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Iseki C, Suzuki S, Fukami T, Yamada S, Hayasaka T, Kondo T, Hoshi M, Ueda S, Kobayashi Y, Ishikawa M, Kanno S, Suzuki K, Aoyagi Y, Ohta Y. Fluctuations in Upper and Lower Body Movement during Walking in Normal Pressure Hydrocephalus and Parkinson's Disease Assessed by Motion Capture with a Smartphone Application, TDPT-GT. SENSORS (BASEL, SWITZERLAND) 2023; 23:9263. [PMID: 38005649 PMCID: PMC10674367 DOI: 10.3390/s23229263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
We aimed to capture the fluctuations in the dynamics of body positions and find the characteristics of them in patients with idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD). With the motion-capture application (TDPT-GT) generating 30 Hz coordinates at 27 points on the body, walking in a circle 1 m in diameter was recorded for 23 of iNPH, 23 of PD, and 92 controls. For 128 frames of calculated distances from the navel to the other points, after the Fourier transforms, the slopes (the representatives of fractality) were obtained from the graph plotting the power spectral density against the frequency in log-log coordinates. Differences in the average slopes were tested by one-way ANOVA and multiple comparisons between every two groups. A decrease in the absolute slope value indicates a departure from the 1/f noise characteristic observed in healthy variations. Significant differences in the patient groups and controls were found in all body positions, where patients always showed smaller absolute values. Our system could measure the whole body's movement and temporal variations during walking. The impaired fluctuations of body movement in the upper and lower body may contribute to gait and balance disorders in patients.
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Affiliation(s)
- Chifumi Iseki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan; (S.K.); (K.S.)
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-2331, Japan; (T.K.); (Y.O.)
| | - Shou Suzuki
- Department of Informatics, Faculty of Engineering, Yamagata University, Yonezawa 992-8510, Japan; (S.S.); (T.F.)
| | - Tadanori Fukami
- Department of Informatics, Faculty of Engineering, Yamagata University, Yonezawa 992-8510, Japan; (S.S.); (T.F.)
| | - Shigeki Yamada
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan;
- Interfaculty Initiative in Information Studies, Institute of Industrial Science, The University of Tokyo, Tokyo 113-8654, Japan
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan;
| | - Tatsuya Hayasaka
- Department of Anesthesiology, Yamagata University School of Medicine, Yamagata 990-2331, Japan;
| | - Toshiyuki Kondo
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-2331, Japan; (T.K.); (Y.O.)
| | - Masayuki Hoshi
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6 Sakaemachi, Fukushima 960-8516, Japan;
| | - Shigeo Ueda
- Shin-Aikai Spine Center, Katano Hospital, Katano 576-0043, Japan;
| | - Yoshiyuki Kobayashi
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Kashiwa II Campus, University of Tokyo, Kashiwa 277-0882, Japan;
| | - Masatsune Ishikawa
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan;
- Rakuwa Villa Ilios, Rakuwakai Healthcare System, Kyoto 607-8062, Japan
| | - Shigenori Kanno
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan; (S.K.); (K.S.)
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan; (S.K.); (K.S.)
| | | | - Yasuyuki Ohta
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-2331, Japan; (T.K.); (Y.O.)
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Iseki C, Hayasaka T, Yanagawa H, Komoriya Y, Kondo T, Hoshi M, Fukami T, Kobayashi Y, Ueda S, Kawamae K, Ishikawa M, Yamada S, Aoyagi Y, Ohta Y. Artificial Intelligence Distinguishes Pathological Gait: The Analysis of Markerless Motion Capture Gait Data Acquired by an iOS Application (TDPT-GT). SENSORS (BASEL, SWITZERLAND) 2023; 23:6217. [PMID: 37448065 DOI: 10.3390/s23136217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
Distinguishing pathological gait is challenging in neurology because of the difficulty of capturing total body movement and its analysis. We aimed to obtain a convenient recording with an iPhone and establish an algorithm based on deep learning. From May 2021 to November 2022 at Yamagata University Hospital, Shiga University, and Takahata Town, patients with idiopathic normal pressure hydrocephalus (n = 48), Parkinson's disease (n = 21), and other neuromuscular diseases (n = 45) comprised the pathological gait group (n = 114), and the control group consisted of 160 healthy volunteers. iPhone application TDPT-GT captured the subjects walking in a circular path of about 1 meter in diameter, a markerless motion capture system, with an iPhone camera, which generated the three-axis 30 frames per second (fps) relative coordinates of 27 body points. A light gradient boosting machine (Light GBM) with stratified k-fold cross-validation (k = 5) was applied for gait collection for about 1 min per person. The median ability model tested 200 frames of each person's data for its distinction capability, which resulted in the area under a curve of 0.719. The pathological gait captured by the iPhone could be distinguished by artificial intelligence.
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Affiliation(s)
- Chifumi Iseki
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-2331, Japan
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Tatsuya Hayasaka
- Department of Anesthesiology, Yamagata University School of Medicine, Yamagata 990-2331, Japan
| | - Hyota Yanagawa
- Department of Medicine, Yamagata University School of Medicine, Yamagata 990-2331, Japan
| | - Yuta Komoriya
- Department of Anesthesiology, Yamagata University School of Medicine, Yamagata 990-2331, Japan
| | - Toshiyuki Kondo
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-2331, Japan
| | - Masayuki Hoshi
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6 Sakaemachi, Fukushima 960-8516, Japan
| | - Tadanori Fukami
- Department of Informatics, Faculty of Engineering, Yamagata University, Yonezawa 992-8510, Japan
| | - Yoshiyuki Kobayashi
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Kashiwa II Campus, University of Tokyo, Kashiwa 277-0882, Japan
| | - Shigeo Ueda
- Shin-Aikai Spine Center, Katano Hospital, Katano 576-0043, Japan
| | - Kaneyuki Kawamae
- Department of Anesthesia and Critical Care Medicine, Ohta-Nishinouti Hospital, Koriyama 963-8558, Japan
| | - Masatsune Ishikawa
- Rakuwa Villa Ilios, Rakuwakai Healthcare System, Kyoto 607-8062, Japan
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan
| | - Shigeki Yamada
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan
- Interfaculty Initiative in Information Studies, Institute of Industrial Science, The University of Tokyo, Tokyo 113-8654, Japan
| | | | - Yasuyuki Ohta
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-2331, Japan
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Yamada S, Aoyagi Y, Iseki C, Kondo T, Kobayashi Y, Ueda S, Mori K, Fukami T, Tanikawa M, Mase M, Hoshimaru M, Ishikawa M, Ohta Y. Quantitative Gait Feature Assessment on Two-Dimensional Body Axis Projection Planes Converted from Three-Dimensional Coordinates Estimated with a Deep Learning Smartphone App. SENSORS (BASEL, SWITZERLAND) 2023; 23:617. [PMID: 36679412 PMCID: PMC9865115 DOI: 10.3390/s23020617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
To assess pathological gaits quantitatively, three-dimensional coordinates estimated with a deep learning model were converted into body axis plane projections. First, 15 healthy volunteers performed four gait patterns; that is, normal, shuffling, short-stepped, and wide-based gaits, with the Three-Dimensional Pose Tracker for Gait Test (TDPT-GT) application. Second, gaits of 47 patients with idiopathic normal pressure hydrocephalus (iNPH) and 92 healthy elderly individuals in the Takahata cohort were assessed with the TDPT-GT. Two-dimensional relative coordinates were calculated from the three-dimensional coordinates by projecting the sagittal, coronal, and axial planes. Indices of the two-dimensional relative coordinates associated with a pathological gait were comprehensively explored. The candidate indices for the shuffling gait were the angle range of the hip joint < 30° and relative vertical amplitude of the heel < 0.1 on the sagittal projection plane. For the short-stepped gait, the angle range of the knee joint < 45° on the sagittal projection plane was a candidate index. The candidate index for the wide-based gait was the leg outward shift > 0.1 on the axial projection plane. In conclusion, the two-dimensional coordinates on the body axis projection planes calculated from the 3D relative coordinates estimated by the TDPT-GT application enabled the quantification of pathological gait features.
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Affiliation(s)
- Shigeki Yamada
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan
- Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo 113-8654, Japan
| | | | - Chifumi Iseki
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-9585, Japan
| | - Toshiyuki Kondo
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-9585, Japan
| | - Yoshiyuki Kobayashi
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Kashiwa II Campus, University of Tokyo, Kashiwa 277-0882, Japan
| | - Shigeo Ueda
- Shin-Aikai Spine Center, Katano Hospital, Katano 576-0043, Japan
| | - Keisuke Mori
- School of Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Tadanori Fukami
- Department of Informatics, Faculty of Engineering, Yamagata University, Yamagata 992-8510, Japan
| | - Motoki Tanikawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan
| | - Minoru Hoshimaru
- Shin-Aikai Spine Center, Katano Hospital, Katano 576-0043, Japan
| | - Masatsune Ishikawa
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan
- Rakuwa Villa Ilios, Rakuwakai Healthcare System, Kyoto 607-8062, Japan
| | - Yasuyuki Ohta
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-9585, Japan
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Aoyagi Y, Yamada S, Ueda S, Iseki C, Kondo T, Mori K, Kobayashi Y, Fukami T, Hoshimaru M, Ishikawa M, Ohta Y. Development of Smartphone Application for Markerless Three-Dimensional Motion Capture Based on Deep Learning Model. SENSORS (BASEL, SWITZERLAND) 2022; 22:5282. [PMID: 35890959 PMCID: PMC9322512 DOI: 10.3390/s22145282] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
To quantitatively assess pathological gait, we developed a novel smartphone application for full-body human motion tracking in real time from markerless video-based images using a smartphone monocular camera and deep learning. As training data for deep learning, the original three-dimensional (3D) dataset comprising more than 1 million captured images from the 3D motion of 90 humanoid characters and the two-dimensional dataset of COCO 2017 were prepared. The 3D heatmap offset data consisting of 28 × 28 × 28 blocks with three red-green-blue colors at the 24 key points of the entire body motion were learned using the convolutional neural network, modified ResNet34. At each key point, the hottest spot deviating from the center of the cell was learned using the tanh function. Our new iOS application could detect the relative tri-axial coordinates of the 24 whole-body key points centered on the navel in real time without any markers for motion capture. By using the relative coordinates, the 3D angles of the neck, lumbar, bilateral hip, knee, and ankle joints were estimated. Any human motion could be quantitatively and easily assessed using a new smartphone application named Three-Dimensional Pose Tracker for Gait Test (TDPT-GT) without any body markers or multipoint cameras.
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Affiliation(s)
| | - Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Otsu 520-2192, Japan
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan;
- Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo 153-8505, Japan
| | - Shigeo Ueda
- Shin-Aikai Spine Center, Katano Hospital, Katano 576-0043, Japan; (S.U.); (M.H.)
| | - Chifumi Iseki
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-9585, Japan; (C.I.); (T.K.); (Y.O.)
| | - Toshiyuki Kondo
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-9585, Japan; (C.I.); (T.K.); (Y.O.)
| | - Keisuke Mori
- School of Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan;
| | - Yoshiyuki Kobayashi
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Kashiwa II Campus, University of Tokyo, Kashiwa 277-0882, Japan;
| | - Tadanori Fukami
- Department of Informatics and Electronics, Faculty of Engineering, Yamagata University, Yamagata 992-8510, Japan;
| | - Minoru Hoshimaru
- Shin-Aikai Spine Center, Katano Hospital, Katano 576-0043, Japan; (S.U.); (M.H.)
| | - Masatsune Ishikawa
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan;
- Rakuwa Villa Ilios, Rakuwakai Healthcare System, Kyoto 604-8402, Japan
| | - Yasuyuki Ohta
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata 990-9585, Japan; (C.I.); (T.K.); (Y.O.)
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Onder H, Dinc E, Comoglu S. Ventriculomegaly in Prodromal Idiopathic Normal Pressure Hydrocephalus? Mov Disord Clin Pract 2022; 9:850-851. [DOI: 10.1002/mdc3.13498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital Ankara Turkey
| | - Ege Dinc
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital Ankara Turkey
| | - Selcuk Comoglu
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital Ankara Turkey
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Yamada S, Ishikawa M, Nakajima M, Nozaki K. Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures. Front Neurol 2022; 12:798488. [PMID: 35069426 PMCID: PMC8770742 DOI: 10.3389/fneur.2021.798488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Treatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although ventriculoperitoneal shunt surgery has a long history and is one of the most established neurosurgeries, in the 1970s, the improvement rate of iNPH triad symptoms was poor and the risks related to shunt implantation were high. This led experts to question the surgical indication for iNPH and, over the next 20 years, cerebrospinal fluid (CSF) shunt surgery for iNPH fell out of favor and was rarely performed. However, the development of programmable-pressure shunt valve devices has reduced the major complications associated with the CSF drainage volume and appears to have increased shunt effectiveness. In addition, the development of support devices for the placement of ventricular catheters including preoperative virtual simulation and navigation systems has increased the certainty of ventriculoperitoneal shunt surgery. Secure shunt implantation is the most important prognostic indicator, but ensuring optimal initial valve pressure is also important. Since over-drainage is most likely to occur in the month after shunting, it is generally believed that a high initial setting of shunt valve pressure is the safest option. However, this does not always result in sufficient improvement of the symptoms in the early period after shunting. In fact, evidence suggests that setting the optimal valve pressure early after shunting may cause symptoms to improve earlier. This leads to improved quality of life and better long-term independent living expectations. However, in iNPH patients, the remaining symptoms may worsen again after several years, even when there is initial improvement due to setting the optimal valve pressure early after shunting. Because of the possibility of insufficient CSF drainage, the valve pressure should be reduced by one step (2–4 cmH2O) after 6 months to a year after shunting to maximize symptom improvement. After the valve pressure is reduced, a head CT scan is advised a month later.
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Affiliation(s)
- Shigeki Yamada
- 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.,Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Masatsune Ishikawa
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan.,Rakuwa Villa Ilios, Rakuwakai Healthcare System, Kyoto, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
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Harris EJ, Khoo IH, Demircan E. A Survey of Human Gait-Based Artificial Intelligence Applications. Front Robot AI 2022; 8:749274. [PMID: 35047564 PMCID: PMC8762057 DOI: 10.3389/frobt.2021.749274] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/01/2021] [Indexed: 12/17/2022] Open
Abstract
We performed an electronic database search of published works from 2012 to mid-2021 that focus on human gait studies and apply machine learning techniques. We identified six key applications of machine learning using gait data: 1) Gait analysis where analyzing techniques and certain biomechanical analysis factors are improved by utilizing artificial intelligence algorithms, 2) Health and Wellness, with applications in gait monitoring for abnormal gait detection, recognition of human activities, fall detection and sports performance, 3) Human Pose Tracking using one-person or multi-person tracking and localization systems such as OpenPose, Simultaneous Localization and Mapping (SLAM), etc., 4) Gait-based biometrics with applications in person identification, authentication, and re-identification as well as gender and age recognition 5) “Smart gait” applications ranging from smart socks, shoes, and other wearables to smart homes and smart retail stores that incorporate continuous monitoring and control systems and 6) Animation that reconstructs human motion utilizing gait data, simulation and machine learning techniques. Our goal is to provide a single broad-based survey of the applications of machine learning technology in gait analysis and identify future areas of potential study and growth. We discuss the machine learning techniques that have been used with a focus on the tasks they perform, the problems they attempt to solve, and the trade-offs they navigate.
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Affiliation(s)
- Elsa J Harris
- Human Performance and Robotics Laboratory, Department of Mechanical and Aerospace Engineering, California State University Long Beach, Long Beach, CA, United States
| | - I-Hung Khoo
- Department of Electrical Engineering, California State University Long Beach, Long Beach, CA, United States.,Department of Biomedical Engineering, California State University Long Beach, Long Beach, CA, United States
| | - Emel Demircan
- Human Performance and Robotics Laboratory, Department of Mechanical and Aerospace Engineering, California State University Long Beach, Long Beach, CA, United States.,Department of Biomedical Engineering, California State University Long Beach, Long Beach, CA, United States
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Roblot P, Mollier O, Ollivier M, Gallice T, Planchon C, Gimbert E, Danet M, Renault S, Auzou N, Laurens B, Jecko V. Communicating chronic hydrocephalus: A review. Rev Med Interne 2021; 42:781-788. [PMID: 34144842 DOI: 10.1016/j.revmed.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/30/2021] [Indexed: 11/25/2022]
Abstract
Formerly called normal pressure hydrocephalus, communicating chronic hydrocephalus (CCH) is a condition affecting 0.1 to 0.5% of patients over 60years of age. The pathophysiology of this disease is poorly understood, but a defect in cerebrospinal fluid (CSF) resorption appears to be commonly defined as the cause of the neurological disorders. The last important discovery is the description of the glymphatic system and its implication in CCH and CSF resorption. Comorbidities (Alzheimer's disease, microangiopathy, parkinsonism) are very frequent, and involve a diagnostic challenge. The clinical presentation is based on the Hakim and Adams triad, comprising gait disorders, mainly impairing walking, cognitive disorders, affecting executive functions, episodic memory, visuospatial cognition, and sphincter disorders as urinary incontinence (detrusor hyperactivity). The diagnosis is suspected through a set of arguments, combining the clinical presentation, the radiological data of the magnetic resonance imaging (MRI) showing a ventriculomegaly associated with signs of transependymomous resorption of the CSF and disappearance of the cortical sulci, and the clinical response to the depletion of CSF. In the presence of all these elements, or a strong clinical suspicion, the standard treatment will be of a permanent CSF shunt, using a ventriculoatrial or ventriculoperitoneal shunt. The effectiveness of this treatment defines the diagnosis. The clinical improvement is better when treatment occurs early after the onset of the disorders, reaching 75 to 90% of motor improvement.
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Affiliation(s)
- P Roblot
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Laboratory of anatomy, university of Bordeaux, Bordeaux, France.
| | - O Mollier
- Neurosurgery department B, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - M Ollivier
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - T Gallice
- Neurosurgery department B, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Department of critical care, Bordeaux university hospital, 33076 Bordeaux, France
| | - C Planchon
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Neurosurgery department B, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - E Gimbert
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - M Danet
- Department of geriatric medicine, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - S Renault
- Department of neurology, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - N Auzou
- Institute for neurodegenerative diseases, CNRS UMR 5293, university Bordeaux, Bordeaux, France
| | - B Laurens
- Department of neurology, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Institute for neurodegenerative diseases, CNRS UMR 5293, university Bordeaux, Bordeaux, France
| | - V Jecko
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Université de Bordeaux, CNRS UMR 5287, INCIA, Zone nord, Bat 2, 2e étage, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France
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9
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Yamada S, Aoyagi Y, Ishikawa M, Yamaguchi M, Yamamoto K, Nozaki K. Gait Assessment Using Three-Dimensional Acceleration of the Trunk in Idiopathic Normal Pressure Hydrocephalus. Front Aging Neurosci 2021; 13:653964. [PMID: 33790781 PMCID: PMC8006335 DOI: 10.3389/fnagi.2021.653964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
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Affiliation(s)
- Shigeki Yamada
- 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.,Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan
| | | | - Masatsune Ishikawa
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan.,Rakuwa Villa Ilios, Rakuwakai Healthcare System, Kyoto, Japan
| | - Makoto Yamaguchi
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Kazuo Yamamoto
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
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10
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Hnin HH, Bovonsunthonchai S, Witthiwej T, Vachalathiti R, Ariyaudomkit R. Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients. Dement Neuropsychol 2021; 15:79-87. [PMID: 33907600 PMCID: PMC8049582 DOI: 10.1590/1980-57642021dn15-010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Action observation (AO) has been proved to be of benefit in several neurological
conditions, but no study has previously been conducted in idiopathic normal
pressure hydrocephalus (iNPH).
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Affiliation(s)
- Htet Htet Hnin
- Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand
| | - Sunee Bovonsunthonchai
- Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand
| | - Theerapol Witthiwej
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University - Bangkok, Thailand
| | | | - Rattapha Ariyaudomkit
- Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand
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11
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The entity of asymptomatic ventriculomegaly with features of idiopathic normal pressure hydrocephalus on magnetic resonance imaging? J Neurol Sci 2021; 423:117329. [PMID: 33636662 DOI: 10.1016/j.jns.2021.117329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 11/22/2022]
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12
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Kimihira L, Iseki C, Takahashi Y, Sato H, Kato H, Kazui H, Kuriyama N, Nakajima M, Miyajima M, Endo K, Kobayashi Y, Saegusa T, Takeda Y, Sato S, Tomogane Y, Baba T, Miyake H, Matsumae M, Onozuka S, Murai H, Kajimoto Y, Kimura T, Kobayashi M, Yamazaki M, Arai H, Kato T. A multi-center, prospective study on the progression rate of asymptomatic ventriculomegaly with features of idiopathic normal pressure hydrocephalus on magnetic resonance imaging to idiopathic normal pressure hydrocephalus. J Neurol Sci 2020; 419:117166. [DOI: 10.1016/j.jns.2020.117166] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022]
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