A comparison of gait characteristics between older women with and without peripheral neuropathy in standard and challenging environments.

OBJECTIVES To compare gait patterns in older women with and without peripheral neuropathy (PN) in standard (smooth surface, normal lighting) and challenging environments (CE) (irregular surface, low lighting). DESIGN Observational, controlled study of 24 subjects. SETTING Biomechanical research laboratory. PARTICIPANTS Twenty-four older women, 12 with PN and 12 without PN (mean age +/- standard deviation =67.1 +/- 7.9 and 70.2 +/- 4.3, respectively). MEASUREMENTS Gait parameters and, in the 12 PN subjects, neuropathy severity. RESULTS The CE was associated with increases in step width, step-width variability, step-width range, step width-to-step length ratio, step time and step-time variability, and decreases in step length and speed. The PN subjects demonstrated a greater step width-to-step length ratio and step time and shorter step length and slower speed than the control subjects. In adapting to the CE, the PN subjects demonstrated greater increases in step width-to-step length ratio and step-time variability and a greater decrease in step length than did the control subjects. In the standard environment, only one gait parameter correlated with PN severity, whereas in the CE, four gait parameters did so. CONCLUSION The subjects demonstrated a gait that was slower, less efficient, and more variable temporally and in the frontal plane in the CE. Control and PN subjects demonstrated similar variability in medial-lateral step placement in the CE but at the cost of speed and efficiency for the PN subjects. Because the CE magnified gait differences between the two groups of subjects and caused gait changes in the PN subjects that correlated with PN severity, the CE may offer improved resolution for detecting gait abnormalities.