Gait analysis in a challenging environment differentiates between fallers and no

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Arch Phys Med Rehabil. 2005 Aug;86(8):1539-44.

Gait analysis in a challenging environment differentiates between

fallers and nonfallers among older patients with peripheral

neuropathy.

Department of Physical Medicine and Rehabilitation, University of

Michigan, Ann Arbor, MI.

JK, Thies SB, DeMott TK, Ashton- JA.

OBJECTIVE: To identify differences in gait based on fall history

among a group of older subjects with peripheral neuropathy (PN) in 2

environments: standard (SE) (smooth surface, normal lighting) and

challenging (CE) (irregular surface, low lighting). DESIGN:

Observational, case-control study of PN subjects with and without a

history of falling in the previous year. SETTING: A biomechanical

laboratory.

PARTICIPANTS: Forty-two subjects (mean age, 64.7+/-9.8y; 20 [47.6%]

women), including 22 (52.4%) with a history of at least 1 fall in the

previous year.

INTERVENTION: Subjects walked in the SE and CE while kinematic data

were obtained.

MAIN OUTCOME MEASURES: Step width variability, step time variability,

step width-to-step length ratio, step length, and step time and speed

(with step length and speed normalized for height) in the SE and CE.

RESULTS: In the SE, gait parameters of subjects with and without a

history of falls did not differ significantly. However, in the CE,

subjects with a history of falls had increased step time variability

(P=.001). Moreover, significant interactions between environment and

fall status were identified: in the CE, subjects with a history of

falls had greater increases in step time variability (P=.010) and

step width-to-step length ratio (P=.009) and greater decreases in

step length (P=.007) and speed (P=.045) than did subjects with no

fall history.

CONCLUSIONS: Analysis of gait in the CE and adjustment to the CE from

the SE effectively identified gait characteristics associated with

falls in an older PN population, whereas analysis of gait in the SE

did not. PN-associated gait dysfunction is more sensitively detected

on an irregular rather than on a flat surface.