A CANE REDUCES LOSS OF BALANCE IN PATIENTS WITH PERIPHERAL NEUROPATHY- RESULTS FROM A CHALLENGING UNIPEDAL BALANCE TEST

Objective: To test the hypothesis that use of a cane in the nondominan t hand during challenging balance tasks would significantly decrease l oss of balance in patients with peripheral neuropathy while transferri ng from bipedal to unipedal stance on an unsteady surface. Design: Non randomized control study. Setting: Tertiary-care institution. Particip ants: Eight consecutive patients with peripheral neuropathy (PN) and e ight 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 degrees or +/-4 degrees fronta l plane tilt of the support surface at 70% of weight transfer, and bal ance unipedally for at least 3 seconds. The efficacy of their weight t ransfer was evaluated over 112 consecutive randomized and blocked tria ls by calculating loss of balance as failure rates (%FR) with and with out visual feedback, and with and without use of a cane in the nondomi nant (left) hand. Results were analyzed using a 2x2x2x2x2 repeated-mea sures analysis of variance (rm-ANOVA) and post hoc t tests. Results: T he 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 f eedback, simulating the dark of night, increased the FR fourfold (p =. 000). Use of a cane in the contralateral nondominant hand significantl y reduced the FR (p =.000), particularly in the PN group (cane x disea se 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 t han an eversion perturbation (p =.007). The PN group employed larger m ean peak cane forces (21.9% BW) than C (13.6% BW) in restoring their b alance (p =.000). Conclusion: Use of a cane by PN patients significant ly re duced their risk of losing balance on unstable surfaces, especia lly under low-light conditions. (C) 1996 by the American Congress of R ehabilitation Medicine and the American Academy of Physical Medicine a nd Rehabilitation