{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T02:23:37Z","timestamp":1790130217732,"version":"4.0.1"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait deterioration, cognitive disturbances, and urinary incontinence. Gait deficits pose safety hazards due to frequent falls, yet objective investigations of gait improvement following ventriculoperitoneal shunt (VPS) placement are limited. Therefore, the aim of this study was to assess objective improvement in gait parameters for patients with iNPH after VPS placement.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n All patients treated with a VPS for iNPH by the senior author at a single tertiary care center from December 2017 to January 2023 were retrospectively reviewed. Patients who underwent detailed motion analysis testing before surgery with > 1 follow-up assessment were included. Analyzed parameters included gait velocity, gait cadence, stride length, stride width, gait stability ratio, total support, and single support. Time-dependent linear mixed-effects models and generalized additive mixed-effects models (GAMMs) were used to model short-term and longitudinal gait parameter changes, respectively.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 212 patients (137 male, median age was 75.2 years) who underwent VPS placement for iNPH were included, with a total of 747 gait analyses performed at a median last-gait analysis follow-up duration of 12.0 months. Statistically significant changes in all gait parameter values were seen between the preoperative time point and first postoperative follow-up (within 3 months) time point (paired Wilcoxon p < 0.001), with a statistically significant majority of patients experiencing improvement (binominal p < 0.0001). Longitudinal analyses using a GAMM showed increased gait velocity, single support, and stride length, with decreased stability ratio, step width, and total support at early time points, while a plateau was achieved around 6 months.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n A detailed gait analysis demonstrated significant improvements in objective ambulation metrics, particularly in the gait velocity, stride length, and gait stability ratio, following VPS placement in patients with iNPH. Most patients maintained marked improvement from baseline to the last follow-up assessment, although a plateau of the benefit was experienced over longer follow-up.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.3.jns241416","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T22:44:03Z","timestamp":1751064243000},"page":"1254-1261","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating longitudinal changes of gait parameters following shunt placement in patients with idiopathic normal pressure hydrocephalus"],"prefix":"10.3171","volume":"143","author":[{"given":"Rahul","family":"Kumar","sequence":"first","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman M.","family":"Hamouda","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria D.","family":"Astudillo Potes","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahnoor","family":"Shafi","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana","family":"Hallak","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandesh G.","family":"Bhat","sequence":"additional","affiliation":[{"name":"Biomedical Engineering, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asghar","family":"Rezaei","sequence":"additional","affiliation":[{"name":"Biomedical Engineering, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Jusu\u00e9-Torres","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic Health System, Eau Claire, Wisconsin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Graff-Radford","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Jones","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Botha","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy K.","family":"Cutsforth-Gregory","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farwa","family":"Ali","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petrice M.","family":"Cogswell","sequence":"additional","affiliation":[{"name":"Radiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenton R.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Biomedical Engineering, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Elder","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"},{"name":"Biomedical Engineering, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Neurol Sci","first-page":"307","article-title":"The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. 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Nat Clin Pract Neurol. 2006;2(7):375\u2013381."},{"issue":"2","key":"b3","series-title":"Neurol Med Chir (Tokyo)","first-page":"63","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): endorsed by the Japanese Society of Normal Pressure Hydrocephalus","volume":"61","author":"Nakajima M","year":"2021","unstructured":"Nakajima M, Yamada S, Miyajima M, Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): endorsed by the Japanese Society of Normal Pressure Hydrocephalus. Neurol Med Chir (Tokyo). 2021;61(2):63\u201397."},{"issue":"9","key":"b4","series-title":"Clin Neurophysiol","first-page":"1678","article-title":"Gait analysis in idiopathic normal pressure hydrocephalus\u2014which parameters respond to the CSF tap test?","volume":"111","author":"Stolze H","year":"2000","unstructured":"Stolze H, Kuhtz-Buschbeck JP, Dr\u00fccke H, Gait analysis in idiopathic normal pressure hydrocephalus\u2014which parameters respond to the CSF tap test? Clin Neurophysiol. 2000;111(9):1678\u20131686."},{"issue":"2","key":"b5","series-title":"Geriatrics","first-page":"32","article-title":"When to consider normal pressure hydrocephalus in the patient with gait disturbance","volume":"63","author":"Factora R","year":"2008","unstructured":"Factora R, Luciano M. When to consider normal pressure hydrocephalus in the patient with gait disturbance. Geriatrics. 2008;63(2):32\u201337."},{"issue":"Pt 11","key":"b6","series-title":"Brain","first-page":"2904","article-title":"Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage","volume":"131","author":"Lenfeldt N","year":"2008","unstructured":"Lenfeldt N, Larsson A, Nyberg L, Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage. Brain. 2008;131(Pt 11):2904-2912."},{"issue":"3 Suppl","key":"b7","series-title":"Neurosurgery","first-page":"S4","article-title":"Diagnosing idiopathic normal-pressure hydrocephalus","volume":"57","author":"Relkin N","year":"2005","unstructured":"Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. 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Physical capacity and activity in patients with idiopathic normal pressure hydrocephalus. Front Neurol. 2022;13:845976."},{"issue":"2","key":"b13","series-title":"J Med Life","first-page":"194","article-title":"The effects of ventriculoperitoneal shunt on gait performance","volume":"12","author":"Baltateanu D","year":"2019","unstructured":"Baltateanu D, Ciobanu I, Berteanu M. The effects of ventriculoperitoneal shunt on gait performance. J Med Life. 2019;12(2):194\u2013198."},{"issue":"3","key":"b14","series-title":"Neurology","first-page":"307","article-title":"Surgical treatment of idiopathic hydrocephalus in elderly patients","volume":"35","author":"Petersen RC","year":"1985","unstructured":"Petersen RC, Mokri B, Laws ER Jr. Surgical treatment of idiopathic hydrocephalus in elderly patients. 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Neurosurgery. 2013;73(6):1054\u20131060."},{"issue":"10","key":"b21","series-title":"PLoS One","first-page":"e0204926","article-title":"Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance","volume":"13","author":"Isaacs AM","year":"2018","unstructured":"Isaacs AM, Riva-Cambrin J, Yavin D, Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance. PLoS One. 2018;13(10):e0204926."},{"issue":"9","key":"b22","series-title":"Acta Neurochir (Wien)","first-page":"2367","article-title":"Gait, falls, cognitive function, and health-related quality of life after shunt-treated idiopathic normal pressure hydrocephalus-a single-center study","volume":"164","author":"Hallqvist C","year":"2022","unstructured":"Hallqvist C, Gr\u00f6nstedt H, Arvidsson L. Gait, falls, cognitive function, and health-related quality of life after shunt-treated idiopathic normal pressure hydrocephalus-a single-center study. Acta Neurochir (Wien). 2022;164(9):2367\u20132373."},{"issue":"11","key":"b23","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1282","article-title":"Normal pressure hydrocephalus: long-term outcome after shunt surgery","volume":"79","author":"Pujari S","year":"2008","unstructured":"Pujari S, Kharkar S, Metellus P, Shuck J, Williams MA, Rigamonti D. Normal pressure hydrocephalus: long-term outcome after shunt surgery. J Neurol Neurosurg Psychiatry. 2008;79(11):1282\u20131286."},{"key":"b24","series-title":"World Neurosurg","first-page":"e126","article-title":"Normal pressure hydrocephalus and comorbidities: a quality study of the University Hospital M\u00fcnster","volume":"177","author":"Nienhaus S","year":"2023","unstructured":"Nienhaus S, Stummer W, Khaleghi Ghadiri M. 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Biomed Tech (Berl). 2002;47(3):54\u201358."},{"issue":"1","key":"b28","series-title":"Sci Rep","first-page":"18460","article-title":"Association of gait and cognition after surgery in patients with idiopathic normal pressure hydrocephalus","volume":"13","author":"Ishikawa M","year":"2023","unstructured":"Ishikawa M, Mori E. Association of gait and cognition after surgery in patients with idiopathic normal pressure hydrocephalus. Sci Rep. 2023;13(1):18460."},{"issue":"5","key":"b29","series-title":"Arq Neuropsiquiatr","first-page":"324","article-title":"Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test","volume":"76","author":"Souza RKM","year":"2018","unstructured":"Souza RKM, Rocha SFBD, Martins RT, Kowacs PA, Ramina R. Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test. 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Sci Rep. 2024;14(1):2053."},{"issue":"4","key":"b31","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Objective assessment of patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement using activity-monitoring data: pilot study","volume":"54","author":"Jusu\u00e9-Torres I","year":"2023","unstructured":"Jusu\u00e9-Torres I, Brown DA, Pennington Z, Objective assessment of patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement using activity-monitoring data: pilot study. Neurosurg Focus. 2023;54(4):E6."},{"issue":"3","key":"b32","series-title":"J Geriatr Phys Ther","first-page":"E42","article-title":"Concurrent validity of the Zeno walkway for measuring spatiotemporal gait parameters in older adults","volume":"42","author":"Vallabhajosula S","year":"2019","unstructured":"Vallabhajosula S, Humphrey SK, Cook AJ, Freund JE. Concurrent validity of the Zeno walkway for measuring spatiotemporal gait parameters in older adults. J Geriatr Phys Ther. 2019;42(3):E42\u2013E50."},{"issue":"4","key":"b1","series-title":"J Neurol Sci","first-page":"307","article-title":"The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics","volume":"2","author":"Hakim S","year":"1965","unstructured":"Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci. 1965;2(4):307\u2013327."},{"issue":"7","key":"b2","series-title":"Nat Clin Pract Neurol","first-page":"375","article-title":"The diagnosis and treatment of idiopathic normal pressure hydrocephalus","volume":"2","author":"Gallia GL","year":"2006","unstructured":"Gallia GL, Rigamonti D, Williams MA. 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