GAIT PATTERN ALTERATION BY FUNCTIONAL SENSORY SUBSTITUTION IN HEALTHY-SUBJECTS AND IN DIABETIC SUBJECTS WITH PERIPHERAL NEUROPATHY

Objective: To evaluate the ability of diabetic and nondiabetic individ uals to learn to use a lower extremity sensory substitution device to cue gait pattern changes. Design: Case-control study. Setting: Gait la boratory. Participants: Thirty diabetic persons-and 20 age-and educati on-matched nondiabetic controls responded to advertisements for study participation. Intervention: Participants walked on a treadmill at thr ee speeds (1, 2, and 2.5mph) with auditory sensory feedback to cue gro und contact greater than 80% duration of baseline. Main Outcome Measur ements: The variables measured included gait cycle (steps per minute) and number of times per minute that any step during a trial exceeded 8 0% duration of ground contacted compared with a measured baseline step length for each speed. Results: Persons in both groups were able to r apidly and significantly alter their gait patterns in response to sign als from the sensory substitution device, by changing their gait cycle s (nondiabetic group, F(17,124) = 5.27, p <.001; diabetic group, F(5,1 72) = 3.45, p <.001). Post hoc analyses showed early gait cycle modifi cation and error reduction among both groups. The nondiabetic group le arned to use the device significantly more quickly than the diabetic g roup during the slow (1 mph, t = 3.57, p <.001) and average (2 mph, t = 2.97, p <.05) trials. By the fast (2.5 mph) ambulation trial, both g roups were performing equally, suggesting a rapid rate of adjustment t o the device. No technical failures from gait trainer malfunction occu rred during the study. Conclusions: Diabetic persons with neuropathy e ffectively used lower extremity sensory substitution, and the technolo gy is now available to manufacture a durable, effective lower extremit y sensory substitution system. (C) 1997 by the American Congress of Re habilitation Medicine and the American Academy of Physical Medicine an d Rehabilitation.