Technological Advances for Gait and Balance in Normal Pressure Hydrocephalus: A Systematic Review.

Normal pressure hydrocephalus (NPH) is a recognized cause of reversible cognitive and motor decline, with gait and balance impairments often emerging early. Technologies providing gait and balance measures can aid in early detection, diagnosis, and prognosis of the disease. This systematic review comprehensively discusses previous studies on the instrumental assessment of gait and balance in NPH. A PubMed search following PRISMA guidelines identified studies published between 2000 and 2024 that used laboratory instruments to assess gait and balance in NPH. Studies underwent quality assessment for internal, statistical, and external validity. Methodological details such as motor tasks, instruments, analytical approaches, and main findings were summarized. Overall, this review includes 41 studies on gait and 17 on balance, most of which used observational, cross-sectional designs. These studies employed various tools, such as pressure-sensitive platforms, optoelectronic motion-capture systems, and wearable inertial sensors. Significant differences in kinematic measures of gait and balance have been found in NPH patients compared to healthy controls and individuals with other neurological conditions. Finally, this review explores potential pathophysiological mechanisms underlying the kinematic changes in gait and balance in NPH and emphasizes the absence of longitudinal data, which hinders drawing definitive conclusions for prognostic purposes.