Análise tridimensional da marcha para detectar mudanças na avaliação de pacientes com hidrocefalia de pressão normal

Abstract

Background: Normal pressure hydrocephalus (NPH) is characterized by ventricular dilatation with normal cerebrospinal fluid pressure, and it is manifested by the presence of a triad of symptoms: dementia, gait disturbances, and urinary incontinence. Of these, gait impairment is the earliest symptoms, characterized by under stride length, broad base and reduced speed. Since the disorder progresses slowly, analyzing the gait of idiopathic NPH (iNPH) patients is crucial to a fuller understanding of this dysfunction. Therefore, in order to describe gait changes in detail, it is fundamental to compare them with normal gait patterns, and to determine which variable is the best for assessing gait patterns before and after an intervention. Objective: Thus, this doctoral thesis was divided into 2 studies, with the following objectives: 1: To describe the clinical indices of gait analysis and the kinematic characteristics of iNPH patients when compared to healthy elderly; 2: To determine repeatability, standard error of measurement (SEM), minimum detectable change of linear variables, and gait deviation index (GDI) of patients with suspected iNPH. Results: In the first study, patients with iNPH presented lower speed, cadence, time and stride length, as well as an increase in the 1st and 2nd double support and reduced simple support with an effect size between 0.49 - 0.74. In the second study, GDI presented the highest levels of repeatability for all variables (ICC: 0.85 (0.83-0.87), SEM: 7.65%), followed by stride length (ICC: 0.95 (0.94-0.96), SEM: 7.89%). Conclusion: Patients with iNPH had a change in gait in both the gait indexes and in the linear and angular parameters when compared to healthy elderly. Additionally, among the variables studied, gait deviation index (GDI) and stride length had the highest repeatability and the least variability during the three-dimensional gait analysis.