Quantitative trunk sway analysis under challenging gait conditions in early and untreated Parkinson's disease.

INTRODUCTION: Even experienced clinicians may encounter difficulties in making a definitive diagnosis in the early motor stages of Parkinson's disease (PD). We investigated whether quantitative biomechanical trunk sway analysis could support the diagnosis of PD early on. METHODS: We quantified trunk sway performance using body-worn sensors during a test battery of six challenging gait conditions in a cohort of 17 early and untreated PD patients (with evidence of reduced tracer uptake in the basal ganglia on dopamine transporter scans) and 17 age- and sex-matched healthy controls (HCs). RESULTS: Compared to HC, the PD group (Hoehn & Yahr ≤ 2, Unified Parkinson's Disease Rating Scale motor score: mean 13.7 ± 3.5 points) showed significant trunk rigidity in five challenging gait tasks (decreased medio-lateral direction and sway angle area). Post hoc receiver operating characteristic analysis of the significant parameters revealed excellent discrimination with high sensitivity and specificity. CONCLUSION: In the early and untreated motor stages of PD, patients exhibit significant trunk rigidity during challenging gait tasks. Trunk sway motion recorded with body-worn sensors might be a useful tool to disclose a sometimes hard-to-trace cardinal motor sign of PD and support an early clinical diagnosis.

Assessment of neurological symptoms in adult hydrocephalus occlusus. A pilot study.

BACKGROUND: Comprehensively describe and compare (pre/postoperatively) the clinical symptomatology in adult non-communicated hydrocephalus. Associated hydrocephalus signs were analyzed with the idiopathic Normal Pressure Hydrocephalus Scale (iNPH Scale). A standardized clinical scale for non-communicated hydrocephalus is currently not in use. METHODS: Ten patients with hydrocephalus occlusus (HO) were analyzed. Hydrocephalus signs were examined with the iNPH Scale in gait, neuropsychology, continence, and balance before and three months after treatment with shunt operation or third endoscopic ventriculostomy. RESULTS: Patients significantly improved in iNPH total score (25.8%) and gait score (35.4%) three months after neurosurgical intervention. Domain scores in neuropsychology, continence, and balance reached statistical trends (p ≤ 0.066). Most clinical symptoms and signs at baseline improved after surgery (dizziness, lapse of concentration, gait instability, and headache). CONCLUSION: Patients with non-communicated HO also showed classical hydrocephalus symptoms as communicated in iNPH patients. The iNPH Scale allows a structured neurological assessment over the disease's progress and surgical intervention. Further studies with a larger patient samples are necessary to support our results.

A comprehensive clinico-radiological, neuropsychological and biomechanical analysis approach to patients with idiopathic normal pressure hydrocephalus.

BACKGROUND: A systematic approach to patients with suspected idiopathic normal pressure hydrocephalus (iNPH) is essential to recognize the subset of patients who may benefit from ventriculoperitoneal shunt surgery (VPS). Quantitative biomechanical analysis of gait and balance (QBAGB) may help objectify the response to the cerebrospinal fluid tap test (CSF-TT) and VPS outcome after 3 months and support identification of candidates for VPS. METHODS: We retrospectively reviewed data from all patients with probable iNPH who 1) underwent clinico-radiological and neuropsychological assessments using validated scales (iNPH Scale and iNPH Radscale) at our centre in the period from January to December 2018; and 2) had completed QBAGB before CSF-TT ('baseline'), shortly after CSF-TT, and at three months after either VPS or conservative treatment. RESULTS: At the time-points 'after CSF-TT' and '3 months', patients with iNPH and VPS (n = 11) significantly improved on the Kiefer Scale score, iNPH Scale total score and gait domain score, as well as in gait velocity and step length measured by QBAGB. In contrast, patients without surgery (n = 10) had unchanged iNPH Scale scores and motor performance throughout. Using data from all patients, we calculated cut-off levels for substantial improvements in gait velocity, step length, and the iNPH Scale domain gait score at the time-point 'after CSF-TT'. CONCLUSION: QBAGB helps to objectify the response to CSF-TT to select candidates for VPS and corroborates clinico-radiological and neuropsychological data derived from validated scales. The QBAGB cut-off values for substantial improvement after CSF-TT need further elucidation in larger, preferably prospective studies.

N,N-Dimethylglycine in patients with progressive multiple sclerosis: result of a pilot double-blind, placebo, controlled randomized clinical trial.

Oral administration of N,N-Dimethylglycine (DMG), a tertiary amino acid, presumably enhances oxygen utilization by tissue and complex with free radicals. Beneficial effects are improved endurance performance and reduction fatigue in humans and animals. This pilot study reports the results over a one-year double-blind, placebo-controlled trial of DMG in 30 randomized patients with progressive multiple sclerosis. No treatment effects were found between the placebo group and the DMG group for disability, fatigue, cognitive, or gait parameters.

Cognitive impairment predicts worse short-term response to spinal tap test in normal pressure hydrocephalus.

INTRODUCTION: In patients with idiopathic normal pressure hydrocephalus (iNPH), the spinal tap test (STT) is commonly used to predict ventriculoperitoneal shunt responsiveness. Clinical improvement following STT usually is measured by testing gait function. In our study, we investigated the impact of cognitive impairment on gait improvement after STT. METHODS: 22 patients with the clinical and radiological diagnosis of iNPH underwent gait analyses (mobile measuring system Medilogic) before and 2-4h after STT in self-paced gait velocity over 7m. Prior to STT, cognition was evaluated by the Mini Mental State Examination (MMSE). MMSE<24/30 points was used to define the subgroup of patients with cognitive impairment (iNPH-CI). Spatio-temporal parameters of gait before STT vs. after STT were analyzed with ANOVA with repeated measures. RESULTS: 1. Baseline gait parameters did not differ between the two groups: patients with iNPH and normal cognition (n=11) and patients with iNPH-CI (n=11). 2. Following STT, there was significant improvement of gait parameters in patients without cognitive impairment, while patients with iNPH-CI did not benefit from STT. CONCLUSION: Subjects with iNPH have a higher probability of lack of gait improvement 2-4h following STT, if cognitive impairment is present. Further studies are needed to elucidate the associations of cognitive impairment and quantitative gait parameters measured early and at later time points after STT.

3-week whole body vibration does not improve gait function in mildly affected multiple sclerosis patients--a randomized controlled trial.

OBJECTIVE: To investigate the effects of whole body vibration (WBV) training on gait function in persons with mild multiple sclerosis (MS). DESIGN: A randomized controlled trial. SUBJECTS: 18 patients with MS were assigned randomly to WBV (intervention group) or to placebo WBV. METHODS: Both groups performed a 3-week training period under static conditions on a vibration platform. In the placebo group, the vibration platform was covered and therefore vibrations could not operate. Gait function (gait velocity, stride length, double support phase, single-step variability left and right) was assessed at baseline, after 3-weeks of WBV intervention or sham WBV, 4-weeks after baseline, and 5-weeks after baseline using a mobile plantar food pressure system and the "Timed Up and Go" test under four different gait conditions (comfortable overground gait, comfortable gait on treadmill, -20% comfortable gait velocity on treadmill and +20% comfortable gait velocity on treadmill). RESULTS: None of the outcome measures of gait function showed statistically significant alterations following 3-weeks of intervention/placebo WBV. CONCLUSION: The applied protocol of WBV does not show a meaningful improvement of gait function in mildly affected MS patients.

Objectification of psychogenic postural instability by trunk sway analysis.

INTRODUCTION: The attribution of balance or gait disorders to psychogenic origin can be exceedingly challenging, as clinical tests involving distraction maneuvers are prone to subjective bias. We tested the value of biomechanical balance analysis to identify psychogenic balance and gait (PBG) disorders. METHODS: We quantified and compared the effects of distraction maneuvers on balance based on four stance conditions (eyes open, EO; eyes closed, EC; EO on foam, EOF; and EC on foam; ECF) in subjects with suspected PBG (n = 12), subjects with balance and gait disorder due to multiple sclerosis (MS; n = 12) and healthy controls (n = 12). We measured trunk inclination in transverse plane (°)(2) and the corresponding body angular velocity (°/s). Distractibility of postural stability was analysed using ANOVA with repeated measures. RESULTS: In evident contrast to the MS group and healthy controls, the PBG group showed increased values of (°)(2) and (°/s) and significant distractibility in all four stance conditions. CONCLUSIONS: Biomechanical balance analysis can help clinicians to get objective, quantified results of distraction maneuvers and confirm a positive diagnosis of PBG disorders. Large prospective studies are needed to confirm these results.