(From application). This application requests support for the applicant to receive the didactic training and practical research experience necessary for him to become an independent, patient-oriented investigator. During the first two years of the award didactic course work will predominate, and during the last three research will be the greater focus; however, there will be elements of didactic education and participation in research throughout the duration of an award. The main focus of the coursework will be in biostatistics, epidemiology, and experimental design. Other didactic work will be through attendance at seminars sponsored by the University of Michigan Pepper Center and Institute of Gerontology, as well as appropriate basic science and clinical conferences in other departments. Research to be performed will be under the direction of James Ashton-Miller, who will function as the applicant's mentor. It has been observed that in older patients with even mild peripheral neuropathy (PN) the rate of falls is increased. Specific distal lower extremity afferent and efferent impairments in such patients which underlie their postural instability have also been identified. The proposed research in this application will investigate the efficacy of interventions to compensate for these impairments by means of two randomized, controlled studies. In the first, older adults will be randomized to receive touch of a vertical surface, a standard cane, or a health-related video. Outcomes will include ankle inversion/eversion proprioceptive thresholds and comfortable gait speed and errors on a challenging walking task (irregular surface, low light). In the second, older adults with PN will undergo a 12-week strengthening program specifically designed for them or a control regimen. Outcomes will include maximum voluntary strength of ankle inversion/eversion, comfortable gait speed and errors on the same challenging walking task, ability to recover from a lateral leans test, rate of ankle strength development, and unipedal stance time. Stratification of the subjects in the first group by the presence of carpal tunnel syndrome and testing the subjects in the second group at 3 and 12 weeks may give insight into the mechanisms responsible for improvement noted.
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