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      Gait apraxia evaluation in normal pressure hydrocephalus using inertial sensors. Clinical correlates, ventriculoperitoneal shunt outcomes, and tap-test predictive capacity

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          Abstract

          Background

          Idiopathic normal pressure hydrocephalus (iNPH) is a neurological condition with gait apraxia signs from its early manifestation. Ventriculoperitoneal shunt (VPS) is a surgical procedure available for treatment. The Cerebrospinal fluid Tap Test (CSF-TT) is a quick test used as selection criterion for VPS treatment. Its predictive capacity for VPS outcomes is still sub judice. This study is aimed to test the hypothesis that wearable motion sensors provide valid measures to manage iNPH patients with gait apraxia.

          Methods

          Forty-two participants of the Bologna PRO-Hydro observational cohort study were included in the analyses. The participants performed the Timed Up and Go (TUG) and the 18 m walking test (18mW) with inertial sensors at baseline, three days after the CSF-TT, and six months after VPS. 21 instrumental variables described gait and postural transitions from TUG and 18mW recordings. Furthermore, participants were clinically assessed with scales (clinical variables). We tested the hypothesis by analysing the concurrent validity of instrumental and clinical variables, their individual- and group-level responsiveness to VPS, and their predictive validity for VPS outcomes after CSF-TT.

          Results

          The instrumental variables showed moderate to high correlation with the clinical variables. After VPS, most clinical and instrumental variables showed statistically significant improvements that reflect a reduction of apraxic features of gait. Most instrumental variables, but only one clinical variable (i.e., Tinetti POMA), had predictive value for VPS outcomes (significant adjusted R 2 in the range 0.12–0.70).

          Conclusions

          These results confirm that wearable inertial sensors may represent a valid tool to complement clinical evaluation for iNPH assessment and prognosis.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12987-022-00350-y.

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          Most cited references42

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          Statistical Power Analysis for the Behavioral Sciences

          <i>Statistical Power Analysis</i> is a nontechnical guide to power analysis in research planning that provides users of applied statistics with the tools they need for more effective analysis. The Second Edition includes: <br> * a chapter covering power analysis in set correlation and multivariate methods;<br> * a chapter considering effect size, psychometric reliability, and the efficacy of "qualifying" dependent variables and;<br> * expanded power and sample size tables for multiple regression/correlation.<br>
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            Intraclass correlations: Uses in assessing rater reliability.

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              Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM.

              Reliability, the consistency of a test or measurement, is frequently quantified in the movement sciences literature. A common metric is the intraclass correlation coefficient (ICC). In addition, the SEM, which can be calculated from the ICC, is also frequently reported in reliability studies. However, there are several versions of the ICC, and confusion exists in the movement sciences regarding which ICC to use. Further, the utility of the SEM is not fully appreciated. In this review, the basics of classic reliability theory are addressed in the context of choosing and interpreting an ICC. The primary distinction between ICC equations is argued to be one concerning the inclusion (equations 2,1 and 2,k) or exclusion (equations 3,1 and 3,k) of systematic error in the denominator of the ICC equation. Inferential tests of mean differences, which are performed in the process of deriving the necessary variance components for the calculation of ICC values, are useful to determine if systematic error is present. If so, the measurement schedule should be modified (removing trials where learning and/or fatigue effects are present) to remove systematic error, and ICC equations that only consider random error may be safely used. The use of ICC values is discussed in the context of estimating the effects of measurement error on sample size, statistical power, and correlation attenuation. Finally, calculation and application of the SEM are discussed. It is shown how the SEM and its variants can be used to construct confidence intervals for individual scores and to determine the minimal difference needed to be exhibited for one to be confident that a true change in performance of an individual has occurred.
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                Author and article information

                Contributors
                david.milletti@isnb.it
                Journal
                Fluids Barriers CNS
                Fluids Barriers CNS
                Fluids and Barriers of the CNS
                BioMed Central (London )
                2045-8118
                23 June 2022
                23 June 2022
                2022
                : 19
                : 51
                Affiliations
                [1 ]Science & Technology Park for Medicine, TPM, Mirandola, Modena Italy
                [2 ]GRID grid.7548.e, ISNI 0000000121697570, Department of Engineering “Enzo Ferrari”, , University of Modena and Reggio Emilia, ; Modena, Italy
                [3 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi” (DEI), , University of Bologna, ; Bologna, Italy
                [4 ]GRID grid.492077.f, Unit of Rehabilitation Medicine, , IRCCS Istituto delle Scienze Neurologiche di Bologna, ; Bellaria Hospital Via Altura 3, 40139 Bologna, Italy
                [5 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Department of Biomedical and Neuromotor Sciences (DIBINEM), , University of Bologna, ; Bologna, Italy
                [6 ]GRID grid.492077.f, Unit of Neurology, , IRCCS Istituto delle Scienze Neurologiche di Bologna, ; Bologna, Italy
                [7 ]GRID grid.492077.f, Unit of Neuroradiology, , IRCCS Istituto delle Scienze Neurologiche di Bologna, ; Bologna, Italy
                [8 ]GRID grid.492077.f, Unit of Neurosurgery, , IRCCS Istituto delle Scienze Neurologiche di Bologna, ; Bologna, Italy
                [9 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Health Sciences and Technologies Interdepartmental Center for Industrial Research (CIRI-SDV), , University of Bologna, ; Bologna, Italy
                Article
                350
                10.1186/s12987-022-00350-y
                9219204
                35739555
                41a2f411-0110-4381-934c-5a2303915504
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 12 January 2022
                : 7 June 2022
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Neurology
                idiopathic normal pressure hydrocephalus,gait analysis,ventriculoperitoneal shunt,tap test,gait apraxia

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