Gait apraxia evaluation in normal pressure hydrocephalus using inertial sensors. Clinical correlates, ventriculoperitoneal shunt outcomes, and tap-test predictive capacity

Ferrari, Alberto; Milletti, David; Palumbo, Pierpaolo; Giannini, Giulia; Cevoli, Sabina; Magelli, Elena; Albini-Riccioli, Luca; Mantovani, Paolo; Cortelli, Pietro; Chiari, Lorenzo; Palandri, Giorgio

doi:10.1186/s12987-022-00350-y

Cited by 5 publications

(15 citation statements)

References 48 publications

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“…Pre-post changes of the total iTUG duration as well as of the different iTUG segments are shown in Tables 3 and 4 , respectively. Data on further kinematic iTUG measures such as angular velocity and acceleration were reported in 13 studies [ 21 , 22 , 25 , 26 , 29 – 36 , 38 ].…”

Section: Resultsmentioning

confidence: 99%

“TiC-TUG”: technology in clinical practice using the instrumented timed up and go test—a scoping review

Böttinger,

Labudek,

Schoene

et al. 2024

Aging Clin Exp Res

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Digitized assessments have a considerable potential to guide clinicial decision making and monitor progress and disease trajectories. The Timed Up and Go test (TUG) has been long established for assessment in geriatric medicine and instrumented versions (iTUG) have been developed and validated. This scoping review includes studies that applied the iTUG and aims to identify use cases to show where and how iTUG assessment could guide interventions and clinical management. The literature search was limited to peer-reviewed studies that performed pre- and post-intervention measurements with a 3-meter TUG instrumented with body-worn technology in samples of at least 20 subjects aged 60+ years. Of 3018 identified articles 20 were included. Four clinical use cases were identified: stratification for subsequent therapy, monitoring of disease or treatment-associated changes and evaluation of interventions in patients with idiopathic normal pressure hydrocephalus (1), and patients with Parkinson’s disease (2); monitoring after joint replacement surgery (3), and evaluation after different exercise and rehabilitation interventions (4). The included studies show diversity in terms of iTUG technology and procedures. The identified use cases highlight clinical relevance and high potential for the clinical application of the iTUG. A consensual approach as well as comprehensive reporting would help to further exploit the potential of the iTUG to support clinical management. Future studies should investigate the benefits of segmental iTUG analysis, responsiveness and participants’ perspectives on clinically meaningful changes in iTUG.

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Section: Resultsmentioning

confidence: 99%

“TiC-TUG”: technology in clinical practice using the instrumented timed up and go test—a scoping review

Böttinger,

Labudek,

Schoene

et al. 2024

Aging Clin Exp Res

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show abstract

“…This study presents the data of gait patterns investigation in the home environment, between EHCs and patients with iNPH preoperatively and postoperatively, for 3 days without restrictions on daily activities. The gait pattern analysis of patients with iNPH has been included in some studies ( 10 , 14 , 15 , 20 ), but these were performed in laboratory and medical environments. In addition, gait disturbances occurring from other neurologic disorders can also be present ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies aimed to assess the recovery process of gait disturbances after VP-shunt surgery in patients with iNPH using several tests in a controlled setting ( 20 , 33 , 34 ). For the first time, we aimed to get a more reliable evaluation concerning the response of patients with iNPH to VP-shunt placement by comparing the gait pattern of patients with iNPH preoperatively and postoperatively in the home environment.…”

Section: Discussionmentioning

confidence: 99%

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Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus

et al. 2023

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BackgroundThe identification of patients with gait disturbance associated with idiopathic normal pressure hydrocephalus (iNPH) is challenging. This is due to the multifactorial causes of gait disturbance in elderly people and the single moment examination of laboratory tests.ObjectiveWe aimed to assess whether the use of gait sensors in a patient's home environment could help establish a reliable diagnostic tool to identify patients with iNPH by differentiating them from elderly healthy controls (EHC).MethodsFive wearable inertial measurement units were used in 11 patients with iNPH and 20 matched EHCs. Data were collected in the home environment for 72 h. Fifteen spatio-temporal gait parameters were analyzed. Patients were examined preoperatively and postoperatively. We performed an iNPH sub-group analysis to assess differences between responders vs. non-responders. We aimed to identify parameters that are able to predict a reliable response to VP-shunt placement.ResultsNine gait parameters significantly differ between EHC and patients with iNPH preoperatively. Postoperatively, patients with iNPH showed an improvement in the swing phase (p = 0.042), and compared to the EHC group, there was no significant difference regarding the cadence and traveled arm distance. Patients with a good VP-shunt response (NPH recovery rate of ≥5) significantly differ from the non-responders regarding cycle time, cycle time deviation, number of steps, gait velocity, straight length, stance phase, and stance to swing ratio. A receiver operating characteristic analysis showed good sensitivity for a preoperative stride length of ≥0.44 m and gait velocity of ≥0.39 m/s.ConclusionThere was a significant difference in 60% of the analyzed gait parameters between EHC and patients with iNPH, with a clear improvement toward the normalization of the cadence and traveled arm distance postoperatively, and a clear improvement of the swing phase. Patients with iNPH with a good response to VP-shunt significantly differ from the non-responders with an ameliorated gait pattern.

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“…Similarly, previous studies have identified challenges in the application and variability of results while using activity-monitoring tracking data for the assessment of gait improvement in iNPH after CSF diversion surgery. 21,22 Also, in a study by Ferrari et al, there was a significant correlation between clinical variables and data from inertial sensors, 23 although paired analysis was not performed comparing the changes over time.…”

Section: Discussionmentioning

confidence: 99%

Objective assessment of patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement using activity-monitoring data: pilot study

Jusué-Torres

Brown

Pennington

et al. 2023

Neurosurgical Focus

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OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) results in significant morbidity in the elderly with symptoms of dementia, gait instability, and urinary incontinence. In well-selected patients, ventriculoperitoneal shunt (VPS) placement often results in clinical improvement. Most postshunt assessments of patients rely on subjective scales. The goal of this study was to assess the utility of remote activity monitoring to provide objective evidence of gait improvement following VPS placement for iNPH. METHODS Patients with iNPH were prospectively enrolled and fitted with 5 activity monitors (on the hip and bilateral thighs and ankles) that they wore for 4 days preoperatively within 30 days of surgery and for 4 days within 30 days postoperatively. Monitors collected continuous data for number of steps, cadence, body position (upright, prone, supine, and lateral decubitus), gait entropy, and the proportion of each day spent active or static. Data were retrieved from the devices and a comparison of pre- and postoperative movement assessment was performed. The gait data were also correlated with formal clinical gait assessments before and after lumbar puncture and with motion analysis laboratory testing at baseline and 1 month and 1 year after VPS placement. RESULTS Twenty patients fulfilled the inclusion and exclusion criteria (median age 76 years). The baseline median number of daily steps was 1929, the median percentage of the day spent inactive was 70%, the median percentage of the day with a static posture was 95%, the median gait velocity was 0.49 m/sec, and the median number of steps required to turn was 8. There was objective improvement in median entropy from pre- to postoperatively, increasing from 0.6 to 0.8 (p = 0.002). There were no statistically significant differences for any of the remaining variables measured by the activity monitors when comparing the preoperative to the 1-month postoperative time point. All variables from motion analysis testing showed statistically significant differences or a trend toward significance at 1 year after VPS placement. Among the significantly correlated variables at baseline, cadence was inversely correlated with percentage of gait cycle spent in the support phase (contact with ground vs swing phase). CONCLUSIONS This pilot study suggests that activity monitoring provides an early objective measure of improvement in gait entropy after VPS placement among patients with iNPH, although a more significant improvement was noted on the detailed clinical gait assessments. Further long-term studies are needed to determine the utility of remote monitoring for assessing gait improvement following VPS placement.

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Gait apraxia evaluation in normal pressure hydrocephalus using inertial sensors. Clinical correlates, ventriculoperitoneal shunt outcomes, and tap-test predictive capacity

Cited by 5 publications

References 48 publications

“TiC-TUG”: technology in clinical practice using the instrumented timed up and go test—a scoping review

“TiC-TUG”: technology in clinical practice using the instrumented timed up and go test—a scoping review

Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus

Objective assessment of patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement using activity-monitoring data: pilot study

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