Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and University of Geneva, 4 rue Gabrielle-Perret-Gentil, Geneva 1211, Switzerland.
J Neuroeng Rehabil. 2013 Dec 21;10:117. doi: 10.1186/1743-0003-10-117.
Gait disturbances found in patients with idiopathic normal pressure hydrocephalus (iNPH) are unspecific to the diagnosis and commonly occur in neurodegenerative or vascular conditions (iNPH-like conditions). This current retrospective pre-post intervention study aims to determine whether changes in quantitative gait parameters during dual task condition differed between iNPH and iNPH-like conditions before and after cerebrospinal fluid (CSF) tapping.
49 patients assessed before and after CSF tapping were included in this study (27 with iNPH and 22 with iNPH-like conditions). Gait analysis during single and dual task conditions (walking and backward counting) was performed before and after a CSF spinal tap of 40 ml. Gait parameters were compared between iNPH and iNPH-like conditions patients. Logistic regressions were used to examine the association between iNPH and gait parameters.
Improvements of step width (-9.03 (20.75)% for iNPH group; +0.28 (21.76)% for iNPH-like conditions group), stride length (+7.82 (20.71)% for iNPH group; -0.62 (19.22)% for iNPH-like conditions group), walking speed (+12.20 (29.79)% for iNPH group; +2.38 (32.50)% for iNPH-like conditions group) and stance duration (-1.23 (4.03)% for iNPH group; +0.49 (5.12)% for iNPH-like conditions group) during dual task, after CSF spinal tapping, were significant in patients with iNPH compared to patients with iNPH-like conditions. No between group difference was observed for the single walking task evaluation. The multiple logistic regression revealed that among these four gait parameters, only the improvement in step width was associated with the diagnosis of iNPH.
Dual-task related changes in spatio-temporal gait parameters before and after CSF tapping might be a novel and discriminative method of identifying iNPH patients from other similar conditions.
特发性正常压力脑积水（iNPH）患者的步态障碍与诊断不相关，常见于神经退行性或血管性疾病（iNPH 样疾病）。本回顾性干预前后研究旨在确定在脑脊液（CSF）引流前后，双任务条件下定量步态参数的变化是否在 iNPH 和 iNPH 样疾病之间有所不同。
本研究纳入了 49 例 CSF 引流前后评估的患者（27 例 iNPH，22 例 iNPH 样疾病）。在 CSF 腰穿前和腰穿后进行单任务和双任务条件（行走和倒计数）的步态分析。比较 iNPH 和 iNPH 样疾病患者的步态参数。使用逻辑回归检验 iNPH 和步态参数之间的关联。
步宽改善（iNPH 组为-9.03（20.75）%；iNPH 样疾病组为+0.28（21.76）%）、步长增加（iNPH 组为+7.82（20.71）%；iNPH 样疾病组为-0.62（19.22）%）、行走速度提高（iNPH 组为+12.20（29.79）%；iNPH 样疾病组为+2.38（32.50）%）和站立时间缩短（iNPH 组为-1.23（4.03）%；iNPH 样疾病组为+0.49（5.12）%）在 iNPH 患者中，在 CSF 腰穿后进行双任务时，明显优于 iNPH 样疾病患者。在单步行任务评估中，两组间无差异。多元逻辑回归显示，在这四个步态参数中，只有步宽的改善与 iNPH 的诊断相关。
在 CSF 引流前后，双任务相关的时空步态参数变化可能是一种新颖且具有鉴别能力的方法，可用于识别 iNPH 患者与其他类似疾病。
