The effects of cerebrospinal fluid tap-test on idiopathic normal pressure hydrocephalus: an inertial sensors based assessment

Abstract

Background: Gait disturbances are typical of persons with idiopathic normal pressure hydrocephalus (iNPH) without signs distinctive from other neurodegenerative and vascular conditions. Cerebrospinal fluid tap-test (CSF-TT) is expected to improve the motor performance of iNPH patients and is a prognostic indicator in their surgical management. This observational prospective study aims to determine which spatio-temporal gait parameter(s), measured during instrumented motor tests, and clinical scale(s) may provide a relevant contribution in the evaluation of motor performance pre vs. post CSF-TT on iNPH patients with and without important vascular encephalopathy. Methods: Seventy-six patients (20 with an associated vascular encephalopathy) were assessed before, and 24 and 72 h after the CSF-TT by a timed up and go test (TUG) and an 18 m walking test (18 mW) instrumented using inertial sensors. Tinetti Gait, Tinetti Balance, Gait Status Scale, and Grading Scale were fulfilled before and 72 h after the CSF-TT. Stride length, cadence and total time were selected as the outcome measures. Statistical models with mixed effects were implemented to determine the relevant contribution to response variables of each quantitative gait parameter and clinical scales. Results and conclusion: From baseline to 72 h post CSF-TT patients improved significantly by increasing cadence in 18 mW and TUG (on average of 1.7 and 2.4 strides/min respectively) and stride length in 18 mW (on average of 3.1 cm). A significant reduction of gait apraxia was reflected by modifications in double support duration and in coordination index. Tinetti Gait, Tinetti Balance and Gait Status Scale were able to explain part of the variability of response variables not covered by instrumental data, especially in TUG. Grading Scale revealed the highest affinity with TUG total time and cadence when considering clinical scales alone. Patients with iNPH and an associated vascular encephalopathy showed worst performances compared to pure iNPH but without statistical significance. Gait improvement following CSF-TT was comparable in the two groups. Overall these results suggest that, in order to augment CSF-TT accuracy, is key to assess the gait pattern by analyzing the main spatiotemporal parameters and set post evaluation at 72 h. Trial registration: Approved by ethics committee: CE 14131 23/02/2015.

Quantitative Evaluation of Gait Changes Using APDM Inertial Sensors After the External Lumbar Drain in Patients With Idiopathic Normal Pressure Hydrocephalus

“…Previous studies have reported that the gait features used in determining the diagnosis of iNPH are not specific for identifying individuals who responded to tap tests ( 17 ). However, some quantitative studies have shown contrary results ( 4 , 18 – 20 ). Our study provides evidence that gait and balance parameters are useful for quantifying changes after ELD in patients with iNPH.…”

Evaluation of the Effectiveness of the Tap Test by Combining the Use of Functional Gait Assessment and Global Rating of Change

“…It has been reported that the time and the number of steps taken in a 10 m walk at free speed after the tap test correlate with the improvement of iNPH grading scale ( 23 ). Other reports suggest that the Tinetti Tool Assessment which involves different gait parameters is more effective at 72 h than at 24 h as the timing of evaluation after the tap test ( 24 , 25 ).…”

The Pathogenesis Based on the Glymphatic System, Diagnosis, and Treatment of Idiopathic Normal Pressure Hydrocephalus

“… 55 The reliability of shunt surgery is often estimated by comparing the gait assessment before and after TT because of the better improvement of gait disorder by shunt surgery, and the assessment process can yield good results with or without the aid of equipment. 76 , 77 Most importantly, a sufficient volume of CSF needs to be drained to have an effect on the glymphatic system function, which can improve symptoms over time, in order to better assess the shunt effect. 56 , 59 Gait is usually reassessed 30 min to 4 h after the test, and there is also an assessment of urinary and cognitive function after one week in clinical trials.…”