Peripheral neuropathy, sensorimotor function and balance

我们已经证明，广泛性周围多神经病变（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的对照组的15倍。此外，PN很常见，影响了15%到20%的美国老年人。我们已经确定并量化了PN受试者远端感觉（踝关节内翻/外翻本体感觉阈值增加）和运动（踝关节力量发展速度下降）功能的损伤，这是他们姿势不稳定的基础，特别是在额平面。我们将通过两项随机对照研究，探索补偿感官（IDS 1）和运动（IDS 2）障碍的干预措施。在IDS研究中，1240名患有PN的老年人将随机接受四种干预措施中的一种，一种是鹅卵石矫正器，用于改善足底皮肤感觉，一种是标准的直手杖，触摸肩高的垂直表面，一种是健康相关的视频（对照组）。结果将包括踝关节倒置/外翻本体感觉阈值，舒适的步态速度和具有挑战性的行走任务（不规则表面，低光）的错误和单脚站立时间。在IDS中，120名老年PN患者将被随机分配到专门为PN患者设计的为期12周的平衡和强化计划或对照运动方案中。结果将是踝关节内翻者和内翻者的最大自主力量，舒适的步态速度和行走任务中的错误次数，从侧倾测试率或踝关节力量发展和单脚站立时间中恢复的能力。这项工作的结果将指导未来的介入性研究，旨在预防社区PN患者跌倒。

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.