Dataset Information

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

ABSTRACT:

Background

Idiopathic normal pressure hydrocephalus (iNPH) is a neurological condition with gait apraxia signs from its early manifestation. Ventriculoperitoneal shunt (VPS) is a surgical procedure available for treatment. The Cerebrospinal fluid Tap Test (CSF-TT) is a quick test used as selection criterion for VPS treatment. Its predictive capacity for VPS outcomes is still sub judice. This study is aimed to test the hypothesis that wearable motion sensors provide valid measures to manage iNPH patients with gait apraxia.

Methods

Forty-two participants of the Bologna PRO-Hydro observational cohort study were included in the analyses. The participants performed the Timed Up and Go (TUG) and the 18 m walking test (18mW) with inertial sensors at baseline, three days after the CSF-TT, and six months after VPS. 21 instrumental variables described gait and postural transitions from TUG and 18mW recordings. Furthermore, participants were clinically assessed with scales (clinical variables). We tested the hypothesis by analysing the concurrent validity of instrumental and clinical variables, their individual- and group-level responsiveness to VPS, and their predictive validity for VPS outcomes after CSF-TT.

Results

The instrumental variables showed moderate to high correlation with the clinical variables. After VPS, most clinical and instrumental variables showed statistically significant improvements that reflect a reduction of apraxic features of gait. Most instrumental variables, but only one clinical variable (i.e., Tinetti POMA), had predictive value for VPS outcomes (significant adjusted R² in the range 0.12-0.70).

Conclusions

These results confirm that wearable inertial sensors may represent a valid tool to complement clinical evaluation for iNPH assessment and prognosis.

SUBMITTER: Ferrari A

PROVIDER: S-EPMC9219204 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

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

Ferrari Alberto A Milletti David D Palumbo Pierpaolo P Giannini Giulia G Cevoli Sabina S Magelli Elena E Albini-Riccioli Luca L Mantovani Paolo P Cortelli Pietro P Chiari Lorenzo L Palandri Giorgio G

Fluids and barriers of the CNS 20220623 1

<h4>Background</h4>Idiopathic normal pressure hydrocephalus (iNPH) is a neurological condition with gait apraxia signs from its early manifestation. Ventriculoperitoneal shunt (VPS) is a surgical procedure available for treatment. The Cerebrospinal fluid Tap Test (CSF-TT) is a quick test used as selection criterion for VPS treatment. Its predictive capacity for VPS outcomes is still sub judice. This study is aimed to test the hypothesis that wearable motion sensors provide valid measures to mana ...[more]

PMID: 35739555

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Project description:BackgroundDisproportionately enlarged subarachnoid space hydrocephalus is a specific radiologic marker for idiopathic normal pressure hydrocephalus. However, controversy exists regarding the prognostic utility of disproportionately enlarged subarachnoid space hydrocephalus.PurposeOur aim was to evaluate the prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus and its predictive utility regarding prognosis in patients treated with ventriculoperitoneal shunt surgery.Data sourcesWe used MEDLINE and EMBASE databases.Study selectionWe searched for studies that reported the prevalence or the diagnostic performance of disproportionately enlarged subarachnoid space hydrocephalus in predicting treatment response.Data analysisThe pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus was obtained. Pooled sensitivity, specificity, and area under the curve of disproportionately enlarged subarachnoid space hydrocephalus to predict treatment response were obtained. Subgroup and sensitivity analyses were performed to explain heterogeneity among the studies.Data synthesisTen articles with 812 patients were included. The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus was 44% (95% CI, 34%-54%). The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus was higher in the studies using the second edition of the Japanese Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus compared with the studies using the international guidelines without statistical significance (52% versus 43%, P = .38). The pooled sensitivity and specificity of disproportionately enlarged subarachnoid space hydrocephalus for prediction of treatment response were 59% (95% CI, 38%-77%) and 66% (95% CI, 57%-74%), respectively, with an area under the curve of 0.67 (95% CI, 0.63-0.71).LimitationsThe lack of an established method for assessing disproportionately enlarged subarachnoid space hydrocephalus using brain MR imaging served as an important cause of the heterogeneity.ConclusionsOur meta-analysis demonstrated a relatively low prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus and a poor diagnostic performance for treatment response.

Project description:BackgroundThe cerebrospinal fluid (CSF) tap test (TT) has been regarded as an important test for the prediction of shunt effectiveness in patients with suspected idiopathic normal pressure hydrocephalus (iNPH). Although its specificity and sensitivity are reportedly high, there remains some disagreement over this point. Herein, the TT as a test for predicting shunt effectiveness was investigated in our multicenter prospective study named SINPHONI and strategies to increase its predictability were examined.MethodsOne hundred suspected iNPH patients with the following entry criteria were enrolled in the study: (1) 60 to 85 years old, (2) one or more of the NPH triad signs, (3) ventriculomegaly (Evans index > 0.3), (4) high convexity tightness in coronal-section MRI, and (5) no antecedent disorders. Changes in NPH triad symptoms were assessed using the iNPH grading scale and other measures before and after removal of 30 ml lumbar CSF. A positive response to TT was pre-defined by specific improvements on the grading and other scales. A ventriculoperitoneal shunt was performed with a programmable valve. The sensitivity and specificity of the TT was calculated with a contingency table. A decision tree analysis was performed to increase the predictability of the TT.ResultsAmong 100 patients, 80 were shunt responders. A statistically-significant variable between shunt responders and non-responders was CSF pressure. The changes in single variables in the iNPH grading scale after TT showed high specificity with low sensitivity. In contrast, change of the total score in the iNPH grading scale showed a relatively high sensitivity of 71.3% with specificity of 65%. A decision tree analysis revealed that using the iNPH grading scale total score and pre-shunt CSF pressure ≥ 15 cmH20, sensitivity increased to 82.5%, without a decrease in specificity.ConclusionsThe sensitivity and specificity of the TT for predicting shunt responsiveness were optimum when improvement on any iNPH grading scale was combined with CSF pressure ≥ 15 cmH20. To increase the sensitivity of the TT, further effort is necessary.Trial registrationThis study is registered with ClinicalTrials.gov, with the number NCT00221091.

Project description:BackgroundGait disturbance is the most pronounced symptom in idiopathic normal pressure hydrocephalus (iNPH). Some gait parameters have been previously described, but an in-depth description of the gait pattern is lacking. The aim was to quantitatively evaluate gait in iNPH patients before and after shunt surgery and compare it to healthy individuals (HI), and correlate it with functional tests preoperatively.MethodsIn total, 47 patients and 42 HI were included. The patients were assessed with the iNPH scale (total, gait and balance domain scores were analyzed), the timed up and go test (TUG) and an inertial sensor gait analysis system, RehaGait®, pre- and postoperatively. The HI were assessed with TUG and RehaGait®. Gait variables were: stride length, stride duration, velocity, cadence, variability, stance, swing, single support, double support, step height, hip, knee and ankle joint angles.ResultsCompared to HI, the main differences in the gait variables were: decreased stride length (p < 0.01), velocity (p < 0.01), swing time (p < 0.01), single support (p < 0.01), hip flexion (p < 0.01), heel strike angle (p < 0.01) and toe-off angle (p < 0.01). Step height was normalized postoperatively; all other variables remained significantly worse than the HI. There were strong correlations between stride length, velocity, heel strike angle, and toe-off angle and the functional gait tests, but no correlations for any variable and the balance domain score.ConclusionsThe patients walked with reduced hip flexion, heel strike angle and toe-off angle, and had shorter strides, decreased velocity, and increased time for swing and single support, compared to HI. Step height was the only gait variable normalized after shunt surgery. Ankle joint kinematics correlated strongly with the results in functional gait tests. More research is warranted about how gait speed affects other gait variables in iNPH.Trial registrationClinicalTrials.gov NCT04795089.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

Similar Datasets

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