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 nondominant hand during challenging balance tasks would significantly decrease loss of balance in patients with peripheral neuropathy while transferring from bipedal to unipedal stance on an unsteady surface. Design: Nonrandomized control study. Setting: Tertiary-care institution. Participants: Eight consecutive patients with peripheral neuropathy (PN) and eight 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 frontal plane tilt of the support surface at 70% of weight transfer, and balance unipedally for at least 3 seconds. The efficacy of their weight transfer was evaluated over 112 consecutive randomized and blocked trials by calculating loss of balance as failure rates (%FR) with and without visual feedback, and with and without use of a cane in the nondominant (left) hand. Results were analyzed using a 2x2x2x2x2 repeated-measures analysis of variance (rm-ANOVA) and post hoc t tests. Results: The 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 feedback, simulating the dark of night, increased the FR fourfold (p =.000). Use of a cane in the contralateral nondominant hand significantly reduced the FR (p =.000), particularly in the PN group (cane x disease 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 than an eversion perturbation (p =.007). The PN group employed larger mean peak cane forces (21.9% BW) than C (13.6% BW) in restoring their balance (p =.000). Conclusion: Use of a cane by PN patients significantly re duced their risk of losing balance on unstable surfaces, especially under low-light conditions. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation