Advertisement

A cane reduces loss of balance in patients with peripheral neuropathy: Results from a challenging unipedal balance test

  • James A. Ashton-Miller
    Correspondence
    Reprint requests to James A. Ashton-Miller, PhD, Department of Mechanical Engineering & Applied Mechanics, Biomechanics Research Laboratory, University of Michigan, Ann Arbor, MI 48109-2125.
    Affiliations
    Biomechanics Research Laboratories, University of Michigan, Ann Arbor, USA

    Department of Mechanical Engineering and Applied Mechanics, University of Michigan, Ann Arbor, USA

    Institute of Gerontology, University of Michigan, Ann Arbor, USA
    Search for articles by this author
  • Mark W.L. Yeh
    Affiliations
    Biomechanics Research Laboratories, University of Michigan, Ann Arbor, USA

    Department of Mechanical Engineering and Applied Mechanics, University of Michigan, Ann Arbor, USA
    Search for articles by this author
  • James K. Richardson
    Affiliations
    Biomechanics Research Laboratories, University of Michigan, Ann Arbor, USA

    Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA
    Search for articles by this author
  • Todd Galloway
    Affiliations
    Biomechanics Research Laboratories, University of Michigan, Ann Arbor, USA

    Department of Mechanical Engineering and Applied Mechanics, University of Michigan, Ann Arbor, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Objective: To test the hypothesis that use of a cane in the nondominant hand during challenging balance tasks would significantly decrease loss of balance in patients with peripheral neuropathy while transferring from bipedal to unipedal stance on an unsteady surface.
      Design: Nonrandomized control study.
      Setting: Tertiary-care institution.
      Participants Eight consecutive patients with peripheral neuropathy (PN) and eight age- and gender-matched controls (C) with a mean (SD) age of 65 (8.2) years.
      Methods: Subjects were asked to transfer their weight onto their right foot, despite a rapid ±2° or ±4° frontal plane tilt of the support surface at 70% of weight transfer, and balance unipedally for at least 3 seconds. The efficacy of their weight transfer was evaluated over 112 consecutive randomized and blocked trials by calculating loss of blanace as failure rates (%FR) with and without visual feedback, and with and without use of a cane in the nondominant (left) hand. Results were analyzed using a 2×2×2×2×2 repeated-measures analysis of variance (rm-ANOVA) and post hoc t tests.
      Results: The rm-ANOVA showed that the FR of the PN subjects (47.6% [18.1%]) was significantly higher than C (29.2% [15.2%], p = .036). Removing visual feedback, simulting the dark of night, increased the FR fourfold (p = .000). Use of a cane in the contralateral nondominant hand significantly reduced the FR (p = .000), particularly in the PN group (cane × disease interaction: p = .055). Post hoc t tests showed that with or without visual feedback, the cane reduced the FR of the PN group fourfold and enabled them to perform more reliably than matched controls not using a cane (p = .011). An inversion perturbation resulted in a higher FR than an aversion perturbation (p = .007). The PN group employed larger mean peak cane forces (21.9% BW) than C (13.6% BW) in restoring their balance (p = .000).
      Conclusion: Use of a cane by PN patients significantly reduced their risk of losing balance on unstable surfaces, especially under low-light conditions.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Richardson JK
        • Ching C
        • Hurvitz EA
        The relationship between electromyographically documented peripheral neuropathy and falls.
        J Am Geriatr Soc. 1992; 40: 1008-1012
        • Nevitt MC
        • Cummings SR
        Type of fall and risk of hip and wrist fractures: the study of osteoporotic features.
        J Am Geriatr Soc. 1993; 41: 1226-1234
        • Chen HC
        • Ashton-Miller JA
        • Alexander NB
        • Schultz AB
        Age effects on strategies used to avoid obstacles.
        Gait Posture. 1994; 2: 139-146
        • Hanke TA
        • Rogers MW
        Reliability of ground reaction force measurements during dynamic transitions from bipedal to single-limb stance in healthy adults.
        Phys Ther. 1992; 72: 810-816
        • Chen HC
        • Ashton-Miller JA
        • Alexander NB
        • Schultz AB
        Stepping over obstacles: gait patterns of healthy young and old adults.
        J Gerontol Med Sci. 1991; 46: M196-M203
        • Bohannon RW
        • Larkin PA
        • Cook AC
        • Gear J
        • Singer J
        Decrease in timed balance test scores with aging.
        Phys Ther. 1984; 64: 1067-1070
        • Balogun JA
        • Akindele KA
        • Nihinlola JO
        • Marzouk DK
        Age-related changes in balance performance.
        Disabil Rehabil. 1994; 16: 58-62
        • Lee SG
        Theoretical and experimental biomechanical analyses of the effects of age and peripheral neuropathy on unipedal stance.
        in: 2nd rev. ed. dissertation. University of Michigan, Ann Arbor (MI)1993
        • Milczarek JJ
        • Kirby L
        • Harrison ER
        • MacLeod DA
        Standard and four-footed canes: their effect on the standing balance of patients with hemiparesis.
        Arch Phys Med Rehabil. 1993; 74: 281-285
        • Vargo MM
        • Robinson LR
        • Nicholas JJ
        Contralateral v ipsilateral cane use: effects on muscle crossing the knee joint.
        Am J Phys Med Rehabil. 1992; 71: 170-176
        • Winter DA
        • Deathe AB
        • Halliday S
        • Ishac M
        • Olin M
        A technique to analyze the kinetics and energetics of cane-assisted gait.
        Clin Biomech. 1993; 8: 37-43
        • Dean E
        • Ross J
        Relationships among cane fitting, function, and falls.
        Phys Ther. 1993; 73: 494-504
        • Robbins S
        • Gouw GJ
        • McClaren J
        Shoe sole thickness and hardness influence balance in older men.
        J Am Geriatr Soc. 1992; 40: 1089-1094
      1. EMGPRO [computer program]. University of Michigan Software©, Ann Arbor (MI)1993
        • Kimura J
        Electrodiagnosis in disease of nerve and muscle.
        in: Principles and Practice. 2nd rev. ed. Davis, Philadelphia1989
        • VanDenBosch C
        • Gilsing M
        • Lee S-G
        • Richardson JK
        • Ashton-Miller JA
        Effect of peripheral neuropathy on thresholds for detecting ankle inversion and eversion.
        Arch Phys Med Rehabil. 1995; 76: 850-856
        • Sainsbury R
        • Mulley GP
        Walking sticks used by the elderly [letter].
        BMJ. 1982; 284: 1751
        • Blount WP
        Don't throw away the cane.
        J Bone Joint Surg. 1956; 38-A: 695-708
        • Joyce BM
        • Kirby RL
        Cane, crutches and walkers.
        Am Fam Physician. 1991; 43: 535-542
        • Nichols PJR
        • Williams E
        Aids and appliance.
        in: Mattingley S Rehabilitation today in Great Britain. Update Books, London1981: 78
        • Ottaviani R
        • Ashton-Miller JA
        • Kothari SU
        • Wojtys EM
        Basketball shoe height and the maximal muscular resistance to applied ankle inversion/eversion moments.
        Am J Sports Med. 1995; 23: 1-6
        • Jebsen RH
        Use and abuse of ambulation aids.
        JAMA. 1967; 199: 63-68
        • Ragnarsson KT
        Lower extremity orthotics, shoes and gait aids.
        in: DeLisa JA Rehabilitation medicine: principles and practice. 2nd ed. Lippincott, Philadelphia1993
        • MacKinnon CD
        • Winter DA
        Control of whole body balance in the frontal plane during human walking.
        J Biomech. 1993; 26: 633-644
        • Fitzpatrick R
        • Rogers DK
        • McCloskey DI
        Stable human standing with lower-limb muscle afferents providing the only sensory input.
        J Physiol (Lond). 1994; 480: 395-403
        • Fitzpatrick R
        • McCloskey DI
        Proprioceptive, visual and vestibular thresholds for the perception of sway during standing in humans.
        J Physiol (Lond). 1994; 478: 173-186
        • Melville Jones G
        • Watt DGD
        Muscular control of landing from an unexpected falls in man.
        J Physiol (Lond). 1971; 219: 729-737