Dynamic gait stability in patients with idiopathic normal pressure hydrocephalus with high and low fall-risk

Yasutaka Nikaido; Hideyuki Urakami; Yohei Okada; Yoshinaga Kajimoto; Naoya Ishida; Yuki Kawami; Toshihiro Akisue; Ryuichi Saura

doi:10.1016/j.clinbiomech.2022.105757

Dynamic gait stability in patients with idiopathic normal pressure hydrocephalus with high and low fall-risk

Clin Biomech (Bristol, Avon). 2022 Oct:99:105757. doi: 10.1016/j.clinbiomech.2022.105757. Epub 2022 Sep 5.

Authors

Yasutaka Nikaido¹, Hideyuki Urakami², Yohei Okada³, Yoshinaga Kajimoto⁴, Naoya Ishida², Yuki Kawami⁵, Toshihiro Akisue⁶, Ryuichi Saura⁷

Affiliations

¹ Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan. Electronic address: yasutaka.nikaido@ompu.ac.jp.
² Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
³ Graduate School of Health Sciences, Kio University, Nara, Japan; Neurorehabilitation Research Center of Kio University, Nara, Japan.
⁴ Department of Neurosurgery, Division of Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan.
⁵ 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.
⁶ Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan.
⁷ Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.

PMID: 36113194
DOI: 10.1016/j.clinbiomech.2022.105757

Abstract

Background: This study aimed to investigate whether dynamic gait stability differs between idiopathic normal-pressure hydrocephalus with high- and low-fall-risk.

Methods: Participants comprised 40 idiopathic normal-pressure hydrocephalus patients and 23 healthy-controls. Idiopathic normal-pressure hydrocephalus patients were divided into those with high-fall-risk (n = 20) and low-fall-risk (n = 20) groups using the cut-off score of ≤14/30 for fall-risk on the Functional Gait Assessment. Dynamic stability during gait was assessed by three-dimensional motion analysis. Dynamic stability was defined as the ability to maintain an extrapolated center of mass within the base of support at heel contact, with the distance between the two defined as the margin of stability. Conscious motor control was assessed by the Movement-Specific Reinvestment Scale.

Findings: Anteroposterior and mediolateral margin of stabilities were significantly larger in both idiopathic normal-pressure hydrocephalus groups than in healthy-controls. The mediolateral margin of stability was significantly higher in the high-fall-risk group than in the low-fall-risk group; whereas, the anteroposterior margin of stability did not differ between idiopathic normal-pressure hydrocephalus groups. The Movement-Specific Reinvestment Scale was significantly higher in the high-fall-risk group than in the low-fall-risk group.

Interpretation: Idiopathic normal-pressure hydrocephalus patients with have high forward and lateral dynamic stability during gait regardless of their fall-risk. In particular, idiopathic normal-pressure hydrocephalus patients with high-fall-risk may consciously maintain lateral dynamic stability to a greater extent than those with low-fall-risk. These findings highlight a conscious motor control component in the pathological gait of idiopathic normal-pressure hydrocephalus, and provide clues for rehabilitation and fall prevention strategies in idiopathic normal-pressure hydrocephalus patients.

Keywords: Conscious motor control; Dynamic stability; Fall risk; Gait disturbance; Idiopathic normal pressure hydrocephalus; Pathological gait.

MeSH terms

Gait
Humans
Hydrocephalus, Normal Pressure*
Postural Balance
Risk Factors