Peripheral neuropathy, sensorimotor function and balance

我们已经证明，全身性周围多发性神经病（PN）是福尔斯的一个强有力的危险因素，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15%至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/外翻本体感受阈值增加）和运动（踝关节力量发展速度下降）功能的损伤，这些损伤是其姿势不稳定的基础，特别是在额面。拟议的工作将探索干预措施，以弥补我们通过两项随机对照研究确定的感觉（IDS 1）和运动（IDS 2）障碍。在IDS 1中，240名患有PN的老年人将随机接受四种干预措施之一，即用于改善足底皮肤感觉的鹅卵石矫形器、标准直手杖、肩部高度的垂直表面触摸和健康相关视频（对照组）。结果将包括踝关节内翻/外翻本体感受阈值、舒适步态速度和具有挑战性的行走任务（不规则表面、弱光）错误以及单足站立时间。在IDS 2中，120名患有PN的老年人将被随机分配至专门为PN患者设计的12周平衡和强化计划或对照运动方案。结果将是踝关节内翻肌和内翻肌的最大随意力量、行走任务中的舒适步态速度和错误次数、从侧向倾斜测试中恢复的能力或踝关节力量发展和单足站立时间。这项工作的结果将指导未来的干预性研究，旨在防止生活在社区的PN患者中的福尔斯。

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.