Yasutaka Nikaido1, Toshihiro Akisue2, Yoshinaga Kajimoto3, Takuya Ikeji4, Yuki Kawami4, Hideyuki Urakami5, Hisatomo Sato5, Tadayuki Nishiguchi5, Tetsuya Hinoshita5, Yuka Iwai5, Kenji Kuroda5, Hiroshi Ohno5, Ryuichi Saura6. 1. Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan; Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan. 2. Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan. Electronic address: akisue@med.kobe-u.ac.jp. 3. Department of Neurosurgery, Division of Surgery, Osaka Medical College, Osaka, Japan. 4. Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan. 5. Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan. 6. Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical College, Osaka, Japan.
Abstract
BACKGROUND: Although gait and balance disturbances are core symptoms of idiopathic normal pressure hydrocephalus (iNPH), the ambulatory center of mass (COM) movements in patients with iNPH remain unclear. We aimed to clarify the ambulatory COM movements using an accelerometer on the patients' lower torsos and to investigate the changes in COM movement after cerebrospinal fluid tap tests (TT) and shunt surgeries (SS). METHODS: Twenty-three patients with iNPH and 18 age-matched healthy controls (HCs) were recruited. A triaxial accelerometer was fixed with a belt onto each participant's torso at the L3 vertebra level. We assessed each patient's 10-m gait before TT, 3 days after TT, and 1 week after SS. RESULTS: Compared to the HCs, the patients exhibited decreased gait velocities, increased step numbers, and increased step times. Their movement trajectory amplitudes (i.e., the COM movements) were increased in the medial/lateral direction and decreased in the vertical direction. They also exhibited greater variability (measured as coefficients of variation) in step time and movement trajectory amplitude in both the medial/lateral and vertical directions. The patients' gait parameters were significantly improved after TT and SS. SIGNIFICANCE: Our results suggest that iNPH-associated gait disturbances could cause abnormal ambulatory COM movements and that these disturbances are mitigated by TT and SS.
BACKGROUND: Although gait and balance disturbances are core symptoms of idiopathic normal pressure hydrocephalus (iNPH), the ambulatory center of mass (COM) movements in patients with iNPH remain unclear. We aimed to clarify the ambulatory COM movements using an accelerometer on the patients' lower torsos and to investigate the changes in COM movement after cerebrospinal fluid tap tests (TT) and shunt surgeries (SS). METHODS: Twenty-three patients with iNPH and 18 age-matched healthy controls (HCs) were recruited. A triaxial accelerometer was fixed with a belt onto each participant's torso at the L3 vertebra level. We assessed each patient's 10-m gait before TT, 3 days after TT, and 1 week after SS. RESULTS: Compared to the HCs, the patients exhibited decreased gait velocities, increased step numbers, and increased step times. Their movement trajectory amplitudes (i.e., the COM movements) were increased in the medial/lateral direction and decreased in the vertical direction. They also exhibited greater variability (measured as coefficients of variation) in step time and movement trajectory amplitude in both the medial/lateral and vertical directions. The patients' gait parameters were significantly improved after TT and SS. SIGNIFICANCE: Our results suggest that iNPH-associated gait disturbances could cause abnormal ambulatory COM movements and that these disturbances are mitigated by TT and SS.