The results of this work will guide a future interventional study designed to prevent falls among PN patients living in the community.