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South Med J. 2013 Oct;106(10):565-9. doi: 10.1097/SMJ.0000000000000009.

Sharpening the tandem walking test for screening peripheral neuropathy.

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  • 1From the Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, the Department of Obstetrics and Gynecology, and the Department of Neurology, Baylor College of Medicine, the Universities Space Research Association, the Wyle Science, Technology and Engineering Group, and the Neuroscience Research Laboratories, NASA/Johnson Space Center, Houston, Texas.



Few tests of functional motor behavior are useful for rapidly screening people for lower extremity peripheral neuropathy. The goal of this study was to improve the widely used tandem walking (TW) test.


We tested "normal" (control) adult and ambulatory patients with peripheral neuropathy (PN) with their eyes open and eyes closed while they performed TW on industrial carpeting in sock-covered feet. Each subject wore a torso-mounted inertial motion unit to measure kinematic data. The data of subjects with PN also were compared with historical data on patients with vestibular impairments.


The normal and PN groups differed significantly on TW and on the number of steps completed. PN and vestibular impairments data also differed significantly on both visual conditions. Kinematic data showed that patients with PN were more unstable than normal patients in the group. For the number of steps taken during the eyes open condition, receiver operating characteristic (ROC) values were only 0.81 and for the number of steps taken during the eyes closed condition, ROC values were 0.88. Although not optimal, this ROC value is better. Sensitivity and specificity at a cutoff of two steps were 0.81 and 0.92, respectively, and at a cutoff of three steps were 0.86 and 0.75, respectively. ROC values for kinematic data were <0.8, and when combined with the ROC value for the number of steps, the total ROC value did not improve appreciably.


Although not ideal for screening patients who may have PN, counting the number of steps during TW is a quick and useful clinical test. TW is most sensitive to patients with PN when they are tested with eyes closed.

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