Abstract Details

Title Leveraging Markerless Video-based Gait Analysis to Diagnose iNPH.

Topic Movement Disorders

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 16-007

Objective To predict whether gait parameters from markerless video-based gait analysis, align with clinician-determined drain-trial response in individuals being worked up for iNPH

Background iNPH often shows gait improvement after a temporary CSF drain trial used to select shunt candidates. The 10-meter walk (10MWT) is practical and captures meaningful change, yet the trial’s negative predictive value is limited. In routine care, clinicians time the 10MWT but rarely leverage richer quantitative features (e.g., stride length/width, stride-time variability/asymmetry). We hypothesized that advanced gait metrics would better align with a clinician-determined drain response and help connect objective trial gains with post-operative outcomes.

Design/Methods Single-center cohort of 28 iNPH patients with pre- and post-drain 10MWT videos were analyzed using an automated markerless pose-estimation pipeline. Primary endpoint: gait speed (m/s); responders specified as ≥20% relative increase. We derived step count, cadence, step width, and stride/step variability/asymmetry. MRIs were scored via iNPH Radscale. Within-subject change used paired tests and standardized response mean. A baseline-speed threshold was estimated by Youden’s index. The comparator was a multidisciplinary committee-determined clinical drain response.

Results Mean gait speed increased from 0.544 to 0.666 m/s; mean within-subject change +0.121 m/s (+32.8%) (p<0.003). Responders: 13/28 (46.4%) by Δ≥0.10 m/s and 11/28 (39.3%) by ≥20%. Baseline pre-drain speed alone showed rule-in utility (high specificity, limited sensitivity). Advanced gait metrics changed in the expected direction (e.g., longer strides, higher cadence), stride-time variability/asymmetry effects were heterogeneous. Imaging markers and MoCA showed non-significant associations with percent speed change.

Conclusions Video based 10MWT detected clinically relevant post-drain gains, with ~38% meeting the ≥20% responder criterion. Neither baseline speed, MoCA category, nor Radscale components reliably identified responders. Findings support feasibility of automated video analytics and the ≥20% benchmark, while highlighting the need for larger, prospective studies to refine simple prediction rules, select differentiating gait variables, and link drain trial changes to patient-centered post-shunt outcomes.

Authors/Disclosures
Tatiana Lopez, MD PRESENTER	Dr. Lopez has nothing to disclose.
Kevin Yin	Mr. Yin has nothing to disclose.
Joshua Johnston (Cleveland Clinic Lerner Research Institute)	No disclosure on file
Roman Popov	Mr. Popov has nothing to disclose.
Masatomo Kobayashi, PhD	Dr. Kobayashi has nothing to disclose.
Yasunori Yamada, PhD	Dr. Yamada has nothing to disclose.
Erhan Bilal, PhD	Mr. Bilal has nothing to disclose.
Jeffrey Rogers, PhD	Dr. Rogers has received personal compensation for serving as an employee of IBM.
Benjamin L. Walter, MD (Cleveland Clinic)	Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Acorda. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Lundbeck. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medtronic. Dr. Walter has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbott.
Hubert H. Fernandez, MD, FAAN (Center for Neurological Restoration, Cleveland Clinic)	Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intrance. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Fernandez has received publishing royalties from a publication relating to health care. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as a Steering Committee/Advisory Committee Member with Parkinson Study Group.
Sean Nagel, MD	Dr. Nagel has nothing to disclose.
Jay L. Alberts, PhD (Cleveland Clinic)	Dr. Alberts has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ceraxis. Dr. Alberts has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceraxis. The institution of Dr. Alberts has received research support from NIH. The institution of Dr. Alberts has received research support from Department of Defense. The institution of Dr. Alberts has received research support from Michael J. Fox Foundation. Dr. Alberts has received intellectual property interests from a discovery or technology relating to health care. Dr. Alberts has received personal compensation in the range of $500-$4,999 for serving as a Member, Health and Wellness Council with Peloton Interactive.
James Liao, MD	The institution of Dr. Liao has received research support from American Parkinson Disease Association. The institution of Dr. Liao has received research support from a Cleveland Clinic - IBM Research Collaboration, in the form of in-kind support. Dr. Liao has received intellectual property interests from a discovery or technology relating to health care. Dr. Liao has a non-compensated relationship as a Investigator with Adult Hydrocephalus Research Network that is relevant to AAN interests or activities.

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