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Trunk sway in idiopathic normal pressure hydrocephalus: quantitative assessment in clinical practice
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Vrinnevi Hospital, Norrköping, Sweden.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
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2017 (English)In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, p. 62-70, article id 54Article in journal (Refereed) Published
Abstract [en]

Background: In diagnosis and treatment of patients with idiopathic normal pressure hydrocephalus (iNPH), there is need for clinically applicable, quantitative assessment of balance and gait. Using a body worn gyroscopic system, the aim of this study was to assess postural stability of iNPH patients in standing, walking and during sensory deprivation before and after cerebrospinal fluid (CSF) drainage and surgery. A comparison was performed between healthy elderly (HE) and patients with various types of hydrocephalus (ventriculomegaly (VM)).

Methods: Trunk sway was measured in 31 iNPH patients, 22 VM patients and 58 HE. Measurements were performed at baseline in all subjects, after CSF drainage in both patient groups and after shunt surgery in the iNPH group.

Results: Preoperatively, the iNPH patients had significantly higher trunk sway compared to HE, specifically for the standing tasks (p < 0.001). Compared to VM, iNPH patients had significantly lower sway velocity during gait in three of four cases on firm support (p < 0.05). Sway velocity improved after CSF drainage and in forward-backward direction after surgery (p < 0.01). Compared to HE both patient groups demonstrated less reliance on visual input to maintain stable posture.

Conclusions: INPH patients had reduced postural stability compared to HE, particularly during standing, and for differentiation between iNPH and VM patients sway velocity during gait is a promising parameter. A reversible reduction of visual incorporation during standing was also seen. Thus, the gyroscopic system quantitatively assessed postural deficits in iNPH, making it a potentially useful tool for aiding in future diagnoses, choices of treatment and clinical follow-up. 

Place, publisher, year, edition, pages
Elsevier, 2017. p. 62-70, article id 54
Keywords [en]
Idiopathic normal pressure hydrocephalus, Trunk sway, Balance, Gait, Gyroscope
National Category
Biomedical Laboratory Science/Technology
Identifiers
URN: urn:nbn:se:umu:diva-138239DOI: 10.1016/j.gaitpost.2017.02.017ISI: 000405044400011PubMedID: 28259041Scopus ID: 2-s2.0-85014113899OAI: oai:DiVA.org:umu-138239DiVA, id: diva2:1133615
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2023-03-23Bibliographically approved
In thesis
1. Wearable systems and sensors for the assessment of motor control: Development and validation of methods for clinical assessment of idiopathic normal pressure hydrocephalus
Open this publication in new window or tab >>Wearable systems and sensors for the assessment of motor control: Development and validation of methods for clinical assessment of idiopathic normal pressure hydrocephalus
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Bärbara system och sensorer för bedömning av motorisk kontroll : Utveckling och validering av metoder för klinisk bedömning av idiopatisk normaltryckshydrocefalus
Abstract [en]

Human gait and balance are controlled by automatic processes in the central nervous system, and in sensory and proprioceptive systems. If a disturbance occurs in any of these complex structures, it may lead to balance and gait problems. Equally important are the systems controlling the upper extremity functions where reach, grasp and manipulation skills may be affected. For the neurodegenerative disease idiopathic normal pressure hydrocephalus (iNPH), balance and gait disturbances are cardinal symptoms. Motor control of the upper extremities is also affected. In clinic today, physical impairment of persons with iNPH is commonly visually assessed using subjective, course tests with ordinal scales with the risk of missing minor changes. There is a lack of objective and quantitative ways to measure motor control in daily patient care. The aim of this thesis was to develop and validate tools for objective assessment of parameters that affect motor control in persons with iNPH.

Postural stability in stance and walking was assessed using gyroscopes in patients with iNPH, healthy elderly (HE) and patients with ventriculomegaly (VM). Compared to HE, patients with iNPH had reduced postural stability and relied less on vision. iNPH patients also had a lower trunk sway velocity than VM during walking. The gyroscopic system could quantitatively assess postural deficits in iNPH, making it a potentially useful tool for diagnosis and for clinical follow-up. The differences found during gait also suggests that walking, rather than quiet stance, should be further investigated for facilitating differential diagnosis compared to other patient groups with ventriculomegaly.

The gait in patients with iNPH is according to guidelines defined as slow, shuffling with a low foot-lift, and wide based. To objectively quantify the latter two features, a system (Striton) was developed in-house to assess the increased distance between the feet and the peak heel-height at the push-off phase of the gait cycle. It was validated in experimental setups, compared to gold standard motion capture systems (MCS), on healthy elderly (HE), through test-retest and day-to-day evaluations, and in four patients with iNPH. Striton demonstrated high correlations, in step-width and in heel-height, compared with the MCS. The mean step-width in the HE was 5.2 ± 0.9 cm (mean±Standard Deviation) and the heel-height 16.7±0.6 cm. Test-retest and day-to-day variations were small, ±0.5 cm in step-width and ±1.2 cm in heel-height, and differences in the parameters were seen between HE and iNPH both before and after surgery. Thus, Striton has the potential of quantitatively assessing gait parameters in HE and iNPH in a valuable manner.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2021. p. 50
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2130
Keywords
Gait, step-width, heel-heigt, balance, trunk sway, idiopathic normal pressure hydrocephalus, IMU, Inter-rater reliability, kinematics
National Category
Medical Engineering Neurology
Research subject
medical informatics
Identifiers
urn:nbn:se:umu:diva-182784 (URN)978-91-7855-523-9 (ISBN)978-91-7855-524-6 (ISBN)
Public defence
2021-06-04, Betula, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
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Supervisors
Note

Disputationen sänds även via Zoom.

Available from: 2021-05-12 Created: 2021-05-04 Last updated: 2021-12-06Bibliographically approved

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Bäcklund, TomasFrankel, JenniferIsraelsson, HannaMalm, JanSundström, Nina

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