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.
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