Comparative Assessment of Gait and Balance in Patients with Parkinson's Disease and Normal Pressure Hydrocephalus

Ozgur Oztop Cakmak; Kardelen Akar; Hussein Youssef; Mustafa Yavuz Samanci; Sibel Ertan; Atay Vural

doi:10.14744/SEMB.2023.79990

Comparative Assessment of Gait and Balance in Patients with Parkinson's Disease and Normal Pressure Hydrocephalus

Sisli Etfal Hastan Tip Bul. 2023 Jun 20;57(2):232-237. doi: 10.14744/SEMB.2023.79990. eCollection 2023.

Authors

Ozgur Oztop Cakmak¹, Kardelen Akar², Hussein Youssef², Mustafa Yavuz Samanci³, Sibel Ertan¹, Atay Vural^{1

2}

Affiliations

¹ Department of Neurology, Koc University Faculty of Medicine, Istanbul, Türkiye.
² Motion Analysis Laboratory, Koc University, KUTTAM, Istanbul, Türkiye.
³ Department of Neurosurgery, Koc University Faculty of Medicine, Istanbul, Türkiye.

Abstract

Objectives: We aim to compare balance and gait parameters in patients diagnosed with Parkinson's disease (PD) and normal pressure hydrocephalus (NPH).

Methods: A total of 13 patients with NPH, 20 with PD, and 13 healthy controls (HC) recruited in the study. Three IMU sensors (Ambulatory PD Monitoring Inc., OR, USA) were placed on the lumbar area and the feet of the participants. The balance evaluations comprised eight successive standing tasks; the modified clinical test of sensory interaction on balance test. These tasks involved standing with feet apart and eyes open as well as eyes closed on a firm and foam surface, standing with feet together and eyes open as well as eyes closed, and tandem stance with the right foot front and the left foot front. Functional evaluations of gait were conducted using the 10-M Walk Test (10 MWT), the 2 min-Walk Test (2 MWT), and the timed-up and go (TUG). Parameters of the gait and balance were analyzed and then compared.

Results: NPH patients displayed a notable decrease in both stride length and gait speed as compared with both PD patients and healthy participants. The balance tests revealed that the NPH group demonstrated significantly poorer performance, specifically in the feet-apart eyes-closed foam-surface test, and the tandem stance test. During the tasks while eyes were open on firm and foam surfaces, PD and NPH groups showed an increase in root mean square sway, range, and mean velocity (p<0.05) of sway in the anteroposterior plane. In addition, during the TUG test, the NPH group exhibited a significant prolongation in the time needed to complete the task and a decline in turning velocity as compared to PD, but no notable difference was seen in comparison to the HC group.

Conclusion: Our study indicated that the patients with NPH exhibited notably worse gait and balance measurements in comparison to both the PD patients and HC groups. These findings emphasize the significance of monitoring and managing gait and balance impairments in NPH patients. Sensor-based technologies may offer objective parameters for a more precise and efficient follow-up of these patients in terms of gait and balance.

Keywords: Ambulatory PD monitoring; Parkinson’s disease; balance; gait analysis; normal pressure hydrocephalus.