Utility of 3D gait analysis in iNPH, version 1
Research type
Research Study
Full title
Utility of 3-dimensional gait analysis in reference to clinical assessments to detect significant change after a cerebrospinal fluid tap test in patients investigated for idiopathic normal pressure hydrocephalus
IRAS ID
302102
Contact name
Tobias Langheinrich
Contact email
Sponsor organisation
Northern Care Alliance NHS Foundation Trust
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Idiopathic normal pressure hydrocephalus (iNPH) is a condition causing progressive decline of gait, bladder and cognition. Decline of gait in particular can be improved with drainage of cerebrospinal fluid (CSF) in many patients. To determine which patients are likely to benefit, CSF is temporarily drained during a lumbar puncture (LP, “tap test” or TT). Demonstration of improvement in patients’ mobility after TT is crucial to correctly identify which patients should be offered permanent treatment. Current practice relies on manual mobility assessments. Changes can be difficult to detect if gait is only mildly impaired or change is discrete. Video-recorded gait performance is often used. There is no universally accepted, standardized rating system. The test is often rated as “equivocal” or "no improvement" and people with iNPH (pwN) are consequently denied treatment. Few studies have used advanced gait analysis techniques in pwN - none has reported analyses which include joint kinetics and kinematics. A more sensitive method to identify changes in mobility in pwN is needed. This work will be the first to (i) characterise gait impairment in pwN compared to healthy controls (HC) using 3 dimensional gait analysis (3D); (ii) quantify changes after LP in gait in reference to clinical assessments; and (iii) explore thresholds to differentiate responders from non-responders to LP compared to clinical assessments with the aim of providing an objective reliable primary outcome variable for future randomized controlled clinical trials and to improve clinical care. The outcomes of this work will inform clinical care guidelines and research into better diagnosis and treatment of pwN. pwN will be recruited from the regional NPH clinic at Salford Royal Hospital (SRH) where they undergo TT, HC from the general public. Clinical scientific oversight is provided by our partners at Gothenburg University (GU). 3D will be conducted at the Manchester Metropolitan University (MMU).
Lay summary of study results: Aims:
This study aimed to provide detailed analysis of gait of individuals with suspected iNPH as compared to healthy people of similar age.Background:
Few studies have used advanced gait analysis techniques for identification and monitoring of people with idiopathic Normal Pressure Hydrocephalus (iNPH), a neurological condition of excess fluid on the brain causing difficulties with mobility - those that have only report simple measures that can be obtained through simple techniques such as visual inspection/video-recording and there is currently no research working towards an objective rating system.Methods:
Detailed 3D gait analysis was conducted recording gait speed, step length and width, and angulations of the large joints.Key findings:
Results indicate that all gait parameters were significantly different, and patients exhibited 63% slower gait speeds, 64% shorter step lengths, 418% larger step widths. Patients with iNPH also displayed reduced angles and ranges of motion.Patients with suspected iNPH exhibit clear gait deficiencies when compared to healthy controls. Future work will aim to evaluate these characteristics following cerebrospinal fluid tap-test and include techniques to predict which patient is likely to benfit. The results will therefore inform future clinical care guidelines.
REC name
East Midlands - Leicester Central Research Ethics Committee
REC reference
22/EM/0213
Date of REC Opinion
11 Oct 2022
REC opinion
Further Information Favourable Opinion