Yasutaka Nikaido1, Hideyuki Urakami2, Toshihiro Akisue3, Yohei Okada4, Naoya Katsuta5, Yuki Kawami6, Takuya Ikeji3, Kenji Kuroda5, Tetsuya Hinoshita5, Hiroshi Ohno5, Yoshinaga Kajimoto7, Ryuichi Saura8. 1. Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan. Electronic address: reh055@osaka-med.ac.jp. 2. Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan; Graduate School of Health Science, Kio University, Nara, Japan. 3. Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan. 4. Graduate School of Health Science, Kio University, Nara, Japan; Neurorehabilitation Research Center of Kio University, Nara, Japan. 5. Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan. 6. Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan; Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Hyogo, Japan. 7. Department of Neurosurgery, Division of Surgery, Osaka Medical College, Osaka, Japan. 8. Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical College, Osaka, Japan.
Abstract
OBJECTIVES: The factors influencing falls in idiopathic normal pressure hydrocephalus (iNPH) remain unclear, although iNPH-associated gait and balance disturbances can lead to an increased risk of falls. This study aimed to investigate the associations among fall status, gait variability, balance function in iNPH, and to identify fall-related factors in iNPH. PATIENTS AND METHODS: Sixty-three patients with iNPH with a positive cerebrospinal fluid tap test result according to the iNPH diagnosis criteria participated in this prospective cross-sectional study. Patients were assessed using the 10-meter walk test (10MWT), the Functional Gait Assessment (FGA), the Berg Balance Scale (BBS), and the isometric quadriceps strength (QS). We also investigated each patient's history of falls in the past 6 months. Gait variability was measured using a triaxial accelerometer attached to the patient's torso at the L3 vertebra level during the 10MWT. RESULTS: Fall status correlated significantly with gait variability (measured as the coefficient of variation; CV) in step time and movement trajectory amplitude (i.e., center of mass movement) in the medial/lateral (ML) and vertical (VT) directions, with balance function as assessed by FGA and BBS scores. In contrast, QS was not correlated with fall status. The independent variables associated with the risk of falling were step time CV, FGA score, and age. CONCLUSION: The factors associated with the risk of falling in iNPH were aging and gait-balance instability, particularly temporal gait variability and dynamic balance dysfunction. Our results may enable physicians to identify the patients with iNPH who are at risk of falling and implement suitable prevention strategies.
OBJECTIVES: The factors influencing falls in idiopathic normal pressure hydrocephalus (iNPH) remain unclear, although iNPH-associated gait and balance disturbances can lead to an increased risk of falls. This study aimed to investigate the associations among fall status, gait variability, balance function in iNPH, and to identify fall-related factors in iNPH. PATIENTS AND METHODS: Sixty-three patients with iNPH with a positive cerebrospinal fluid tap test result according to the iNPH diagnosis criteria participated in this prospective cross-sectional study. Patients were assessed using the 10-meter walk test (10MWT), the Functional Gait Assessment (FGA), the Berg Balance Scale (BBS), and the isometric quadriceps strength (QS). We also investigated each patient's history of falls in the past 6 months. Gait variability was measured using a triaxial accelerometer attached to the patient's torso at the L3 vertebra level during the 10MWT. RESULTS: Fall status correlated significantly with gait variability (measured as the coefficient of variation; CV) in step time and movement trajectory amplitude (i.e., center of mass movement) in the medial/lateral (ML) and vertical (VT) directions, with balance function as assessed by FGA and BBS scores. In contrast, QS was not correlated with fall status. The independent variables associated with the risk of falling were step time CV, FGA score, and age. CONCLUSION: The factors associated with the risk of falling in iNPH were aging and gait-balance instability, particularly temporal gait variability and dynamic balance dysfunction. Our results may enable physicians to identify the patients with iNPH who are at risk of falling and implement suitable prevention strategies.
Authors: Alberto Ferrari; David Milletti; Pierpaolo Palumbo; Giulia Giannini; Sabina Cevoli; Elena Magelli; Luca Albini-Riccioli; Paolo Mantovani; Pietro Cortelli; Lorenzo Chiari; Giorgio Palandri Journal: Fluids Barriers CNS Date: 2022-06-23