Article

The objective of this study was to determine which gait measures on
smooth and uneven surfaces predict falls and fall-related injuries in older
subjects with diabetic peripheral neuropathy. DESIGN: Twenty-seven subjects (12
women) with a spectrum of peripheral nerve function ranging from normal to
moderately severe diabetic peripheral neuropathy walked on smooth and uneven
surfaces, with gait parameters determined by optoelectronic kinematic techniques.
Falls and injuries were then determined prospectively over the following year.
RESULTS: Seventeen subjects (62.9%) fell and 12 (44.4%) sustained a fall-related
injury. As compared with nonfallers, the subject group reporting any fall, as
well as the subject group reporting fall-related injury, demonstrated decreased
speed, greater step width (SW), shorter step length (SL), and greater SW-to-SL
ratio (SW:SL) on both surfaces. Uneven surface SW:SL was the strongest predictor
of falls (pseudo-r = 0.65; P = 0.012) and remained so with inclusion of other
relevant variables into the model. Post hoc analysis comparing injured with
noninjured fallers showed no difference in any gait parameter. CONCLUSION: SW:SL
on an uneven surface is the strongest predictor of falls and injuries in older
subjects with a spectrum of peripheral neurologic function. Given the
relationship between SW:SL and efficiency, older neuropathic patients at
increased fall risk appear to sacrifice efficiency for stability on uneven
surfaces. TO CLAIM CME CREDITS: Complete the self-assessment activity and
evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES::
Uponcompletion of this article, thereader should be able to: (1) Identify
health-related outcomes associated with walking for exercise in older
populations; (2) Describe the gait pattern, most strongly associated with falls
and injuries in the older population with diabetic peripheral neuropathy (DPN);
and (3) Incorporate the assessment and treatment of gait abnormalities known to
increase fall risk in older patient with DPN into the patients care plan. LEVEL:
Advanced ACCREDITATION: : The Association of Academic Physiatrists is accredited
by the Accreditation Council for Continuing Medical Education to provide
continuing medical education for physicians. The Association of Academic
Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1
Credit(s). Physicians should only claim credit commensurate with the extent of
their participation in the activity.

Langue : ANGLAIS