Spatiotemporal and kinematic characterisation of gait in individuals with idiopathic Normal Pressure Hydrocephalus

Riaz, Mariam (2025) Spatiotemporal and kinematic characterisation of gait in individuals with idiopathic Normal Pressure Hydrocephalus. Masters by Research thesis (MSc), Manchester Metropolitan University.

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Abstract

Background: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, cognitive impairment, and impaired bladder control. This disturbance to gait results in a slow, unstable, short stepping pattern, with increased fall risk. There is currently no research providing in-depth, laboratory-based characterization of gait and balance in patients with iNPH, instead relying mainly on more subjective, clinical measures to identify the condition. This approach makes it difficult to distinguish iNPH from competing conditions which also affect gait, including Parkinson’s disease and normal ageing. Objective: This thesis was the first to provide full gait analysis and joint kinematics of iNPH patients. This thesis focused on the detailed characterization of gait abnormalities in patients with idiopathic Normal Pressure Hydrocephalus (iNPH) by analysing temporal and kinematic gait parameters. The primary aim was to provide a comprehensive assessment of gait impairment in iNPH patients to aid in diagnosis and establish a foundation for future evaluations of treatment effectiveness using gait analysis variables. Specifically, the study aimed to identify key gait and balance variables that objectively characterize mobility impairment in iNPH and accurately quantify changes in mobility and balance before and after the cerebrospinal fluid tap test (TT), a standard clinical procedure used to assess the potential benefit of permanent CSF drainage via a neurosurgical shunt. Methods: The study involved recruiting iNPH patients from Northern Care Alliance (Salford Royal) NHS Foundation Trust. Gait assessment was conducted using a 3D motion capture system to collect detailed data on gait dynamics. Temporal and kinematic parameters, including walking speed, cadence, step length, and range of motion at the hip, knee, and ankle joints across all three planes of motion (sagittal, frontal, and transverse), were measured. These parameters were then compared to those of age-matched healthy controls to identify deviations specific to iNPH patients. Results: Group comparison analysis revealed significant deviations in temporal and kinematic parameters in iNPH patients compared to healthy controls. iNPH patients walked slower, had lower cadence, smaller step lengths, and exhibited reduced range of motion at all three joints and planes of motion. These findings align with existing literature that documents gait disturbances in iNPH, such as slowed walking speed and increased step variability. This study is among the first to apply 3D gait analysis in this context, providing detailed insights into gait dynamics that surpass traditional 2D methods. Limitations: The study's scope was limited by the inability to compare joint kinetics successfully due to multiple foot strikes across the force plates. While part of the larger study, this thesis also did not include pre and post tap test comparisons of patients making it difficult to evaluate the effect of the procedure on gait. Furthermore, this study did not include muscle activation patterns, which are crucial for a comprehensive biomechanical analysis. Additionally, recruiting small group of patients exclusively from Salford Royal introduces potential selection bias and small sample size, limiting the generalisability of the findings. Conclusion: While this study contributes valuable knowledge about gait abnormalities in iNPH, it highlights the need for more comprehensive biomechanical analyses and broader patient recruitment strategies. Future research should focus on strategies to obtain high-quality kinetic data by using advanced techniques to analyse kinetic data effectively. Future work should also prioritize the inclusion of pre- and post- tap test comparisons to provide a comprehensive understanding of gait improvement. Biomechanical assessments, such as EMG, provide objective measurements of muscle activity and movement patterns. By objectively quantifying these parameters, researchers can track changes over time and evaluate the effectiveness of interventions or treatments (Hermens et al., 2000). Addressing these limitations will enhance the understanding of iNPH and improve diagnostic and therapeutic approaches.