Role of the Functional Gait Assessment in Validating Item Difficulty Hierarchy and Fall Risk for Idiopathic Normal Pressure Hydrocephalus

Yasutaka Nikaido ¹, Hideyuki Urakami ¹, Naoya Ishida ¹

⁰Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.

Movement Disorders Clinical Practice +

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April 18, 2025

View abstract on PubMed

Summary

Falls and gait disturbances are key symptoms in idiopathic normal pressure hydrocephalus (iNPH). The Functional Gait Assessment (FGA) effectively identifies fall risk in iNPH patients, aiding early diagnosis and intervention.

Area Of Science

Neurology
Geriatrics
Rehabilitation Medicine

Background

Falls and gait-balance disturbances are significant clinical manifestations of idiopathic normal pressure hydrocephalus (iNPH).
Accurate assessment of fall risk is crucial for managing iNPH patients and preventing injuries.

Purpose Of The Study

To validate the Functional Gait Assessment (FGA) item-difficulty hierarchy in iNPH.
To determine the optimal cutoff score of the FGA for predicting falls.
To identify specific FGA items most indicative of fall risk in iNPH.

Main Methods

One hundred eighty-eight iNPH patients were assessed using the FGA, Timed Up-and-Go (TUG), and 10-Meter Gait Speed (10MGS) tests.
Rasch analysis was employed to confirm the FGA item hierarchy and score-logit relationships.
Logistic regression identified the optimal FGA fall cutoff and key fall-related items.

Main Results

The FGA item hierarchy was validated, with item 7 ('gait with narrow base of support') being the most difficult.
An FGA cutoff score of ≤15 demonstrated high accuracy (AUC: 0.901) in predicting falls, outperforming TUG and 10MGS.
Key fall-related FGA items included 'change in gait speed,' 'gait with narrow base of support,' and 'stair steps.'

Conclusions

The FGA is a valid and effective tool for assessing fall risk in iNPH patients.
Leveraging FGA's item difficulty and characteristics can facilitate early diagnosis and personalized interventions.
Findings support the use of FGA for tailored rehabilitation and fall prevention strategies in iNPH.

Keywords:

balance falls functional gait assessment gait hydrocephalus