Influence of an irregular surface and low light on the step variability of patients with peripheral neuropathy during level gait

Patients with peripheral neuropathy (PN) report greater difficulty walking on irregular surfaces with low light (IL) than on flat surfaces with regular lighting (FR). We tested the primary hypothesis that older PN patients would demonstrate greater step width and step width variability under IL conditions than under FR conditions. Forty-two subjects (22 male, 20 female: mean ± S.D.: 64.7 ± 9.8 years) with PN underwent history, physical examination, and electrodiagnostic testing. Subjects were asked to walk 10 m at a comfortable speed while kinematic and force data were measured at 100 Hz using optoelectronic markers and foot switches. Ten trials were conducted under both IL and FR conditions. Step width, time, length, and speed were calculated with a MATLAB® algorithm, with the standard deviation serving as the measure of variability. The results showed that under IL, as compared to FR, conditions subjects demonstrated greater step width (197.1 ± 40.8 mm versus 180.5 ± 32.4 mm; P < 0.001) and step width variability (40.4 ± 9.0 mm versus 34.5 ± 8.4 mm; P < 0.001), step time and its variability (P < 0.001 and P = 0.003, respectively), and step length variability (P < 0.001). Average step length and gait speed decreased under IL conditions (P < 0.001 for both). Step width variability and step time variability correlated best under IL conditions with a clinical measure of PN severity and fall history, respectively. We conclude that IL conditions cause PN patients to increase the variability of their step width and other gait parameters.