Sensor-derived heel pressure metrics capture reversible gait dysfunction beyond conventional gait measures in normal pressure hydrocephalus.
Seongmin Hong, Wonhee Lee, Seung-Ick Choi and 4 others
PMID 42399967WHAT IT FOUND
After a spinal fluid tap test, heel pressure patterns changed in responders.
Adding heel pressure to a 10-m walk test showed added clinical usefulness, but did not clearly separate responders better.
Key findings
01People with possible iNPH had lower toe and heel peak pressures and higher heel pressure variability than controls.
02After the CSF tap test, responders had higher heel peak pressure and lower right heel pressure variability, and these changes were maintained after surgery in 19 participants.
03Adding heel pressure metrics to the 10-m walk test did not significantly improve separation of responders from non-responders, but decision curve analysis showed higher net benefit.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only participants able to walk 10 m without assistance were included, so the findings may not apply to people with more severe gait impairment. The responder and non-responder mix may not represent the wider iNPH population. The sample was small, and only 19 surgical participants were followed for 3 months. The insoles could have subtly changed gait or shoe fit. The predictive models were not externally validated, and multiple comparisons were not formally corrected. Cognitive and urinary outcomes were not analysed with gait changes. No direct comparison was made with other gait assessment platforms.
Declared interests
Funded by the Ministry of Health and Welfare, Republic of Korea.
The easy way to misread this
Do not conclude that instrumented insoles can replace the 10-m walk test or determine shunt candidacy. The AUROC improvement was not statistically significant, the sample was small, and the model was not externally validated.