Using smartphone-based accelerometers to gauge postoperative outcomes in patients with NPH: Implications for ambulatory monitoring

Abstract

Background: The surgical treatment of normal pressure hydrocephalus (NPH) with shunting remains controversial due to the difficulty in distinguishing such pathology from other neurological conditions that can present similarly. Thus, patients with suspected NPH should be carefully selected for surgical intervention. Historically, clinical improvement has been measured by the use of functional grades, alleviation of symptoms, and/or patient/family-member reported surveys. Such outcome analysis can be subjective, and there is difficulty in quantifying cognition. Thus, a push for a more quantifiable and objective investigation is warranted, especially for patients with idiopathic NPH (INPH), for which the final diagnosis is confirmed with postoperative clinical improvement. We aimed to use Apple Health (Apple Inc., Cupertino, CA) data to approximate physical activity levels before and after shunt placement for NPH as an objective outcome measurement. The patients were contacted and verbally consented to export Apple Health activity data. The patient’s physical activity data were then analyzed. A chart review from the patient’s EMR was performed to understand and better correlate recovery. Case Description: Our first patient had short-term improvements in activity levels when compared to his preoperative activity. The patient’s activity level subsequently decreased at 6 months and onward. This decline was simultaneous to new-onset lumbar pain. Our second patient experienced sustained improvements in activity levels for 12 months after his operation. His mobility data were in congruence with his subjectively reported improvement in clinical symptoms. He subsequently experienced a late-decline that began at 48-months. His late deterioration was likely confounded by exogenous factors such as further neurodegenerative diseases coupled with old age. Conclusion: The use of objective activity data offers a number of key benefits in the analysis of shunted patients with NPH/INPH. In this distinctive patient population, detailed functional outcome analysis is imperative because the long-term prognosis can be affected by comorbid factors or life expectancy. The benefits from using smartphone-based accelerometers for objective outcome metrics are abundant and such an application can serve as a clinical aid to better optimize surgical and recovery care.

Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus

“…The applications use accelerometer and gyroscope data to assess balance and gait and to detect the freezing of gait patterns ( 30 ). The use of such technology with patients with iNPH has been reported in two patients so far ( 31 ). A recent study investigated the walking pattern of healthy subjects and patients with iNPH in a controlled and real-world environment through the use of wearable gait assessment devices ( 21 ).…”

Objective assessment of patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement using activity-monitoring data: pilot study

“…Similarly, previous studies have identified challenges in the application and variability of results while using activity-monitoring tracking data for the assessment of gait improvement in iNPH after CSF diversion surgery. 21,22 Also, in a study by Ferrari et al, there was a significant correlation between clinical variables and data from inertial sensors, 23 although paired analysis was not performed comparing the changes over time.…”