Alteration of Postural Stability after Cerebrospinal Fluid Tap Test in Patients with Idiopathic Normal Pressure Hydrocephalus

doi:10.21203/rs.3.rs-3198125/v1

Download PDF

Article

Alteration of Postural Stability after Cerebrospinal Fluid Tap Test in Patients with Idiopathic Normal Pressure Hydrocephalus

https://doi.org/10.21203/rs.3.rs-3198125/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

In patients with idiopathic normal pressure hydrocephalus (iNPH), the characteristics of balance disturbance are less understood than those of gait. We examined the changes in postural stability after the cerebrospinal fluid tap test (CSFTT) during quiet standing. Furthermore, we explored the relationship between frontal lobe function and the amount of spontaneous body sway.

Methods

All patients with iNPH underwent CSFTT and were evaluated using a frontal assessment battery (FAB) and center of pressure (COP) using a force plate during quiet standing before and after CSFTT. After COP measurement, we calculated COP parameters using time and frequency domain analysis. We determined whether there were alterations of COP parameters before and after CSFTT and the relationship between FAB and COP parameters using SPSS.

Results

In total, 72 patients with iNPH were recruited, and 56 patients who positively responded to CSFTT were finally included. Following CSFTT, there were significantly improved COP parameters using time domain analysis (velocity of COP, vCOP, p = 0.002; root-mean-square of COP, p = 0.032; turn index, p = 0.017; torque, p = 0.003; base of support, BOS, p = 0.014) compared to before CSFTT. In COP parameters using frequency domain analysis after CSFTT, we observed decreased power spectral density (PSD) values in the anteroposterior (peak value, p = 0.049; average value, p = 0.030) and mediolateral (peak value, p = 0.003; average value, p = 0.028) directions at low-frequency oscillation, below 0.5 Hz. In addition, FAB scores were negatively correlated with the vCOP (r = − 0.359, p = 0.007), BOS (r = − 0.302, p = 0.025), and the peak PSD value (r = − 0.464, p = 0.002) and average PSD value (r = − 0.424, p = 0.004) in anteroposterior direction for iNPH patients, respectively.

Conclusions

In patients with iNPH who responded to CSFTT, spontaneous body sway during quiet standing improved after CSFTT. The increased spontaneous sway is associated with impaired frontal lobe function, which may be linked to postural control circuits in patients with iNPH.

Health sciences/Neurology/Neurological disorders/Hydrocephalus

Health sciences/Health care/Health services/Rehabilitation

Normal pressure hydrocephalus

Postural balance

Spinal puncture

Idiopathic normal pressure hydrocephalus (iNPH), with enlarged brain ventricle and normal cerebrospinal fluid (CSF) pressure, is characterized by gait and balance disturbance, cognitive impairment, and urinary incontinence^1,2. Gait and balance disturbances are often the most prominent clinical features and the first to become apparent^1,3. Compared with healthy individuals, the gait of patients with iNPH is characterized by a broad base, short stride length, low speed, and increased variability in stride time and length⁴. The CSF tap test (CSFTT) is a widely used diagnostic and therapeutic tool for improving gait disturbance^4–7. In accordance with the Japanese guideline, clinical improvement after the CSFTT increases diagnostic certainty of iNPH from possible to probable⁵. In patients with iNPH, these gait characteristics are relatively better known than balance characteristics⁸.

Postural stability, also referred to as balance, is the ability of the body to maintain the center of gravity (COG) within the base of support (BOS), which is the area of contact with the support surface^9,10. Force platforms have been used to quantify the characteristics of postural stability and calculate indirect changes in spontaneous body sway, i.e., the center of pressure (COP) calculated from ground reaction force^11,12. The COP indicates the weighted average of all forces created from the BOS and reflects the trajectory of the COG. When the limit of stability of BOS is exceeded, an individual must take a step to reestablish the BOS below the COG to prevent a fall¹³. Consequently, measuring COP displacement is related to the spontaneous joint movements needed to maintain the body against gravity¹⁴.

Although quiet standing appears still, passive skeletal alignment and muscular and postural tone are needed to prevent collapse against gravity, known as static steady-state balance^9,14. The power spectral density (PSD) of COP calculated via frequency domain analysis using Fourier transformation is a helpful tool for evaluating the effects of small and rapid movements on spontaneous body sway during quiet standing in older adults¹⁵, patients with Parkinson’s disease^16,17, and patients with multiple sclerosis¹⁸.

There have been a few studies on the quantitative measurement of balance disturbance in patients with iNPH. A previous study reported an improvement in the radius and sway area of COP after shunt surgery in nine patients with iNPH¹⁹. Furthermore, Blomsterwall et al.²⁰ described that patients with iNPH had a larger sway area and higher COP velocity than those with subcortical arteriosclerotic encephalopathy, but this study was limited by the inclusion of secondary NPH patients. In addition, Nikaido et al.²¹ demonstrated that patients with iNPH showed improved COP trajectories after shunt surgery, but this study was limited to only 23 participants with iNPH. The characteristics of imbalance and alteration in postural stability after CSFTT have yet to be elucidated in patients with iNPH.

This study aimed to quantitatively measure changes in COP during quiet standing after CSFTT in iNPH patients who responded positively to the CSFTT. We examined alteration in COP parameters using time and frequency domain analysis before and after CSFTT. Furthermore, we investigated the relationship between frontal lobe function and COP during quiet standing at baseline. Our hypotheses were as follows. First, when a patient with iNPH stands quietly, COP parameters improve after CSFTT compared to before CSFTT. Second, the amount of spontaneous body sway is associated with frontal lobe dysfunction, which might affect postural control.

1. Participants

This study included patients diagnosed with iNPH, using the following criteria proposed by previous diagnostic guidelines: (1) aged > 40 years, (2) symptoms that have progressed insidiously over 6 months (i.e., gait disturbance with at least cognitive impairment), (3) presented with normal CSF opening pressure, (4) showed enlarged ventricles (Evans’ ratio of > 0.3) and no macroscopic obstruction of CSF flow on brain magnetic resonance imaging, and (5) positive responsiveness after CSFTT^5,22. A lumbar tap removed 30–50 ml of CSF on each INPH patient. After the CSFTT, patients were re-evaluated with the Korean-Mini Mental State Examination (K-MMSE), the iNPH Grading Scale (iNPHGS), and the Timed Up and Go Test (TUG). Gait changes were evaluated multiple times over 7 days following the tap, and changes in cognition and urination were assessed at 1 week. CSFTT response was defined using these 3 major scales²³. INPH patients who had a positive response to the CSFTT according to the Japanese guidelines for iNPH were enrolled²³. The exclusion criteria were as follows: (1) history of stroke; (2) history of heavy alcohol use; (3) history of hospitalization due to a major psychiatric disorder; (4) history of other neurologic, metabolic, neoplastic, or musculoskeletal disorder; and (5) evidence of secondary hydrocephalus after traumatic brain injury, intracerebral hemorrhage, or meningitis. The Frontal Assessment Battery (FAB) scores ranged from 0 to 18, with a higher score indicating better cognitive function associated with the frontal lobe²⁴.

This prospective study included patients admitted to the Department of Neurology at Kyungpook National University Chilgok Hospital between September 2021 and November 2022. Written informed consent was obtained from all participants. The Institutional Review Board of Kyungpook National University Chilgok Hospital provided ethical approval (No. 2021-07-023). All experiments were performed in accordance with relevant guidelines and regulations.

2. COP measurement

We assessed all participants for measuring COP at pre-CSFTT and the day after the CSFTT. We measured COP using a force-measuring plate sampled at 60 Hz (Zebris FDM-S®, Germany) during quiet standing with eyes opened. We instructed the participants to try to stand with their bare feet as close together as possible. For 30 s, they stood quietly on the force plate and arms held comfortably on their sides. We assessed COP twice before CSFTT (pre-CSFTT) and after CSFTT within 24 to 48 h (post-CSFTT).

3. Data analysis

We conducted time and frequency domain analysis of COP using Python 3.7.15 (https://www.python.org) and Python signal processing package SciPy 1.9.1 (https://scipy.org) and calculated the COP parameters using analytical methods proposed by Palmieri et al.¹² and Kotolova et al.²⁵.

3.1. COP parameters using time domain analysis

We calculated the velocity of COP (vCOP) by dividing the displacement of the COP trajectory by the recording time, t. The anteroposterior (AP) and mediolateral (ML) directions represent the AP and ML positions, respectively.

$$\text{v}\text{C}\text{O}\text{P}=\frac{{\sum }_{\text{n}=1}^{\text{N}}\sqrt{{\left({AP}_{n-1} - {AP}_{n}\right)}^{2} + {\left({ML}_{n-1} - {ML}_{n}\right)}^{2}}}{t} (\text{m}\text{m}/\text{s})$$

We calculated the root mean square COP (rmsCOP) as the distance between the displacement of COP and mean COP position $\left({{\mu }}_{\text{A}\text{P}}, {{\mu }}_{\text{M}\text{L}}\right)$. Then, we calculated the sum of the distances and divided it by the number of frames N during the recording time.

$$\text{r}\text{m}\text{s}\text{C}\text{O}\text{P}=\frac{{\sum }_{\text{n}=1}^{\text{N}}\sqrt{{\left({AP}_{n} - {\mu }_{AP}\right)}^{2} + {\left({ML}_{n} -{ \mu }_{ML}\right)}^{2}}}{N} (\text{m}\text{m}/\text{f}\text{r}\text{a}\text{m}\text{e})$$

We calculated the turn index by dividing the sum of the COP trajectory length in each direction by its standard deviation (${{\sigma }}_{\text{A}\text{P}}, {{\sigma }}_{\text{M}\text{L}})$in that direction; the obtained value was then divided by the recording time.

$$Turn index=\frac{{\sum }_{\text{n}=1}^{\text{N}}\sqrt{{\left(\frac{{AP}_{n-1} - {AP}_{n} }{{\sigma }_{AP}}\right)}^{2} + {\left(\frac{{ML}_{n-1} - {ML}_{n} }{{\sigma }_{ML}}\right)}^{2}}}{t} (\text{m}\text{m}/\text{s})$$

The torque was calculated by multiplying the weight with vCOP, where ${\text{F}}_{\text{G}}$ indicates each patient’s weight.

Torque = $\frac{{\sum }_{n=1}^{N}{F}_{G} \cdot \sqrt{{\left({AP}_{n-1} – {AP}_{n}\right)}^{2} + {\left({ML}_{n-1} – {ML}_{n}\right)}^{2}} }{t} (\text{k}\text{g}\bullet \frac{\text{m}}{\text{s}}$)

The area of BOS was calculated as the area between both feet in contact with the force plate (${\text{c}\text{m}}^{2}$), as shown in Supplementary Fig. 1.

3.2. COP parameters using frequency domain analysis

We quantified COP oscillations using Fourier analysis and power spectral density (PSD). We calculated the PSD values of COP as follows: the peak PSD in AP and peak PSD in ML indicated the maximum PSD values of the AP and ML direction within the frequency range of interest, and the average PSD in AP and average PSD in ML were calculated as the average value of PSD within the frequency range of interest. Based on previous studies^17,18,26, we considered the frequency ranges of interest as 0–0.5 Hz and 0.5-1.0 Hz.

4. Statistical analysis

We performed all statistical analyses using SPSS software version 23 (SPSS, Inc, Armonk, NY, USA). We confirmed a normal distribution of data using the Shapiro–Wilk test (p < 0.05). We used a Paired t-test to compare changes in COP parameters using time and frequency domain analysis at pre- and post-CSFTT. Furthermore, we used Pearson’s correlation to evaluate the relationship between FAB and COP parameters. The correlation coefficient (r) of ≥ 0.3 was considered to be medically significant²⁷. A p value of < 0.05 was considered to indicate statistical significance.

We recruited 72 patients with iNPH, 3 of whom failed quiet standing for 30 s at pre-CSFTT, and 2 patients were lost to COP measurements after CSFTT. Also, we excluded 11 patients who did not respond to CSFTT. Finally, we included 56 patients with iNPH after positively responding to CSFTT. Of the 56 patients, 36 were male, and 20 were female (mean age 75.45 ± 5.46 years old). The average FAB score was 9.78 ± 3.72 at baseline.

COP parameters using time domain analysis

The representative data of the COP trajectory and the COP displacements in AP and ML directions before and after CSFTT are shown in Fig. 1. During quiet standing at post-CSFTT, vCOP (t = 3.188, p = 0.002), rmsCOP (t = 2.213, p = 0.032), turn index (t = 2.483, p = 0.017), torque (t = 3.102, p = 0.003) and BOS (t = 2.550, p = 0.014) significantly decreased compared with those at pre-CSFTT (Table 1).

Table 1

Center of Pressure Parameters Before and After CSFTT in Patients with Idiopathic Normal Pressure Hydrocephalus
COP parameters		Pre-CSFTT	Post-CSFTT	t	p value
Time Domain Analysis	vCOP	30.32 (12.78)	25.97 (6.95)	3.188	0.002^*
	rmsCOP	9.49 (4.87)	8.42 (3.64)	2.213	0.032^*
	Turns index	286.32 (384.07)	189.76 (150.27)	2.483	0.017^*
	Torque	1.60 (0.54)	1.43 (0.37)	3.102	0.003^*
	BOS	666.75 (141.46)	625.40 (96.67)	2.550	0.014^*
Frequency Domain Analysis	Peak PSD in AP at 0–0.5 Hz	194.39 (301.61)	101.29 (107.74)	2.037	0.049^*
	at 0.5–1.0 Hz	21.56 (27.22)	14.61 (15.21)	1.716	0.095
	Average PSD in AP at 0–0.5 Hz	63.32 (84.16)	35.86 (30.38)	2.262	0.030^*
	at 0.5–1.0 Hz	9.10 (11.24)	5.98 (5.86)	2.026	0.050
	Peak PSD in ML at 0–0.5 Hz	472.97 (679.87)	146.06 (217.07)	3.172	0.003^*
	at 0.5–1.0 Hz	93.29 (427.88)	11.51 (21.79)	1.236	0.224
	Average PSD in ML at 0–0.5 Hz	179.15 (320.19)	61.12 (106.06)	2.289	0.028^*
	at 0.5–1.0 Hz	39.51 (179.85)	5.99 (14.79)	1.247	0.220
The value of mean (standard deviation). AP: anteroposterior, BOS: base of support, COP: center of pressure, CSFTT: cerebrospinal fluid tap test, rms: root-mean-square, ML: mediolateral, PSD: power spectral density, v: velocity. ^* represents a significant difference between pre-and post-CSFTT using Paired t-test (p < 0.05).

COP parameters using frequency domain analysis

We observed a significant decrease in the peak PSD value in AP direction (t = 2.037, p = 0.049), the average PSD value in AP direction (t = 2.262, p = 0.030), the peak PSD value in ML direction (t = 3.172, p = 0.003), and the average PSD value in ML direction (t = 2.289, p = 0.028) at 0–0.5 Hz after CSFTT during quiet standing (Table 1).

Relationship between FAB scores and COP parameters

The FAB score was significantly negatively correlated with vCOP (r = − 0.359, p = 0.007), BOS (r = − 0.302, p = 0.025), and the peak PSD value (r = − 0.464, p = 0.002) and average PSD value (r = − 0.424, p = 0.004) in AP direction at 0-0.5 Hz, respectively (Fig. 2).

We investigated alteration in COP parameters, which indicates spontaneous body sway, after CSFTT during quiet standing in patients with iNPH. The COP displacements associated with time domain analysis reduced after CSFTT. In addition, iNPH patients had low PSD values, indicating less variation in power value of COP in the peak and average in both AP and ML directions at low-frequency oscillation after CSFTT. Interestingly, frontal lobe function was negatively correlated with spontaneous sway.

To evaluate balance function in patients with iNPH, we measured COP during quiet standing. Clinically, balance function is classified into static steady-state balance, which is the ability to maintain a steady position, such as standing, and dynamic steady-state balance, which is the ability to maintain a static position with a shift in the COG, such as walking^9,28. An individual with a good static steady-state balance is expected to perform well in dynamic steady-state balance^28,29. In practice, gait disturbances in patients with iNPH range from mild imbalance to complete inability to walk. In the case of patients who cannot walk independently or experience frequent falls, measuring the static steady-state balance could be helpful. To the best of our knowledge, this is the first study to compare the changes in static steady-state balance before and after CSFTT in patients with iNPH. Further studies are warranted to confirm the relationship between static and dynamic steady-state balance in patients with iNPH.

In our study, iNPH patients showed a decrease in COP parameters using time and frequency domain analysis after CSFTT. These changes could be interpreted as improving the ability to postural control after CSFTT. The PSD value helps evaluate the effect of small and rapid movements on spontaneous body sway²⁶. Previous studies have reported higher PSD values of COP in older adults¹⁵, patients with Parkinson’s disease^16,17, multiple sclerosis¹⁸, idiopathic scoliosis³⁰, and vestibular disorders³¹ than in healthy controls during quiet standing. Furthermore, the range of PSD is closely associated with postural control in older adults and Parkinson’s disease^17,26. Especially, low-frequency oscillation below 0.5 Hz reflects thought to be part of the descending drive to the motor neuron pool^17,18. The exacerbation of low-frequency oscillations probably indicates a loss of motor control of the descending drive to the motor control. This decline in motor control is likely caused by the deterioration of neurons in brain regions related to motor control¹⁷. In this study, lower PSD values in the AP and ML direction below 0.5 Hz suggest a less frequent oscillation of spontaneous body sway during quiet standing after CSFTT. This improvement in low-frequency oscillation may be linked to an improvement in cerebral blood flow in periventricular and frontal white matter regions after CSFTT³². Furthermore, it was suggested that motor function recovery in iNPH patients after CSF removal was related to a reversible suppression of frontal periventricular cortico-basal ganglia-thalamo-cortical circuits³³. However, the mechanisms producing balance recovery in iNPH are still not fully understood, and future studies are warranted to better investigate this aspect.

The spontaneous body sway was inversely associated with frontal lobe function; in other words, lower frontal lobe function was related to more frequent oscillations of body sway. Recent studies reported the ability to balance control was related to cognitive impairment in healthy older people³⁴, Alzheimer's disease³⁵, and Parkinson’s disease³⁶. Even though healthy young adults, postural control was attentionally demanding, secondary tasks could increase their spontaneous body sway^37,38. Postural control is influenced by multifactorial brain areas related to motor control systems, including those associated with higher-level cognitive function (frontal cortex), sensory feedback, coordination (basal ganglia, brainstem, and spinal cord), and generation of forces (motor neurons and muscles) that result in movements that maintain the body’s position³⁹. In patients with iNPH, ventricular enlargement may interrupt the cortical-subcortical connections, such as the basal ganglia circuit, which connects the frontal cortex and basal ganglia^40,41. In our study, severe frontal dysfunction predicted as impaired cortico-subcortical circuits may result in poor balance function in patients with iNPH.

This study has several limitations. We measured participants’ ability to maintain a steady position during standing. Although there is a high similarity between static and dynamic steady-state balance, it might be insufficient to explain dynamic parameters related to gait function. Recent studies have attempted to quantitatively assess dynamic characteristics during gait using a triaxial accelerometer of the trunk in patients with iNPH^42,43. To understand postural instability in patients with iNPH, further large-scale studies are warranted to evaluate the relationship between static and dynamic steady-state balance function in patients with iNPH. Moreover, we did not compare COP parameters between patients with iNPH and healthy older controls. Healthy older adults revealed a difference in spontaneous sway between fallers and non-fallers during quiet standing⁴⁴. Further study is needed to measure alterations of COP parameters in patients with iNPH compared to older adults.

Spontaneous body sway during quiet standing improved after CSFTT in patients with iNPH. Furthermore, the amount of spontaneous sway is negatively associated with frontal lobe function. Our finding suggested that increased postural instability could be related to impaired frontal lobe functions in iNPH patients who suffered from impaired cortico-subcortical circuits.

Acknowledgements

The research was supported by National Research Foundation of Korea (NRF- 2021R1C1C101138713).

Author contributions

K.K., K.P., and T.J. conceptualized this study. K.K. and E.P. recruited participants and performed clinical assessments. E.P., S.L, and JT.L analyzed and interpreted the data. E.P. and S.L. were major contributors in writing the manuscript. All authors read and approved the final manuscript.

Data availability statement

The datasets generated and/or analysed during the current study are not publicly available because we did not get permission to disclosure it from the participants. However, it can be available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Ethics declarations

The study was conducted with written informed consent obtained from all participants. The Institutional Review Board of Kyungpook National University Chilgok Hospital provided ethical approval (No. 2021-07-023).

Hakim, S. & Adams, R. J. J. o. t. n. s. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure: observations on cerebrospinal fluid hydrodynamics. 2, 307–327 (1965).
Adams, R., Fisher, C., Hakim, S., Ojemann, R. & Sweet, W. Symptomatic occult hydrocephalus with normal cerebrospinal-fluid pressure: a treatable syndrome. New England Journal of Medicine 273, 117–126 (1965).
Fisher, C. Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology 32, 1358–1358 (1982).
Lim, Y.-H. et al. Quantitative gait analysis and cerebrospinal fluid tap test for idiopathic normal-pressure hydrocephalus. Scientific Reports 9, 1–8 (2019).
Mori, E. et al. Guidelines for the management of idiopathic normal pressure hydrocephalus. Neurologia medico-chirurgica 52, 775–809 (2012).
Stolze, H. et al. Gait analysis in idiopathic normal pressure hydrocephalus–which parameters respond to the CSF tap test? Clinical Neurophysiology 111, 1678–1686 (2000).
Gallagher, R., Marquez, J. & Osmotherly, P. Gait and balance measures can identify change from a cerebrospinal fluid tap test in idiopathic normal pressure hydrocephalus. Archives of physical medicine and rehabilitation 99, 2244–2250 (2018).
Nutt, J., Marsden, C. & Thompson, P. Human walking and higher-level gait disorders, particularly in the elderly. Neurology 43, 268–268 (1993).
Anne Shumway-Cook, M. H. W. Motor Control: Translating Research into Clinical Practice. Vol. Fourth Edition 161–194 (Lippincott Wiliams & Wilkins, 2012).
Ivanenko, Y. & Gurfinkel, V. S. Human postural control. Frontiers in neuroscience 12, 171 (2018).
Winter, D. A., Patla, A. E. & Frank, J. S. J. M. p. t. Assessment of balance control in humans. 16, 31–51 (1990).
Palmieri, R. M., Ingersoll, C. D., Stone, M. B. & Krause, B. A. J. J. o. s. r. Center-of-pressure parameters used in the assessment of postural control. 11, 51–66 (2002).
Nashner, L. M. Practical biomechanics and physiology of balance. Balance function assessment and management 431 (2014).
Winter, D. A., Patla, A. E., Ishac, M., Gage, W. H. J. J. o. e. & kinesiology. Motor mechanisms of balance during quiet standing. 13, 49–56 (2003).
Prieto, T. E., Myklebust, J. B., Hoffmann, R. G., Lovett, E. G. & Myklebust, B. M. Measures of postural steadiness: differences between healthy young and elderly adults. IEEE Transactions on biomedical engineering 43, 956–966 (1996).
Schmit, J. M. et al. Deterministic center of pressure patterns characterize postural instability in Parkinson’s disease. Experimental brain research 168, 357–367 (2006).
Kamieniarz, A. et al. Detection of postural control in early Parkinson’s disease: Clinical testing vs. modulation of center of pressure. PLoS One 16, e0245353 (2021).
Kanekar, N., Lee, Y.-J. & Aruin, A. S. Frequency analysis approach to study balance control in individuals with multiple sclerosis. Journal of neuroscience methods 222, 91–96 (2014).
Czerwosz, L. et al. Analysis of postural sway in patients with normal pressure hydrocephalus: effects of shunt implantation. European journal of medical research 14, 1–6 (2009).
Blomsterwall, E., Svantesson, U., Carlsson, U., Tullberg, M. & Wikkelsö, C. Postural disturbance in patients with normal pressure hydrocephalus. Acta neurologica scandinavica 102, 284–291 (2000).
Nikaido, Y. et al. Postural control before and after cerebrospinal fluid shunt surgery in idiopathic normal pressure hydrocephalus. Clinical Neurology and Neurosurgery 172, 46–50 (2018).
Relkin, N., Marmarou, A., Klinge, P., Bergsneider, M. & Black, P. M. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57, S2-4-S2–16 (2005).
Ishikawa, M. et al. Guidelines for management of idiopathic normal pressure hydrocephalus guidelines from the Guidelines Committee of idiopathic normal pressure hydrocephalus, the Japanese Society of Normal Pressure Hydrocephalus. Neurologia medico-chirurgica 48, S1-S23 (2008).
Dubois, B., Slachevsky, A., Litvan, I. & Pillon, B. The FAB: a frontal assessment battery at bedside. Neurology 55, 1621–1626 (2000).
Kotolova, V. et al. in Mechatronics 2017: Recent Technological and Scientific Advances. 19–26 (Springer).
Demura, S., Kitabayashi, T. & Noda, M. Power spectrum characteristics of sway position and velocity of the center of pressure during static upright posture for healthy people. Perceptual and motor skills 106, 307–316 (2008).
Mukaka, M. M. A guide to appropriate use of correlation coefficient in medical research. Malawi medical journal 24, 69–71 (2012).
Kiss, R., Schedler, S. & Muehlbauer, T. Associations between types of balance performance in healthy individuals across the lifespan: a systematic review and meta-analysis. Frontiers in physiology 9, 1366 (2018).
Fleishman, E. A. The structure and measurement of physical fitness. (1964).
Sim, T. et al. Analysis of sensory system aspects of postural stability during quiet standing in adolescent idiopathic scoliosis patients. Journal of neuroengineering and rehabilitation 15, 1–11 (2018).
Suarez, H. et al. Changes in postural control parameters after vestibular rehabilitation in patients with central vestibular disorders. Acta oto-laryngologica 123, 143–147 (2003).
Virhammar, J., Laurell, K., Ahlgren, A., Cesarini, K. G. & Larsson, E.-M. Idiopathic normal pressure hydrocephalus: cerebral perfusion measured with pCASL before and repeatedly after CSF removal. Journal of Cerebral Blood Flow & Metabolism 34, 1771–1778 (2014).
Lenfeldt, N. et al. Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage. Brain 131, 2904–2912 (2008).
Goto, S. et al. Relationship between cognitive function and balance in a community-dwelling population in Japan. Acta Oto-Laryngologica 138, 471–474 (2018).
Tangen, G. G., Engedal, K., Bergland, A., Moger, T. A. & Mengshoel, A. M. Relationships between balance and cognition in patients with subjective cognitive impairment, mild cognitive impairment, and Alzheimer disease. Physical therapy 94, 1123–1134 (2014).
Pal, G. et al. Global cognitive function and processing speed are associated with gait and balance dysfunction in Parkinson’s disease. Journal of NeuroEngineering and Rehabilitation 13, 1–8 (2016).
Kerr, J. The experience of arousal: A new basis for studying arousal effects in sport. Journal of sports sciences 3, 169–179 (1985).
Huxhold, O., Li, S.-C., Schmiedek, F. & Lindenberger, U. Dual-tasking postural control: aging and the effects of cognitive demand in conjunction with focus of attention. Brain research bulletin 69, 294–305 (2006).
Takakusaki, K. Functional neuroanatomy for posture and gait control. Journal of movement disorders 10, 1 (2017).
Wu, T. et al. Basal ganglia circuits changes in Parkinson's disease patients. Neuroscience letters 524, 55–59 (2012).
Lee, P. H., Yong, S. W., Ahn, Y. H. & Huh, K. Correlation of midbrain diameter and gait disturbance in patients with idiopathic normal pressure hydrocephalus. Journal of neurology 252, 958–963 (2005).
Yamada, S. et al. Gait assessment using three-dimensional acceleration of the trunk in idiopathic normal pressure hydrocephalus. Frontiers in Aging Neuroscience 13, 653964 (2021).
Nikaido, Y. et al. Associations among falls, gait variability, and balance function in idiopathic normal pressure hydrocephalus. Clinical Neurology and Neurosurgery 183, 105385 (2019).
Howcroft, J., Lemaire, E. D., Kofman, J. & McIlroy, W. E. J. P. o. Elderly fall risk prediction using static posturography. 12, e0172398 (2017).

No competing interests reported.

SupplementaryFigure1.tif
Supplementary Figure 1. Calculating method of the base of support (BOS)

Download PDF

Version 1

posted

You are reading this latest preprint version

Alteration of Postural Stability after Cerebrospinal Fluid Tap Test in Patients with Idiopathic Normal Pressure Hydrocephalus

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Introduction

Method

1. Participants

2. COP measurement

3. Data analysis

3.1. COP parameters using time domain analysis

3.2. COP parameters using frequency domain analysis

4. Statistical analysis

Results

COP parameters using time domain analysis

COP parameters using frequency domain analysis

Relationship between FAB scores and COP parameters

Discussion

Conclusion

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1