Responsiveness to rehabilitation of balance and gait impairment in elderly with peripheral neuropathy

Abstract

Elderly people with peripheral neuropathy of the lower limbs (PNLL) demonstrate a typical balance and gait impairment because of sensory ataxia. There is evidence that rehabilitation produces important gains on balance and gait. However, responsiveness to rehabilitation of balance and gait measures is unknown in PNLL. Aim of the current work is to evaluate the responsiveness to rehabilitation of balance, gait and sensory ataxia measures in elderly with PNLL. Twenty-five elderly with PNLL attending physiotherapy and occupational therapy during inpatient rehabilitation were recruited. Balance and gait measures (including static posturography, TUG test and the 10 m walking test) were administered on admission and discharge. An accelerometer secured to the trunk was used for TUG recording and static balance assessment. Static balance was tested with open and closed eyes, so as to assess sensory ataxia. Following rehabilitation, patients improved gait [admission vs discharge, mean(SD): 0.86(0.33) vs 0.98(0.32) m/s], TUG [18.7(7.8) vs 15.1(5.2) s] and turning [46.2(15.3) vs 53.3(15.3) °/s]. However, none of 12 static balance parameters derived from trunk acceleration significantly changed. Principal component analysis showed that before training, eyes closed and eyes open balance correlated with orthogonal components (one and two vs. three and four). After training, eyes open and eyes closed balance were more similar to each other being both correlated with component one. Responsiveness to rehabilitation is larger for gait than static balance measured by trunk acceleration. However, exercise can also have a beneficial effect on sensory ataxia by making eyes closed balance more similar to eyes open balance.

Keywords: Ataxia; Gait; Polyneuropathies; Postural balance; Rehabilitation.