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Postural stability in patients with chronic subdural hematoma
Nina Sundström1, Linda Djerf2, Zandra Olivecrona2
1Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden. nina.sundstrom@vll.se.
Insights
Chronic subdural hematoma (cSDH) patients exhibit poor postural stability, increasing fall risk. While surgery improves balance, stability issues persist regardless of hematoma size, necessitating fall prevention strategies.
Area of Science:
- Neuroscience
- Geriatrics
- Biomechanics
Background:
- Gait disturbances and falls are prevalent in chronic subdural hematoma (cSDH) patients.
- Current postural stability assessments rely on visual observation, lacking objective quantification.
- No quantitative tools have been established to measure postural stability in cSDH.
Purpose of the Study:
- To quantitatively evaluate postural stability in cSDH patients using trunk sway during stance and gait.
- To compare postural stability between cSDH patients and healthy elderly individuals.
- To investigate correlations between postural stability and factors like age, hematoma size, midline shift, and location.
Main Methods:
- A prospective study involving 22 cSDH patients (pre- and post-surgery) and 58 healthy elderly (HE) participants.
- Trunk sway was measured using a gyroscopic method during seven standing and walking tasks.
- Assessed trunk sway amplitude and velocity in anterior-posterior and medial-lateral directions.
Main Results:
- cSDH patients demonstrated significantly reduced postural stability compared to HE during standing tasks.
- During gait, cSDH patients exhibited increased sway angle and decreased velocity.
- Postural stability improved postoperatively, particularly in the medial-lateral direction, but no correlation was found with hematoma characteristics.
Conclusions:
- Most cSDH patients experience diminished postural stability, which partially recovers after surgery.
- Reduced postural stability is independent of hematoma size and midline shift, indicating a consistent fall risk.
- Clinical management of cSDH patients requires proactive fall prevention measures, especially during hospitalization.
Background:
Gait disturbances and falls are common in patients with chronic subdural hematoma (cSDH). Postural stability is mainly visually assessed and has not been described using an objective and quantitative measurement tool. The objective of this prospective study was to evaluate postural stability in cSDH patients by measuring trunk sway during stance and gait compared to healthy elderly (HE). It was also to evaluate the relationships among postural stability and age, hematoma size, brain midline shift and hematoma location.
Methods:
Using a gyroscopic method, trunk sway was measured in 22 cSDH patients preoperatively, 5 postoperatively and 58 HE during seven standing and walking tasks. Trunk sway amplitude and velocity in the anterior-posterior and medial-lateral directions were assessed.
Results:
Postural stability was reduced in the cSDH group compared to HE for all standing tasks. During gait, the sway angle was increased while velocity was decreased in the cSDH group. Only 18 % of the patients could perform all tasks without losing their balance. Postoperatively, postural stability was normalized in the medial-lateral direction during standing. There were no correlations among age, hematoma size, brain midline shift or location of the hematoma and trunk sway.
Conclusions:
The majority of cSDH patients had reduced postural stability that was partly reversed soon after surgery. It was not correlated to hematoma characteristics, indicating that an increased risk to fall is present regardless of hematoma size and midline shift. This must be accounted for when handling these patients and measures taken to prevent further fall accidents during hospital stays.
