Yamada Shigeki, Aoyagi Yukihiko, Ishikawa Masatsune, Yamaguchi Makoto, Yamamoto Kazuo, Nozaki Kazuhiko
Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan.
Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, Japan.
Front Aging Neurosci. 2021 Mar 10;13:653964. doi: 10.3389/fnagi.2021.653964. eCollection 2021.
The subjective evaluation of pathological gait exhibits a low inter-rater reliability. Therefore, we developed a three-dimensional acceleration of the trunk during walking to assess the pathological gait quantitatively. We evaluated 97 patients who underwent the cerebrospinal tap test and were diagnosed with idiopathic normal pressure hydrocephalus (iNPH) and 68 healthy elderlies. The gait features of all patients were evaluated and classified as one of the following: freezing of gait, wide-based gait, short-stepped gait, shuffling gait, instability, gait festination, difficulty in changing direction, and balance disorder in standing up. All gait features of 68 healthy elderlies were treated as normal. Trunk acceleration was recorded automatically by a smartphone placed on the umbilicus during a 15-foot walking test. Two novel indices were created. The first index was a trunk acceleration index, which was defined as (forward acceleration fluctuation) + (vertical acceleration fluctuation) - (lateral acceleration fluctuation) based on the multivariate logistics regression model, and the second index was created by multiplying the forward acceleration with the vertical acceleration. Additionally, 95% confidence ellipsoid volume of the three-dimensional accelerations was assessed. Forward and vertical acceleration fluctuations were significantly associated with the probability of an iNPH-specific pathological gait. The trunk acceleration index demonstrated the strongest association with the probability of an iNPH-specific pathological gait. The areas under the receiver-operating characteristic curves for detecting 100% probability of an iNPH-specific pathological gait were 86.9% for forward acceleration fluctuation, 88.0% for vertical acceleration fluctuation, 82.8% for lateral acceleration fluctuation, 89.0% for trunk acceleration index, 88.8% for forward × vertical acceleration fluctuation, and 87.8% for 95% confidence ellipsoid volume of the three-dimensional accelerations. The probability of a pathological gait specific to iNPH is high at the trunk acceleration fluctuation, reduced in the forward and vertical directions, and increased in the lateral direction.
对病理性步态的主观评估显示评分者间信度较低。因此，我们开发了一种步行过程中躯干的三维加速度测量方法来定量评估病理性步态。我们评估了97例接受脑脊液检查并被诊断为特发性正常压力脑积水（iNPH）的患者以及68例健康老年人。对所有患者的步态特征进行评估并分类为以下之一：步态冻结、宽基步态、短步幅步态、拖曳步态、不稳定、步态急促、转向困难以及站立时平衡障碍。将68例健康老年人的所有步态特征视为正常。在15英尺步行测试期间，通过放置在脐部的智能手机自动记录躯干加速度。创建了两个新指标。第一个指标是躯干加速度指数，基于多变量逻辑回归模型定义为（向前加速度波动）+（垂直加速度波动）-（侧向加速度波动），第二个指标是通过将向前加速度与垂直加速度相乘得到。此外，还评估了三维加速度的95%置信椭球体体积。向前和垂直加速度波动与iNPH特异性病理性步态的概率显著相关。躯干加速度指数与iNPH特异性病理性步态的概率显示出最强的相关性。用于检测iNPH特异性病理性步态100%概率的受试者操作特征曲线下面积，向前加速度波动为86.9%，垂直加速度波动为88.0%，侧向加速度波动为82.8%，躯干加速度指数为89.0%，向前×垂直加速度波动为88.8%，三维加速度的95%置信椭球体体积为87.8%。iNPH特异性病理性步态的概率在躯干加速度波动时较高，在向前和垂直方向降低，在侧向方向增加。
