Gait Analysis in Idiopathic Normal Pressure Hydrocephalus: A Meta‐Analysis

Abstract

BackgroundGait analysis objectively quantifies gait impairment in idiopathic normal pressure hydrocephalus (iNPH), may improve diagnosis and evaluation for surgical candidacy.ObjectivesThis meta‐analysis aims to understand which objective gait parameters improve after tap‐test (TT) and CSF shunt surgery (CSS), also comparing responders (R) with non‐responders (NR) and to assess if gait restores within the range of healthy controls after procedures.MethodsStudies enrolling iNPH with at least one instrumented gait measure were selected. Three time points of gait assessment were defined: PRE, POST‐TT, and POST‐CSS. Gait velocity, cadence, step length, stride length, and double limb support time were evaluated. Patients were categorized based on responsiveness to CSF diversion procedures.ResultsSeventeen studies including 527 patients were selected. iNPH improved significantly in almost all gait parameters POST‐TT, and to a greater extent POST‐CSS. Gait parameters consistently discriminated iNPH from healthy controls. Despite the aforementioned improvements, iNPH's gait did not completely normalize after CSF diversion procedures. Meta‐regression analysis also revealed that TT's effect on gait velocity plateaus after 24‐48 hours and returns to baseline in 90‐100 hours.ConclusionsGait analysis is a reliable quantitative instrument to assess gait impairment in iNPH, demarking a net differentiation from healthy controls, according to the notion that the iNPH CSF dynamic alteration also leads to an irreversible damage. Specific gait parameters improve among TT‐R, providing an opportunity to select patients that will respond to CSS. Future studies validating a standardized reporting method including criteria of responsiveness, specific gait parameters, and timeframe of assessment are needed.This article is protected by copyright. All rights reserved.

Changes in postural stability after cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus

“…Our study found a strong correlation between static and dynamic steady-state balance at pre-CSFTT in patients with iNPH. Until now, assessments of gait function, which indicate dynamic steady-state balance, have been used as diagnostic and evaluative tools for iNPH ( 4 , 5 , 40 , 41 ). This study suggests that measuring COP parameters during quiet standing, which assesses static steady-state balance, may be useful a potential diagnostic biomarker in iNPH patients who do not walk independently or who frequently fall.…”