Objective: This study aimed at further characterizing the gait of patients with clinically suspected Normal Pressure Hydrocephalus (NPH) by investigating changes in several gait domains after spinal tap test.

Background: Gait disturbances are a diagnostic marker for NPH [1]. Gait velocity differentiates between NPH patients and healthy controls and improves in NPH patients after a diagnostic spinal tap test [2, 3]. While the commonly used 20m walk-test assesses the gait domain tempo, our study aimed at exploring changes in additional gait domains after spinal tap using instrument-supported gait analysis.

Method: We retrospectively analyzed different gait domains in 59 patients with clinically suspected NPH undergoing the spinal tap test, utilizing both the clinical 20m walk-test and additionally an instrument-supported gait analysis. The change in gait velocity was used to differentiate patients with a positive response to the spinal tap (>20% improvement, patients with suspected NPH, sNPH patients) from those with no relevant response to the spinal tap (<20% improvement, patients with suspected other etiologies). Group differences were analyzed using independent sample t-tests and Mann-Whitney U tests.

Results: While the 20m walk test revealed significant changes in the gait domain tempo after the spinal tap test, the instrument-supported analysis revealed additional improvements in the gait domains rhythm, variability and force for the patients with sNPH (n=21) compared to patients with suspected other etiologies (n=38).

Conclusion: Our study confirmed and extended previous research on gait disturbances in patients with sNPH. The 20% improvement in gait velocity effectively differentiated patients with sNPH from those with no relevant response to a spinal tap, likely suffering from other etiologies. Data reaffirm the utility of the standard clinical gait assessment in NPH diagnosis and highlight the supplementary insights provided by instrument-supported gait analysis, further characterizing the NPH gait profile.

References: [1] S. Hakim, R. Adams, The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure: observations on cerebrospinal fluid hydrodynamics, Journal of the neurological sciences 2(4) (1965) 307-327.
[2] H. Stolze, J. Kuhtz-Buschbeck, H. Drücke, K. Jöhnk, C. Diercks, S. Palmie, H. Mehdorn, M. Illert, G. Deuschl, Gait analysis in idiopathic normal pressure hydrocephalus–which parameters respond to the CSF tap test?, Clinical Neurophysiology 111(9) (2000) 1678-1686.
[3] C. Wikkelsø, H. Andersson, C. Blomstrand, G. Lindqvist, The clinical effect of lumbar puncture in normal pressure hydrocephalus, J. Neurol. Neurosurg. Psychiatry 45(1) (1982) 64-69.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/instrument-supported-gait-analysis-characterizes-gait-domain-changes-in-patients-with-suspected-normal-pressure-hydrocephalus-a-retrospective-study/