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Exercise Interventions, Gait, and Balance in Older Subjects with Distal Symmetric Polyneuropathy: A Three-Group Randomized Clinical Trial

Quigley, Patricia A. PhD, ARNP, CRRN, FAAN, FAANP; Bulat, Tatjana MD; Schulz, Brian PhD; Friedman, Yvonne MA, OTR/L, CCRC; Hart-Hughes, Stephanie MSMS, PT, NCS; Richardson, James K. MD; Barnett, Scott PhD

American Journal of Physical Medicine & Rehabilitation: January 2014 - Volume 93 - Issue 1 - p 1–16
doi: 10.1097/PHM.0000000000000052
CME Article . 2014 Series . Number 1

Objective: Older patients with a distal symmetric polyneuropathy are at markedly increase risk for falls and fall-related injuries. Despite this, few studies have investigated the effect of exercise regimens on gait and balance in this high-risk group.

Design: One hundred older patients with distal symmetric polyneuropathy were randomized to one of three interventions: functional balance training, Tai Chi, or education-only control. The subjects in each group received instruction in ten 1-hr weekly sessions. Outcome measures were determined at baseline and the end of the 10-wk intervention. Gait, balance, and falls self-efficacy were assessed with various well established clinical (Berg Balance Scale, 8 Foot Up and Go Test, and Modified Falls Efficacy Scale) and laboratory-based measures (three-dimensional gait analysis and NeuroCom limits of stability and sensory organization tests).

Results: The Tai Chi subjects demonstrated a decreased (faster) Timed Up and Go and increased stride length and time spent in single limb support at the end of intervention as compared with baseline. The functional balance training group demonstrated a significant increase in ankle plantar flexor power and near significant decreases in step width and step width variability. No changes in the education-only control group were observed.

Conclusions: Older patients with distal symmetric polyneuropathy may benefit from Tai Chi and/or functional balance training, with the former improving functional mobility and gait and the latter possibly improving trunk stabilization and forward progression (Lythgo N, Cofré LE: Relationship between ankle plantar flexor power and EMG muscle activity during gait. 30th Annual Conference of Biomechanics in Sports [Melbourne, 2012]. Available at: https://ojs.ub.uni-konstanz.de/cap/article/viewFile/5320/4891). Whether these laudable changes can be maintained or translate into decreased risk for falls and fall-related injuries is unknown.

From the VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital, Tampa, Florida (PAQ, TB, YF, SH-H); Department of Veterans Affairs, Washington, DC (BS); Department of Physical Medicine and Rehabilitation, University of Michigan Health Systems, Ann Arbor (JKR); and Health Services Research & Development, Center of Innovation and Disability Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, Florida (SB).

All correspondence and requests for reprints should be addressed to: Patricia A. Quigley, PhD, ARNP, CRRN, FAAN, FAANP, VISN 8 Patient Safety Center of Inquiry, 8900 Grand Oaks Circle, Tampa, FL 33637.

CME Objectives: Older patients with distal symmetric polyneuropathy (DSP) are at markedly increased risk for falls and fall-related injuries. Few studies have investigated the effect of exercise regimens on gait and balance in this high-risk group. This activity is designed to increase physician competence in the treatment of older patients with DSP. Upon completion of the article, the reader should be able to: (1) Describe common gait abnormalities seen in individuals with peripheral neuropathy, (2) Identify the most important sensory inputs for maintenance of balance and walking, and (3) Distinguish between the effect of Tai Chi versus Functional Balance Training on selected clinical outcomes and measures of gait

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 amaximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Supported by the Office of Research and Development, Rehabilitation Research and Development Service Study no. O4006RA, Department of Veterans Affairs, James A. Haley VA Hospital, and the VISN 8 Patient Safety Center of Inquiry.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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