Quantitative Gait Analysis and Cerebrospinal Fluid Tap Test for Idiopathic Normal-pressure Hydrocephalus

Abstract

We investigated gait performance utilizing a quantitative gait analysis for 2 groups: (1) idiopathic normal-pressure hydrocephalus (INPH) patients who had a positive response to the cerebrospinal fluid tap test (CSFTT) and (2) healthy controls. The aims of the study were (1) to analyze the characteristics of gait features, (2) to characterize changes in gait parameters before and after the CSFTT, and (3) to determine whether there was any relationship between stride time and stride length variability and Frontal Assessment Battery (FAB) scores in INPH patients. Twenty-three INPH patients and 17 healthy controls were included in this study. Compared with healthy controls, the gait of INPH patients was characterized by lower velocity, shorter stride length, and more broad-based gait. Patients with INPH had a longer stance phase with increased double-limb support. Variability in stride time and stride length was increased in INPH patients. Stride time and stride length variability were correlated with FAB score. After the CSFTT, gait velocity, stride length, and step width significantly improved. There were significant decreases in stride time and stride length variability. These results suggest that the CSFTT for INPH patients might improve the so-called balance-related gait parameter (ie, step width) as well. Stride time and stride length variability also responded to the CSFTT. Association between FAB scores and both stride time and stride length variability suggests involvement of similar circuits producing gait variability and frontal lobe functions in INPH patients.

Quantitative gait analysis of idiopathic normal pressure hydrocephalus using deep learning algorithms on monocular videos

“…It was reported that more than half of INPH patients (56%) experienced falls 34 . Further, we previously reported that stride time and stride length variability were increased in INPH patients relative to controls 21 . Therefore, increased gait variability may be one of the main risk factors for falls in INPH patients 21 .…”

“…Further, we previously reported that stride time and stride length variability were increased in INPH patients relative to controls 21 . Therefore, increased gait variability may be one of the main risk factors for falls in INPH patients 21 . We cautiously suggest that the vision-based gait analysis system has the potential to ‘bridge the gap’ between laboratory testing and clinical assessment of fall risk in INPH patients.…”

“…The Frontal Assessment Battery (FAB) has been proven to be a reliable and short bedside cognitive and behavioral test to assess frontal lobe functions 20 . In a prior study of INPH patients, we found that stride time and stride length variability measured by the GAITRite system were correlated with FAB score 21 .…”

“…Forty-six INPH patients (35 CSFTT responders and 11 CSFTT non-responders) constituted the final sample for analysis. Response to the CSFTT was defined in detail elsewhere 21 . Baseline clinical findings of the study cohort are shown in Table 1 .…”

“…INPH gait dysfunction has been traditionally characterized in a general way as lower-body parkinsonism 35 . However, according to recent studies using quantitative gait analysis instruments, INPH gait dysfunctions can be characterized more specifically as follows 21 , 34 , 36 . Dysfunctions possibly related to the basal ganglia circuitry may include decreased walking speed and short stride lengths 21 , 34 , 36 .…”