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Böttinger MJ, Labudek S, Schoene D, Jansen CP, Stefanakis ME, Litz E, Bauer JM, Becker C, Gordt-Oesterwind K. "TiC-TUG": technology in clinical practice using the instrumented timed up and go test-a scoping review. Aging Clin Exp Res 2024; 36:100. [PMID: 38676844 PMCID: PMC11055724 DOI: 10.1007/s40520-024-02733-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/05/2024] [Indexed: 04/29/2024]
Abstract
Digitized assessments have a considerable potential to guide clinicial decision making and monitor progress and disease trajectories. The Timed Up and Go test (TUG) has been long established for assessment in geriatric medicine and instrumented versions (iTUG) have been developed and validated. This scoping review includes studies that applied the iTUG and aims to identify use cases to show where and how iTUG assessment could guide interventions and clinical management. The literature search was limited to peer-reviewed studies that performed pre- and post-intervention measurements with a 3-meter TUG instrumented with body-worn technology in samples of at least 20 subjects aged 60+ years. Of 3018 identified articles 20 were included. Four clinical use cases were identified: stratification for subsequent therapy, monitoring of disease or treatment-associated changes and evaluation of interventions in patients with idiopathic normal pressure hydrocephalus (1), and patients with Parkinson's disease (2); monitoring after joint replacement surgery (3), and evaluation after different exercise and rehabilitation interventions (4). The included studies show diversity in terms of iTUG technology and procedures. The identified use cases highlight clinical relevance and high potential for the clinical application of the iTUG. A consensual approach as well as comprehensive reporting would help to further exploit the potential of the iTUG to support clinical management. Future studies should investigate the benefits of segmental iTUG analysis, responsiveness and participants' perspectives on clinically meaningful changes in iTUG.
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Affiliation(s)
- Melissa J Böttinger
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany.
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany.
| | - Sarah Labudek
- Clinic for Psychiatry and Psychotherapy, Helios Hospital Schwerin, Schwerin, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Daniel Schoene
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Marios-Evangelos Stefanakis
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Elena Litz
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Jürgen M Bauer
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Clemens Becker
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Katharina Gordt-Oesterwind
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
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Na CH, Siebers HL, Reim J, Eschweiler J, Hildebrand F, Clusmann H, Betsch M. Kinematic movement and balance parameter analysis in neurological gait disorders. J Biol Eng 2024; 18:6. [PMID: 38225612 PMCID: PMC10790442 DOI: 10.1186/s13036-023-00398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/07/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Neurological gait disorders are mainly classified based on clinical observation, and therefore difficult to objectify or quantify. Movement analysis systems provide objective parameters, which may increase diagnostic accuracy and may aid in monitoring the disease course. Despite the increasing wealth of kinematic movement and balance parameter data, the discriminative value for the differentiation of neurological gait disorders is still unclear. We hypothesized that kinematic motion and balance parameter metrics would be differently altered across neurological gait disorders when compared to healthy controls. METHODS Thirty one patients (9 normal pressure hydrocephalus < NPH > , 16 cervical myelopathy < CM > , 6 lumbar stenosis < LST >) and 14 healthy participants were investigated preoperatively in an outpatient setting using an inertial measurement system (MyoMotion) during 3 different walking tasks (normal walking, dual-task walking with simultaneous backward counting, fast walking). In addition, the natural postural sway of participants was measured by pedobarography, with the eyes opened and closed. The range of motion (ROM) in different joint angles, stride time, as well as sway were compared between different groups (between-subject factor), and different task conditions (within-subject factor) by a mixed model ANOVA. RESULTS Kinematic metrics and balance parameters were differently altered across different gait disorders compared to healthy controls. Overall, NPH patients significantly differed from controls in all movement parameters except for stride time, while they differed in balance parameters only with regard to AP movement. LST patients had significantly reduced ROMs of the shoulders, hips, and ankles, with significantly altered balance parameters regarding AP movement and passed center-of-pressure (COP) distance. CM patients differed from controls only in the ROM of the hip and ankle, but were affected in nearly all balance parameters, except for force distribution. CONCLUSION The application of inertial measurement systems and pedobarography is feasible in an outpatient setting in patients with different neurological gait disorders. Rather than defining singular discriminative values, kinematic gait and balance metrics may provide characteristic profiles of movement parameter alterations in the sense of specific ´gait signatures´ for different pathologies, which could improve diagnostic accuracy by defining objective and quantifiable measures for the discrimination of different neurological gait disorders. TRIAL REGISTRATION The study was retrospectively registered on the 27th of March 2023 in the 'Deutsches Register für Klinische Studien' under the number DRKS00031555.
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Affiliation(s)
- Chuh-Hyoun Na
- Department of Neurosurgery, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen, 52074, Germany.
| | - Hannah Lena Siebers
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Reim
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Marcel Betsch
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Dias SF, Graf C, Jehli E, Oertel MF, Mahler J, Schmid Daners M, Stieglitz LH. Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus. Front Neurol 2023; 14:1126298. [PMID: 37082443 PMCID: PMC10110860 DOI: 10.3389/fneur.2023.1126298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/01/2023] [Indexed: 04/07/2023] Open
Abstract
BackgroundThe identification of patients with gait disturbance associated with idiopathic normal pressure hydrocephalus (iNPH) is challenging. This is due to the multifactorial causes of gait disturbance in elderly people and the single moment examination of laboratory tests.ObjectiveWe aimed to assess whether the use of gait sensors in a patient's home environment could help establish a reliable diagnostic tool to identify patients with iNPH by differentiating them from elderly healthy controls (EHC).MethodsFive wearable inertial measurement units were used in 11 patients with iNPH and 20 matched EHCs. Data were collected in the home environment for 72 h. Fifteen spatio-temporal gait parameters were analyzed. Patients were examined preoperatively and postoperatively. We performed an iNPH sub-group analysis to assess differences between responders vs. non-responders. We aimed to identify parameters that are able to predict a reliable response to VP-shunt placement.ResultsNine gait parameters significantly differ between EHC and patients with iNPH preoperatively. Postoperatively, patients with iNPH showed an improvement in the swing phase (p = 0.042), and compared to the EHC group, there was no significant difference regarding the cadence and traveled arm distance. Patients with a good VP-shunt response (NPH recovery rate of ≥5) significantly differ from the non-responders regarding cycle time, cycle time deviation, number of steps, gait velocity, straight length, stance phase, and stance to swing ratio. A receiver operating characteristic analysis showed good sensitivity for a preoperative stride length of ≥0.44 m and gait velocity of ≥0.39 m/s.ConclusionThere was a significant difference in 60% of the analyzed gait parameters between EHC and patients with iNPH, with a clear improvement toward the normalization of the cadence and traveled arm distance postoperatively, and a clear improvement of the swing phase. Patients with iNPH with a good response to VP-shunt significantly differ from the non-responders with an ameliorated gait pattern.
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Affiliation(s)
| | - Christina Graf
- Product Development Group Zurich, Department of Mechanical and Process Engineering, Eidgenoessische Technische Hochschule Zurich, Zurich, Switzerland
| | - Elisabeth Jehli
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Julia Mahler
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, Eidgenoessische Technische Hochschule Zurich, Zurich, Switzerland
- *Correspondence: Marianne Schmid Daners
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Messerer M, Blanchard M, Papadimitriou K, Vandenbulcke A, Rutz D, Beaud V, Shiban E, Bally J, Allali G, Daniel RT, Cossu G. Impact of Subjective Evaluations in Predicting Response to Ventriculoperitoneal Shunt for Idiopathic Normal Pressure Hydrocephalus. World Neurosurg 2022; 166:e741-e749. [PMID: 35931340 DOI: 10.1016/j.wneu.2022.07.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cerebrospinal fluid tap test is a common procedure to predict the efficacy of ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus. Objective tests after cerebrospinal fluid tap test are used to establish the surgical indication, but subjective improvements may also be important in selection of surgical candidates. The aim of this study was to evaluate surgical outcomes of patients with ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus, comparing patients showing objective improvement with patients improving only on subjective assessments. METHODS In this retrospective analysis, patients were divided into 2 groups: group 1 included patients with improvement on objective evaluation after cerebrospinal fluid tap test; group 2 included patients who showed only subjective improvement. The surgical outcomes of the 2 groups were compared. RESULTS Of 28 included patients, 17 were objective responders (group 1), and 11 were subjective responders (group 2). Clinical and radiological characteristics were similar. The only significant difference was the baseline Berg Balance Scale, which was lower in objective responders (P = 0.0015). At 3 months after surgery and at last follow-up, there was no difference in surgical outcomes between the 2 groups. However, in the group of subjective responders, a continuous improvement for incontinence and gait was more frequently observed (P = 0.04 and P < 0.001, respectively). CONCLUSIONS Surgical outcomes after ventriculoperitoneal shunt were similar between the 2 groups, with a more favorable trend in terms of symptom improvement for subjective responders. Subjective assessment seems to be an important factor to consider in preoperative evaluation.
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Affiliation(s)
- Mahmoud Messerer
- Service of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Marius Blanchard
- Faculty of Medicine and Biology, University of Lausanne, Lausanne, Switzerland
| | - Kyriakos Papadimitriou
- Service of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Alberto Vandenbulcke
- Service of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Dionys Rutz
- Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Valerie Beaud
- Service of Neuropsychology and Neurorehabilitation, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | - Julien Bally
- Service of Neurology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Gilles Allali
- Leenaards Memory Center, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Roy T Daniel
- Service of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Giulia Cossu
- Service of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
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