\r\n\tb. The growth of digital environments which can educate and empower as well as exploit and destroy (mobile learning, STEM education, tablets, etc.). \r\n\tc. Social, racial, class, and gender-based discriminations that restrict the developmental potential and the prosperity perspectives \r\n\td. Health hazards and illnesses such as the laters COVID-19 pandemic. \r\n\te. Armed conflicts with casualties and displacements of populations seeking refuge \r\n\tf. Lack of physical spaces that will support and nourish development and learning, etc.
\r\n
\r\n\tEducation in the post-modern era strives to address the above issues and develop policies, curricula, methodologies, and strategies to contribute to an environmentally and socially sustainable future. It embraces multiple perspectives and worldviews and seeks to touch on inequalities and discriminations in favor of equity. In this direction, children’s s agency lies at the heart of democratic approaches. Educational processes adopt forms of interactions that actualize learning as “becoming” and place it in a continuum between past, present, and future. This book intends to feature innovative approaches that employ transformative elements (targets, methods, materials, ideas, etc.) and embrace the concept of child development as “becoming” in an ever-changing and challenging world.
\r\n
\r\n\tWe invite authors to contribute original research or research review papers that present innovative approaches addressing personal and social transformation. All aspects of early childhood education will be considered, including research methodology for the early years.
",isbn:"978-1-80355-949-0",printIsbn:"978-1-80355-948-3",pdfIsbn:"978-1-80355-950-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,hash:"351c41dca5c8c997f15e758f2e035178",bookSignature:"Dr. Maria Ampartzaki and Associate Prof. Michail Kalogiannakis",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11281.jpg",keywords:"Early Childhood Education, Preschool, STEAM, Environmental Sustainability, Social Sciences, Social Sustainability, ICT, Digital Devices, Education for Equity, Gender Issues, Post-modern Epistemology, Social Constructivism",numberOfDownloads:34,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 16th 2021",dateEndSecondStepPublish:"December 14th 2021",dateEndThirdStepPublish:"February 12th 2022",dateEndFourthStepPublish:"May 3rd 2022",dateEndFifthStepPublish:"July 2nd 2022",remainingDaysToSecondStep:"5 months",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"Dr. Maria Ampartzaki is an Assistant Professor in Early Childhood Education in the Department of Preschool Education at the University of Crete. Her research interests include ICT in education, science education in the early years, inquiry-based and art-based learning, teachers’ professional development, action research, and the Pedagogy of Multiliteracies, among others. She has run and participated in several funded and non-funded projects on the teaching of Science, Social Sciences, and ICT in education.",coeditorOneBiosketch:"Michail Kalogiannakis is an Associate Professor of the Department of Preschool\r\nEducation, University of Crete in Greece. He graduated from the Physics Department\r\nof the University of Crete and continued his post-graduate studies at the University\r\nParis-7 and University Paris-5 and received his Ph.D. degree at the University Paris 5.\r\nHis research interests include science education in early childhood, science teaching\r\nand learning, e-learning, the use of ICT in science education, and games simulations.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"422488",title:"Dr.",name:"Maria",middleName:null,surname:"Ampartzaki",slug:"maria-ampartzaki",fullName:"Maria Ampartzaki",profilePictureURL:"https://mts.intechopen.com/storage/users/422488/images/system/422488.jpg",biography:"Dr Maria Ampartzaki is an Assistant Professor in Early Childhood Education in the Department of Preschool Education at the University of Crete. Her research interests include ICT in education, science education in the early years, inquiry-based and art-based learning, teachers’ professional development, action research, and the Pedagogy of Multiliteracies, among others. She has run and participated in several funded and non-funded projects on the teaching of Science, Social Sciences, and ICT in education. She also has the experience of participating in five Erasmus+ projects.",institutionString:"University of Crete",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Crete",institutionURL:null,country:{name:"Greece"}}}],coeditorOne:{id:"260066",title:"Associate Prof.",name:"Michail",middleName:null,surname:"Kalogiannakis",slug:"michail-kalogiannakis",fullName:"Michail Kalogiannakis",profilePictureURL:"https://mts.intechopen.com/storage/users/260066/images/system/260066.jpg",biography:"Michail Kalogiannakis is an Associate Professor of the Department of Preschool Education, University of Crete, and an Associate Tutor at School of Humanities at the Hellenic Open University. He graduated from the Physics Department of the University of Crete and continued his post-graduate studies at the University Paris 7-Denis Diderot (D.E.A. in Didactic of Physics), University Paris 5-René Descartes-Sorbonne (D.E.A. in Science Education) and received his Ph.D. degree at the University Paris 5-René Descartes-Sorbonne (PhD in Science Education). His research interests include science education in early childhood, science teaching and learning, e-learning, the use of ICT in science education, games simulations, and mobile learning. 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From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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\n\t\t\t
1. Introduction
\n\t\t\t
Recently, dance movement has been frequently studied using motion capture, but some movements are unable to be analysed by motion data alone. Systematic research of dance movements using several kinds of data captured by simultaneous measurement of body motion and biophysical information are rarely carried out.
\n\t\t\t
In the research literature there are several studies using the analyses of movement through simultaneous measurement of body motion and biophysical information, for instance, the learning environment for sport-form training (Urawaki, 2005), biomechanical analysis of ballet dancers (Humm et al, 1994), and behaviour capture systems (Kurihara et al, 2002), etc. Although there is one study that extracts a target motion from motion captured dance data (Yoshimura et al, 2001), and another where skillfulness of a dancer is investigated by calculating a typical style of the dancing called Okuri (Yoshimura et al, 2004), quantitative analysis on an expert traditional dancer has not been accomplished yet.
\n\t\t\t
We paid attention to leg movements of the lower half of the body. Leg movements of a dancer generate a path of motion, a tempo, and a dance rhythm. In particular, leg movements in Japanese traditional dance allow dancers to express various performances, shift performances, and transfer and retain body weight (Kunieda, 2003).
\n\t\t\t
In the following research, we aim to quantitatively analyse characteristics of leg movement patterns of an expert traditional dancer using simultaneous measurement of body motion and biophysical information (EMG: ElectroMyoGram).
\n\t\t
\n\t\t
\n\t\t\t
2. Method of experiment
\n\t\t\t
We carried out experiments on the leg movements of expert Japanese traditional dancers with simultaneous measurement of body motion and EMG (Choi, 2007).
\n\t\t\t
\n\t\t\t\t
2.1. Subject
\n\t\t\t\t
The subjects who participated in this experiment are two Hanayagi style dancers; one has forty years experience (Expert D) and the other has twenty years experience (Skilled S).
\n\t\t\t\t
Figure 1.
Attaching place of EMG electrodes.
\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
Performance
\n\t\t\t\t\t\t\t
Role of subject
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
Performance 1
\n\t\t\t\t\t\t\t
Guest
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
Performance 2
\n\t\t\t\t\t\t\t
Woman expert entertainer
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
Performance 3
\n\t\t\t\t\t\t\t
Man entertainer
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
Performance 4
\n\t\t\t\t\t\t\t
Warrior
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
Performance 5
\n\t\t\t\t\t\t\t
Coachman
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
Performance 6
\n\t\t\t\t\t\t\t
Carpenter
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
Performance 7
\n\t\t\t\t\t\t\t
Novice entertainer
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
Performance 8
\n\t\t\t\t\t\t\t
Narrator
\n\t\t\t\t\t\t
\n\t\t\t\t\t
Table 1.
Experiment performances in Hokushu.
\n\t\t\t
\n\t\t\t
\n\t\t\t\t
2.2. Performance
\n\t\t\t\t
We measured the traditional Japanese dance named Hokushu using the constructed system. In Hokushu, one dancer plays several roles such as a warrior, a guest, a coachman, a merchant, etc., and acts a total of twenty one performances by oneself. In this research, we measured eight performances from among the twenty-one (see Table 1).
\n\t\t\t
\n\t\t\t
\n\t\t\t\t
2.3. Simultaneous measurement of body motion and EMG
\n\t\t\t\t
In this research, 32 markers were attached on the body of a subject in order to capture motion data, and 12 EMG electrodes on the front and back of both legs.
\n\t\t\t\t
Recording EMG signals needs electrodes, an amplifier and a data recording device. Each EMG signal is obtained by A/D converting data amplified by the amplifier. In this research, we used the SYNA ACT MT11 system (NEC Corp.). The amplitude of an EMG signal is almost proportional to the scale of muscle force. This relationship between EMG signal and muscle force can therefore be used to analyse various human body movements. Because the raw EMG signal obtained by the equipment is corrupted by high frequency noise, we have to employ some noise reduction techniques like low pass filtering. Also, we have to convert the raw signal into a signal that is proportional to the activities of the muscles. Rectification of the signal, or the RMS (Root Mean Square) of the signal is usually used for the analysis.
\n\t\t\t\t
As per the literature on EMG (Choi, (2007)), the attaching place of EMG electrodes is fixed on the following six muscles (see Figure 1): Rectus Femoris (RF), Vastus medialis (VM), Tibialis Anterior (TA), Hamstrings (HA), Gastrocnemius (GAS) and Soleus (SOL). As shown in Table 2, these muscles have functions associated with leg movement. The SOL, VM, and TA muscles are mono-articular muscles. HA, RF, and GAS muscles are bi-articular muscles.
To obtain 3D motion data, the Eagle-Hawk system (Motion Analysis Corp.) at Ritsumeikan University was used. This system incorporates 12 infrared cameras detecting small markers attached to a subject who moves in a 4m × 4m area.
\n\t\t\t\t
We captured data by adjusting the sampling rate of motion capture to 60Hz, and EMG measurement to 1200Hz, and recorded eight performances a total of three times using the simultaneous measurement system.
\n\t\t\t
\n\t\t
\n\t\t
\n\t\t\t
3. Result and discussion of experiment
\n\t\t\t
In this research, we compared the leg movements of an Expert D with that of a Skilled subject S by calculating the center of gravity of the subject\'s body and a co-contraction of the knee and the ankle using a biomechanical method (Winter, 1990). In the following, we will describe the result of our experiment on a part of Performance 1 of Hokushu under the condition of a single support phase.
\n\t\t\t
\n\t\t\t\t
3.1. Center of gravity
\n\t\t\t\t
Firstly, we compared the center of gravity of the two subjects under the condition of a single support phase of both legs in Performance 1.
\n\t\t\t\t
\n\t\t\t\t\t
3.1.1. Computation of center of gravity
\n\t\t\t\t\t
The center of gravity can be used to indicate transfer and retainment of leg movement. The center of gravity \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t(\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tx\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t0\n\t\t\t\t\t\t\t\t\t\t\t\t,\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\ty\n\t\t\t\t\t\t\t\t\t\t\t0\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t,\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tz\n\t\t\t\t\t\t\t\t\t\t\t0\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t)\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\tof Figure 2 can be calculated by Eq. (1) (Winter, 1990).
The co-ordinates \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t(\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tx\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t1\n\t\t\t\t\t\t\t\t\t\t\t\t,\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\ty\n\t\t\t\t\t\t\t\t\t\t\t1\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t,\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tz\n\t\t\t\t\t\t\t\t\t\t\t1\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t)\n\t\t\t\t\t\t\t\t\t\t⋅\n\t\t\t\t\t\t\t\t\t\t⋅\n\t\t\t\t\t\t\t\t\t\t⋅\n\t\t\t\t\t\t\t\t\t\t(\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tx\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\tn\n\t\t\t\t\t\t\t\t\t\t\t\t,\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\ty\n\t\t\t\t\t\t\t\t\t\t\tn\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t,\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tz\n\t\t\t\t\t\t\t\t\t\t\tn\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t)\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\tare the locations of center of gravity in each body segment. These locations in each body segment can be calculated by using anthropometric data (segment weight and segment length) as presented by Matsui (Matsui, (1958)). Figure 2 (b)
\n\t\t\t\t\t
Figure 2.
Center of gravity. (a) Center of gravity in human body. (b) Center of gravity in each segment.
shows the result of our computation for the location of center of gravity in each body segment for subject. The \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tM\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t is a total body weight. \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tM\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\tis equal to\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tm\n\t\t\t\t\t\t\t\t\t\t\t1\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t+\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tm\n\t\t\t\t\t\t\t\t\t\t\t2\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t+\n\t\t\t\t\t\t\t\t\t\t⋅\n\t\t\t\t\t\t\t\t\t\t⋅\n\t\t\t\t\t\t\t\t\t\t⋅\n\t\t\t\t\t\t\t\t\t\t+\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tm\n\t\t\t\t\t\t\t\t\t\t\tn\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t. The values \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t(\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tm\n\t\t\t\t\t\t\t\t\t\t\t1\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t,\n\t\t\t\t\t\t\t\t\t\t⋅\n\t\t\t\t\t\t\t\t\t\t⋅\n\t\t\t\t\t\t\t\t\t\t⋅\n\t\t\t\t\t\t\t\t\t\t,\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tm\n\t\t\t\t\t\t\t\t\t\t\tn\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t)\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\tare the segment weight in each body segment. In this experiment, we use the anthropometric data of Japanese woman (see Table 3).
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3.1.2. Center of gravity on Performance 1
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\n\t\t\t\t\t\tFigure 3 shows the center of gravity data obtained during Performance 1 of Expert D and Skilled S.
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\n\t\t\t\t\t\tFigure 3 (a) and (c) show leg movement under a condition of a single support phase of the right leg during Performance 1. Subjects maintain their body weight with the right leg, while the left leg is swinging. Figure 3 (b) and (d) show leg movement under a condition of a single support phase of the left leg. Subjects retain their body weight with the left leg, while
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Figure 3.
Center of gravity on Performance 1. (a) Single support phase: D (right). (b) Single support phase: D (left). (c) Single support phase: S (right). (d) Single support phase: S (left). (e) Center of gravity in body (right). (f) Center of gravity in body (left). (g) Velocity of CG (right). (h) Velocity of CG (left). (i) Average of velocity of CG (right). (j) Average of velocity of CG (left).
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the right leg is swinging. The two subjects have no significant difference in leg movement during the single support phases.
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\n\t\t\t\t\t\tFigure 3 (e) and (f) show the transfer of the center of gravity of Expert D and Skilled S. Points indicated by “•” in (e) and (f) show the start point of the single support phase of both legs during Performance 1. The two subjects exhibit leg movement with lower center of gravity under a condition of single support phase of the right leg in (e). Skilled S has more transfer of center of gravity than that of Expert D. In (f), the two subjects show leg movement which raised the center of gravity. When we consider the fact that the body height of the two subjects are almost the same (about 153cm), we notice that Expert D raised her center of gravity approximately 10cm higher than that of Skilled S.
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\n\t\t\t\t\t\tFigure 3 (g) and (h) show the velocity of center of gravity of the two subjects under the single support phase of both legs in Performance 1. In (g), Skilled S has a velocity variation of center of gravity of approximately 10-20cm/s greater than that of Expert D. In (h), the velocities of center of gravity of both subjects are almost the same.
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\n\t\t\t\t\t\tFigure 3 (i) and (j) show the average velocity of center of gravity under the single support phase of both legs. In (i), Skilled S has an average velocity and a standard deviation larger than those of Expert D. In (j), the two subjects have almost the same velocity and standard deviation. Expert D dances slowly, about 40cm/s, during the single support phase of Performance 1, but Skilled S dances faster at 40-60cm/s velocity.
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Based on the above data, we found that Skilled S had more center of gravity transfer and velocity variation than Expert D during the single support phase of Performance 1.
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3.2. Movement of knee and ankle
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Secondly, we analysed the characteristics of leg movement of the subjects Expert D and Skilled S by comparing not only the angles of the knees and ankles but also EMG data of muscles used during their movement in Performance 1.
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3.2.1. Knee movement
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\n\t\t\t\t\t\tFigure 4 shows the angle of the knees and the RMS of the EMG during Performance 1. Figure 4 (a) and (c) show movements of the right knee of the two subjects under the single support phase of the right leg. Figure 4 (b) and (d) show movements of the left knee during single support phase of the left leg. There is no significant difference in movement of the knees of two subjects during the single support phases.
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\n\t\t\t\t\t\tFigure 4 (e) and (f) show the angle of the knees of both legs of the two subjects during the single support phase. The angle variation of the knee in (e) indicates that the subjects use knee flexion to lower the leg. The difference of angle variation of the knee between the two subjects was approximately 10-20 . This is not a significant difference. Angle variation of the knees in (f) indicates that the subjects use knee extension to raise the leg.
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\n\t\t\t\t\t\tFigure 4 (g) and (h) show the RMS values of the RF muscle for Expert D and Skilled S. During the single support phase of the right leg in (g), the RF muscles of Expert D and Skilled S discharged approximately 200mV and 400mV, respectively. Compared to Expert D, the RF muscle of Skilled S discharged approximately twice the EMG level to support the body with lowered center of gravity. During the single support phase of the right leg in (h), the RF muscles of Expert D and Skilled S discharged approximately 100mV and 200mV, respectively. Once again, the RF muscle of Skilled S discharged approximately double the EMG signal than that of Expert D.
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Figure 4.
Angle of knee and RMS of EMG on Performance 1. (a) Knee: D (right). (b) Knee: D (left). (c) Knee: S (right). (d) Knee: S (left). (e) Angle of knee (right). (f) Angle of knee (left). (g) RMS of RF(right). (h) RMS of RF (left). (i) RMS of HA (right). (j) RMS of HA (left). (k) Average of RMS (right). (l) Average of RMS (left).
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\n\t\t\t\t\t\tFigure 4 (i) and (j) show the RMS values of the HA muscles of Expert D and Skilled S. Under the single support phase of the right leg in (i), the HA muscle produces less EMG than the RF muscle. In order to lower the leg movement, the subjects are able to flex the knee by using a smaller muscle force due to gravity. The RF muscle antagonistic to HA muscle in knee is activated to support the body weight. Also, the HA muscle produces less EMG than the RF muscle during the single support phase of the left leg in (j). The RF muscle is activated to raise the leg with knee extension.
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The X and Y axes of Figure 4 (k) and (l) show the RMS values of EMG signal from the RF and HA muscles. RF and HA muscles are antagonistic muscle pairs of the knee. Expert D takes a balance of EMG activity between the two antagonist muscles when compared with Skilled S during the single support phase of the right leg in (k). Also, Expert D takes balance of EMG activity compared to Skilled S during the single support phase of left leg in (l).
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Since Skilled S has a larger transfer and velocity variation of center of gravity than Expert D in (e) of Figure 3, we noticed that when flexing the knee the RF muscle of Skilled S had more EMG activity than that of Expert D for supporting the body.
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3.2.2. Ankle movement
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Next, Figure 5 shows the angle of the ankle and the RMS of the EMG signal during Performance 1. Figure 5 (a) and (c) show the movement of the ankle of Expert D and Skilled S during the single support phase of the right leg. Figure 5 (b) and (d) show the movement of the ankle during the single support phase of the left leg.
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\n\t\t\t\t\t\tFigure 5 (e) and (f) show ankle angle of the two subjects during the single support phase of both legs. Ankle angle variation in (e) indicates that the subject used the ankle dorsal to lower the leg. The difference between ankel angle variation between the two subjects was approximately 10 . The angle variation of the knee in (f) indicates that the subjects used ankle plantar flexion to raise the leg.
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\n\t\t\t\t\t\tFigure 5 (g) and (h) show the EMG RMS value of the TA muscle of Expert D and Skilled S. The TA muscles of both subjects produced approximately 100mV during the single support phase of the right leg in (g). During the single support phase of the right leg in (h), the TA muscle of Expert D and Skilled S produced approximately 50mV and 50-200mV, respectively. The TA muscle of Skilled S also produced approximately double the EMG signal compared to Expert D. After maintaining the EMG discharge of approximately 200mV in the TA muscle during the first 0.1 second, Skilled S reduced the discharge of EMG by approximately 50mV during the single support phase of left leg. Expert D maintained the EMG discharge of approximately 50mV. Therefore, we conclude that Skilled S used more muscle force for acting Performance 1.
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\n\t\t\t\t\t\tFigure 5(i) and (j) show the RMS value of the SOL muscles of Expert D and Skilled S. The SOL muscle EMG discharge was maintained at approximately 100mV during the single support phase of the right leg in (i). Also, the EMG discharge of the SOL muscle was maintained at approximately 50mV during the single support phase of the left leg in (j).
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The X and Y axies of Figure 5 (k) and (l) show the EMG RMS values of the TA and SOL muscles. TA and SOL muscles are antagonistic muscles of the ankle. Expert D and Skilled S took a balance of muscle activity between two antagonistic muscles of ankle during the single support phase of the right leg in (k). However, Expert D took a balance of EMG activity of ankle compared to that of Skilled S during the single support phase of the left leg in (l). In this result, Expert D maintained the EMG activity of the ankle muscle during the single support phase. In particular, Expert D takes a balance of EMG activity between two antagonist muscles of the ankle and knee for the single support phase as shown in Figure 4 and 5.
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Figure 5.
Angle of ankle and RMS of EMG on Performance 1. (a) Ankle: D (right). (b) Ankle: D (left). (c) Ankle: S (right). (d) Ankle: S (left). (e) Angle of ankle (right). (f) Angle of ankle (left). (g) RMS of TA (right). (h) RMS of TA (left). (i) RMS of SOL (right). (j) RMS of SOL (left). (k) Average of RMS (right). (l) Average of RMS (left).
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3.3. Efficiency of co-contraction of the knee and ankle
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Thirdly, we compared the efficiency of leg movement of the two subjects during the single support phase in Performance 1. The efficiency of leg movement is calculated by observing co-contraction of the two antagonistic muscles of the knee and ankle. The efficiency of co-contraction of antagonistic muscles can be determined by the following equation (Winter, 1990) (see Figure 6).
We compute the efficiency of leg movement via Eq. (2). Table 4 shows the co-contraction of the knee and ankle of two subjects during Performance 1 of Hokushu. Expert D had high co-contraction that was approximately 10-20% greater than Skilled S. When we take into consideration that the EMG activity of Expert D was less than Skilled S, we notice that Expert D is performing leg movement more efficiently during the single support phase of both legs.
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Figure 6.
Co-contraction of antagonistic muscles during single support phase of right leg. (a) Co-contraction of knee (Expert D). (b) Co-contraction of knee (Skilled S). (c) Co-contraction of ankle (Expert D). (d) Co-contraction of ankle (Skilled S).
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Single support phase (right)
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Single support phase (left)
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Knee
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Ankle
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Knee
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Ankle
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Expert D
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41%
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77%
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53%
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86%
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Skilled S
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25%
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76%
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36%
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83%
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Table 4.
Co-contraction of knee and ankle on Performance 1 of Expert D and Skilled S.
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Figure 7.
Quantized RMS of EMG signal on single support phase during Performance 1. (a) Single support phase of Expert D. (b) Single support phase of Skilled S.
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3.4. Visualization of the single support phase of Performance 1
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Finally, we visualize the leg movement of the two subjects during Performance 1 using CG character animation.
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\n\t\t\t\t\tFigure 7 (a) and (b) show the quantized RMS values of the EMG signal for the RF and TA muscles of both legs during single support phase. We used the RMS data of the RF muscle in (g) and (h) of Figure 4, and the RMS data of the TA muscle in (g) and (h) of Figure 5. The RMS data is quantized to 5 levels. We then made a CG character animation using an OpenGL program, colouring the character\'s legs in accordance with the quantized RMS data. At the same time, we show the leg movement of the single swing phase versus the single support phase of both legs in Figure 7 (a) and (b).
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\n\t\t\t\t\tFigure 8 (a) and (b) show snapshots of the CG character animation with generated colours based on the single support phase of both legs. During high EMG activity, the colour becomes deeper than during low EMG activity, in proportion to the EMG signal level as shown in Figure 8. We found that the differences in leg movement between the Expert D and Skilled S were more obvious when displaying EMG information via the CG character.
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As shown in Figure 8 (a) and (b), we notice that the RF and TA muscles of both legs of Skilled S on are activated to act Performance 1 compared to Expert D. Expert D had less EMG activity than Skilled S for acting the single swing movement during the single support phase.
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Figure 8.
CG character animation of body motion and EMG signal on single support phase during Performance 1. (a) Single support phase of right leg. (b) Single support phase of left leg.
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4. Conclusion and future work
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In this research, we performed quantitative analysis of leg movement patterns of an expert traditional dancer using simultaneous measurement of body motion and leg muscle EMG.
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As a result, we verified that Expert D, who has a forty-year career as a Japanese traditional dancer, has the effective co-contraction of antagonistic muscles of the knee and ankle and less center of gravity transfer than Skilled S, who has only a twenty-year career. Therefore, Expert D can efficiently perform dance leg movements with less EMG activity than Skilled S. Our research can help dancers and researchers of dance by providing new information on dance movement that cannot be analysed via motion capture alone.
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In the future, we will measure the leg movement control of veteran dancers, especially for quantitatively comparing leg movement skills, by recording the leg movements of masters and beginners. Furthermore, we will investigate leg movement skill by simultaneously using EMG equipment and a force plate.
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Acknowledgments
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We would like to thank Ms. Daizo Hanayagi and Ms. Souko Hanayagi for co-operating with us in the motion capturing experiment with EMG measurement. We also thank Prof. Yuka Marumo and Prof. Mamiko Sakata for providing us valuable advice about traditional Japanese dance.This research has been conducted partly by the support of the Global COE Program, the Open Research Center Program, and the Grant-in-Aid for Scientific Research No. (B)16300035, and No. (C)20500105 all from the Ministry of Education, Science, Sports and Culture.
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\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/6447.pdf",chapterXML:"https://mts.intechopen.com/source/xml/6447.xml",downloadPdfUrl:"/chapter/pdf-download/6447",previewPdfUrl:"/chapter/pdf-preview/6447",totalDownloads:2767,totalViews:195,totalCrossrefCites:1,totalDimensionsCites:2,totalAltmetricsMentions:0,impactScore:1,impactScorePercentile:69,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:null,dateReviewed:null,datePrePublished:null,datePublished:"December 1st 2009",dateFinished:null,readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/6447",risUrl:"/chapter/ris/6447",book:{id:"3376",slug:"advances-in-human-robot-interaction"},signatures:"Woong Choi, Tadao Isaka, Hiroyuki Sekiguchi and Kozaburo Hachimura",authors:null,sections:[{id:"sec_1",title:"1. Introduction ",level:"1"},{id:"sec_2",title:"2. Method of experiment",level:"1"},{id:"sec_2_2",title:"2.1. Subject",level:"2"},{id:"sec_3_2",title:"2.2. Performance",level:"2"},{id:"sec_4_2",title:"2.3. Simultaneous measurement of body motion and EMG",level:"2"},{id:"sec_6",title:"3. Result and discussion of experiment",level:"1"},{id:"sec_6_2",title:"3.1. Center of gravity",level:"2"},{id:"sec_6_3",title:"Table 3.",level:"3"},{id:"sec_7_3",title:"3.1.2. Center of gravity on Performance 1",level:"3"},{id:"sec_9_2",title:"3.2. Movement of knee and ankle",level:"2"},{id:"sec_9_3",title:"3.2.1. Knee movement",level:"3"},{id:"sec_10_3",title:"3.2.2. Ankle movement",level:"3"},{id:"sec_12_2",title:"3.3. Efficiency of co-contraction of the knee and ankle",level:"2"},{id:"sec_13_2",title:"3.4. Visualization of the single support phase of Performance 1",level:"2"},{id:"sec_15",title:"4. Conclusion and future work ",level:"1"},{id:"sec_16",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tChoi\n\t\t\t\t\t\t\tW. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tIsaka\n\t\t\t\t\t\t\tT. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSakata\n\t\t\t\t\t\t\tM. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTsuruta\n\t\t\t\t\t\t\tS.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHachimura\n\t\t\t\t\t\t\tK.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2007\n\t\t\t\t\tQuantification of Dance Movement by Simultaneous Measurement of Body Motion and Biophysical Information, International Journal of Automation and Computing, 04\n\t\t\t\t\t1\n\t\t\t\t\t1\n\t\t\t\t\t7\n\t\t\t\t\n\t\t\t'},{id:"B2",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHumm\n\t\t\t\t\t\t\tJ. R. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHarris\n\t\t\t\t\t\t\tG. F.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRaasch\n\t\t\t\t\t\t\tW. 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O.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1994\n\t\t\t\t\tAnatomical Guide for the Electromyographer: The Limbs and Trunk, Charles C. Thomas Publisher\n\t\t\t'},{id:"B7",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tUrawaki\n\t\t\t\t\t\t\tK.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2005\n\t\t\t\t\tA Learing System for Sport Form using Visualization of Biophysical Information, Master’s Thesis, Nara Institute of Science and Technology, Japan, (in Japanese)\n\t\t\t'},{id:"B8",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWinter\n\t\t\t\t\t\t\tDavid. A.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1990\n\t\t\t\t\tBiomechanics and Motor Control of Human Movement, Wiley Interscience\n\t\t\t'},{id:"B9",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWirhed\n\t\t\t\t\t\t\tR.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t1984\n\t\t\t\t\tAthletic ability and the anatomy of motion, Wolfe Medical Publications\n\t\t\t'},{id:"B10",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tYoshimura\n\t\t\t\t\t\t\tM. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tKojima\n\t\t\t\t\t\t\tK. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHachimura\n\t\t\t\t\t\t\tK. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMarumo\n\t\t\t\t\t\t\tY.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tKuromiya\n\t\t\t\t\t\t\tA.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2004\n\t\t\t\t\t Quantification and recognition of basic motion okuri in Japanese traditional dance., In Proceedings of 13th IEEE on Robot and Human Interactive Communication, 205\n\t\t\t\t\t210 , 10.1109/ROMAN.2004.1374757\n\t\t\t\t\n\t\t\t'},{id:"B11",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tYoshimura\n\t\t\t\t\t\t\tM. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMine\n\t\t\t\t\t\t\tN. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tKai\n\t\t\t\t\t\t\tT.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tYoshimura\n\t\t\t\t\t\t\tI.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2001\n\t\t\t\t\tQuantification of Characteristic Features of Japanese Dance for Individuality Recognition., In Proceedings of 10th IEEE on Robot and Human Interactive Communication, 188\n\t\t\t\t\t193 , 10.1109/ROMAN.2001.981900\n\t\t\t\t\n\t\t\t'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Woong Choi",address:"",affiliation:'
Kinugasa Research Organization, Ritsumeikan University, Japan
College of Information Science and Engineering, Ritsumeikan University, Japan
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1. Introduction
The brain and spinal cord are soft and vulnerable structures by their very nature. Cerebrospinal fluid (CSF) is the air cushion of the central nervous system (CNS), which protects the nerve tissue by reducing the speed of the blows to the CNS. 90% of this fluid is produced continuously by specialized cells called choroid plexus in the ventricle and 10% by ependymal cells lining the ventricle surface. CSF, which flows through F. Luschka and F. Magendie into the subarachnoid space to surround the brain and spinal cord, drains into the venous system via arachnoid granulation. Colombian neurosurgeon Hakim et al. [1, 2, 3] described a clinic in 1964 characterized by progressive cognitive decline with ventricular dilatation (normal CSF pressure during lumbar puncture), difficulty walking, and urinary incontinence syndrome. Hakim named this syndrome Normal Pressure Hydrocephalus (NPH). Although a clear clinical triad has been defined, there are important differences in the clinical presentation and progression of this syndrome. This situation leads to an increase in the problems related to the diagnosis and treatment of NPH. In fact, although there have been remarkable developments in the field of medicine since NPH was first defined in 1964, the guidelines determining the diagnosis, management, and operation criteria of NPH were first prepared in 2004 to be implemented only in Japan. Only in 2008 did Ishikawa et al. [4] produce worldwide applicable guidelines for its diagnosis and treatment. The information presented above is the most convincing evidence of the type of dynamic disease we are dealing with. On the other hand, due to reasons such as advancements in health, improved treatment options, increased education level, and conscientious diet, the share of the older population is constantly increasing. It is projected that as people’s quality of life improves and their life expectancy rises, more old people would develop this condition. In the light of current information, it is predicted that 20% of the world population will be individuals over 65 years old by 2050. While the world’s population has grown 4 times in the last 100 years (1950–2050), the fact that the elderly population will grow 10 times is a significant point that should be highlighted. In this case, it becomes even more important to age healthy and to keep the elderly population active. The most important task of neurologists, neurosurgeons, and psychiatrists in society is to provide early diagnosis and appropriate treatment of patients with NPH in society, especially given the socioeconomic consequences of this disease, particularly the burden of dementia on the individual, their families, and society. This is because it is emphasized that the earlier these patients are diagnosed and treated correctly, the more (most if not all) of the clinical symptoms are reversible.
2. Classification
NPH is divided into two groups as secondary NPH (sNPH) that develops due to decreased resorption of CSF due to inflammation and fibrosis at the arachnoid granulation level caused by subarachnoid hemorrhage, intraventricular hemorrhage, meningitis, or traumatic brain injury, and the second is the idiopathic NPH (iNPH) which does not have a causal disorder. A common feature of both diseases is that they do not contain any obstructions to the flow of CSF within the ventricular system of the brain. iNPH and sNPH do not differ in terms of prognosis. The sole significant clinical difference between them is that sNPH affects people of all ages, whereas iNPH often occurs more in the 60-70s [5, 6].
3. Incidence-prevalence
Epidemiological data on NPH are limited. Furthermore, due to the lack of uniform diagnostic criteria, reports on the incidence and prevalence of this disease, which has a wide clinical range, are partially inconsistent. The annual incidence of NPH is estimated to be between 0. 2 and 5.5 cases per 100,000 individuals. Its prevalence is reported to be 0.003% for persons under 65 years of age and 0. 2% to 2.9% for persons 65 years and older [7, 8]. In an epidemiological study conducted by Jaraj et al. [9], the probable prevalence of iNPH was found to be 0. 2% in people aged 70–79, and 5.9% in people aged 80 and older. Another recent epidemiological study also confirmed the inadequacy of incidence-prevalence reports of NPH [10]. Like other neurodegenerative diseases, the prevalence and incidence of NPH increases in direct proportion to age. In various studies, it was determined that there was no difference between males and females in terms of incidence [11, 12, 13].
4. Pathophysiology
It is important to clarify its pathophysiology for reliable diagnosis and treatment of NPH patients. Its pathophysiology is yet unknown, and it differs from other adult hydrocephalus causes. In addition to the fact that pathological alterations change CSF pressure, it is also related to changes in CSF dynamics. The CSF circulation spaces in the brain parenchyma within a rigid cranium work as a dynamic system that continually seeks to adapt to new situations in order to keep the ICP constant. These structures give instantaneous responses to changes in CSF production-absorption, changes in arterial–venous flow to the brain, changes in the compliance of intracranial structures, and changes in intracranial pressure. This process is very important in terms of ensuring the correct functioning of the brain. Cerebral blood flow differs with heart rhythm. The arterial supply is pulsative, whereas the venous flow is non-pulsative, causing temporary rises in CSF pressure. In two ways, the system tries to compensate for this. First, vascular structures can reduce arterial blood flow by changing compliance. The second is that the outflow of CSF increases along the cerebral aqueduct. ICP is attempted to be kept constant thanks to these compensatory mechanisms. The decrease in arterial modulation is first compensated by increased pulsatile CSF flow. However, the progressive increase of the pulsatility amplitude causes large ICP pulsations that determine the “water-hammer” effect. These enhanced vibrations create venous damage in the periventricular region, and the process of pushing the brain against the skull continues to expand the ventricles, resulting in hydrocephalus. As a result, the compensatory mechanisms, that are activated in order to maintain the ICP stable, create pathological changes in neural tissue [14]. In fact, hydrocephalus can be defined as the expansion of the ventricles in response to the reduction of the subarachnoid space in the cerebral tissue. This situation is secondary to the increase in the pressure gradient between the ventricles and the subarachnoid space, known as the transmantle pressure [15]. It is still unclear what triggers the initial reduction in arterial compliance in this process. Ischemia emerging in the white matter surrounding arterioles could explain the insufficiency in autoregulation. The ventricular enlargement causes the arterioles and venules around the ventricle to compress and stretch over time, resulting in poor/insufficient cerebral perfusion [16, 17, 18, 19]. Moreover, a strong relationship has been described between impaired cerebral blood flow and NPH. Therefore, clinically, the association of NPH with cerebrovascular disease is frequently encountered. Ischemic changes in cerebral tissue caused by decreased/insufficient perfusion were shown in Cranial MRI. These structural changes detected by neuro-radiological imaging have also been supported by neuropathological studies [20, 21, 22, 23]. Vascular changes that occur as a natural consequence of aging in humans may be the triggering mechanism in the reduction of vascular compliance. This may explain the relationship between iNPH and vascular disease [24].
NPH also reduces compliance in large vascular structures such as the superior sagittal sinus [25, 26]. Increased transvenular resistance in the sagittal sinuses has been hypothesized as a factor in the onset of NPH. According to this viewpoint, CSF resorption will be affected by increased transvenular resistance [27, 28]. As a result, none of the proposed theories can adequately explain how NPH develops, what factors trigger it, or how structural alterations occur. Although these presented hypotheses appear to complement one other, the debates about pathogenesis continue.
5. Clinic
Symptoms in NPH have been defined as a “triad”. However, having all of the symptoms at the same time is not necessary for diagnosis. The presence of two or more of the key symptoms (even a cardinal clinical symptom) such as apraxia of gait, dementia, and urinary incontinence, as well as bilateral dilatation of the ventricles, is necessary to diagnose the disease. The clinical signs and symptoms of this syndrome are highly diverse. Symptoms of this disease, which has an insidious onset, appear gradually over a period of at least 6 months. The rate and extent of worsening of symptoms vary from one patient to another. Some patients and families are unaware of symptoms until a triggering event, such as surgery, occurs. Careful questioning can clarify the nature of symptom onset.
Decreased cerebral perfusion as a result of ventriculomegaly may be a reason for the classic symptoms of NPH. Neurological signs and symptoms, such as apraxia of walking, are thought to be caused by a combination of mechanical stretching of the periventricular fiber tracts, disruption of brain parenchyma tissue as a result of reduced cerebral blood flow, and periventricular edema [29, 30, 31, 32, 33, 34]. Neuro-psychiatric symptoms have been suggested to be associated with brain regions such as the anterior cingulate cortex (ACC) and thalamus [35, 36, 37] because it has been determined that there is low perfusion in the anterior cingulate cortex and thalamus in NPH patients. Dysfunction in these regions is effective in the emergence of psychiatric symptoms. Therefore, increased/improved cerebral perfusion and oxygen metabolism from the frontal cortex and thalamus may cause neuropsychiatric and other symptoms in NPH patients after shunt surgery [38, 39]. There are publications reporting that psychiatric symptoms and syndromes occurring in the NPH clinic are related to changes in central neurotransmitter activity [40].
Although any of the main symptoms can present as the initial symptom in the NPH clinic, gait and balance disorders usually occur early and have a substantial impact on the individual’s life. Dementia and urinary incontinence are symptoms that progress with the disease, albeit they usually appear at later stages of the disease [41].
6. Gait disorder
As described in many published series and guidelines, gait disturbance is the first clinical symptom that affects almost all patients. Dizziness is a common initial complaint among patients. The instability in NPH is better with the patient’s eyes open, but patients still stand on a wide base even with their eyes open. When a patient’s walking ability is compromised, it has a detrimental influence on their quality of life. At first, gait and balance disorders may appear to be mild. Patients initially complain of climbing and descending stairs, as well as getting up and sitting in a chair. Parallel to the progression of the disease, the patient’s gait pattern deteriorates. Instead of the heel-to-toe gait cycle, which should normally be accomplished by raising the feet, these patients tend to slide their feet on the ground. This way of walking is described as “robotic”, “sticky-footed” or “magnetic phenomenon” [42]. The disconnection between the basal ganglia and the frontal cortex during walking, as well as the co-contraction of opposing muscles, is suggested to be the source of this gait pattern, which is usually found in parkinsonism (bradykinetic, magnetic) [43, 44]. In the absence of primary sensorimotor deficits, these patients have a higher level of gait disturbance and impaired postural and locomotor reflexes [45]. Gait apraxia develops with the advent of cognitive disorders in the later stages of the disease, and individuals become unable to walk. If these patients are not diagnosed and treated early, they are eventually confined to a wheelchair.
Extrapyramidal symptoms may occur rarely in patients with NPH, but spasticity, hyperreflexia, and other upper motor neuron signs and lateralizing findings are not common. Since the symptoms are bilateral in NPH, lateralizing findings should alert the clinician to the presence of other neuropsychiatric disorders in the differential diagnosis. To assess diagnosis and prognosis, a standard gait assessment (e.g., Tinetti score, Boon Scale) should be performed both before and after the lumbar puncture (LP). The clinical finding with the highest probability of recovery (more than 85 percent) after shunt surgery is apraxia of walking, which is frequently the first main symptom of the disease [46, 47, 48].
7. Cognitive disorder
Cognitive deficit in NPH is basically of the “subcortical” type, which includes memory impairment, psychomotor retardation, and impaired ability to apply/use the acquired knowledge [49, 50]. These cognitive and behavioral disorders accompanying NPH are generally defined as “frontal-subcortical dementia or frontal-subcortical dysfunction” [51, 52]. This term is used to describe a pattern of mental decline marked by a lack of interest (apathy) in one’s surroundings and oneself, as well as a lack of inner strength (amotivation) that drives one’s activities and behaviors [53, 54]. For this reason, patients have difficulty in performing their daily living activities even at the onset of the disease. In this period, it is possible that an abnormality will not be identified in the psychometric tests that will be done on the patients.
Dementia is the most serious symptom in the clinical triad, as it has a negative impact on patients’ work capacity as well as their social functioning. NPH is thought to be the etiological cause of 5% of dementia [55]. Even everyday activities like driving, shopping, and keeping track of appointments are challenging for these patients. There is no single type of dementia since dementia symptoms in NPH span a broad clinical spectrum. Instead, depending on the degree of permanent brain damage that has occurred, there are variable degrees of cognitive alteration. For this reason, it is not a very correct approach to define cognitive disorders that occur in NPH as dementia in the early period. Some patients have no clinical evidence of dementia, only mild or moderate cognitive deficits, and most of these patients respond well to shunt surgery [56, 57]. At least two of the following must be present for cognitive abnormalities in NPH patients to be defined as dementia.
In the late phase of the disease, indifference/indifference to environmental stimuli, decreased desire to speak/not speaking at all, decreased thinking/reasoning ability [58].
Since the Mini-Mental State Test and the DEMTEC Test were designed to evaluate cortical dementias, they are not appropriate for evaluating subcortical frontal lobe deficiencies (cognitive deficits) in NPH [59]. The Stroop test, digit span test, and Rey auditory-verbal learning test can be used instead. However, personality changes, anxiety, depression, psychotic syndromes such as delusions, hallucinations, and aggression may also be seen in NPH patients, as well as obsessive–compulsive disorder, Othello syndrome, and various other cognitive disorders such as theft, and mania [60, 61, 62, 63]. Depression can be seen in the NPH clinic, although it is rare. In fact, only a tiny portion of these patients who show clinical signs of depression is really diagnosed with depression. Symptoms such as apathy and bradyphrenia that occur in NPH patients may mimic depression. Differential diagnosis between depression and NPH can be challenging as neuropsychological assessment profiles are similar [64, 65]. Therefore, before being diagnosed with depression, NPH patients should have a thorough psychiatric examination, and therapy should be started if actual depression is present. Again, delirium is not encountered in the NPH clinic, and its presence implies the existence of another disease or pharmacological side effect accompanying the disease [41]. Boon AJ et al. [66] reported that iNPH patients showed severe attention deficits. Although the NPH clinic contains quite different and complex neuropsychiatric symptoms, the decision to have an early shunt surgery can continue to improve cognitive deficits in approximately 80% of patients with NPH, however, the presence of vascular dementia, Alzheimer’s dementia, or comorbid diseases at the same time affects the success of surgical treatment negatively and reduces the recovery rate.
8. Urinary incontinence
Urinary symptoms in NPH may occur as urinary frequency, urgency, or incontinence. The bladder dysfunction of NPH is usually in the form of urinary urgency and this condition is almost always present [67, 68]. These patients have difficulty in preventing bladder emptying [69]. Patients have difficulties keeping urinary continence and may suffer urgency with a few drops of urine leakage before reaching the toilet, even though they are aware of the need to urinate at first. Therefore, nocturia is common in NPH patients. Incontinence or having wet clothes are not characteristic of NPH. True urinary incontinence develops later in the course of the disease. While patients initially suffer from increased urinary frequency, they then develop sudden incontinence and eventually persistent urinary incontinence. Bladder dysfunction is due to stretching of the periventricular nerve fibers and loss of subsequent inhibition (partial) of bladder contractions. Bladder function disorders in NPH are caused by detrusor overactivity due to a lack of central inhibitory control, which can be partial or complete [70]. It is extremely rare for fecal incontinence to occur as a symptom of NPH. Therefore, the presence of fecal incontinence in a patient with NPH should first raise suspicion of another type of neurodegenerative disease in the clinician. If a patient with NPH has fecal incontinence as one of the clinical indicators, it suggests he has severe frontal subcortical dysfunction.
When applied early, a CSF shunt can help about 80% of NPH patients with bladder dysfunction; however, if surgery is done at an advanced stage in the disease, as in other symptoms, the percentage would be no more than 50-60%.
9. Diagnosis
For diagnosis, the physical and neurological examinations, clinical symptoms, neuropsychological and neuroimaging findings should all be evaluated as a whole. For this purpose, the clinician should clearly demonstrate the presence of hydrocephalus and the absence of severe cortical atrophy. All patients with NPH should have enlarged ventricles. Although ventriculomegaly is detected in many neurodegenerative diseases and senile cerebral atrophy, these patients may not have any clinical signs of hydrocephalus. Hence, the terms hydrocephalus and ventriculomegaly are not synonymous. To summarize, not all elderly patients with large ventricles have NPH. Ventriculomegaly makes sense when accompanied by clinical symptoms.
Today, in most cases where neurological symptoms are new, Computerized Brain Tomography (CBT) is often used because it is quick and easy to obtain, or Magnetic Resonance Imaging (MRI) because it provides more detailed information about cerebral anatomy/pathology. Furthermore, high-speed and high-resolution MRI techniques can better define aqueductal stenosis, and MRI phase-contrast techniques show the hyperdynamic aqueductal CSF flow that has been associated with shunt-responsive NPH.
Radiological findings detected by MRI/CBT (Figure 1).
Disproportionate ventricular enlargement to sulcal atrophy with typical rounding of frontal horns.
Periventricular high-density and/or low-density areas (leukoaraiosis) seen diffusely/locally in the white matter due to the transependymal passage of CSF.
Thinning and elevation of the corpus callosum [71].
The Evans index, as determined by dilatation of the third and lateral ventricles without obstruction in the CSF circulation and by MRI or CT, should be at least 0. 3 [72].
Flow gap in the aqueduct detected in spin-echo sequences and called hyperdynamic aqueduct or jet sign (this should be confirmed by hyperdynamic aqueduct phase-contrast MRI) [73].
Figure 1.
MRI images of NPH a: Periventricular hyperintensity, B: Enlargement of Sylvian cistern (sagittal), C: Enlargement of Sylvian cistern (coronal), D: Dilatation in the third ventricle, E: Callosal angle, F: Evans index, G: Hyperintensity in white matter, H: Bulging on the roof of the ventricle, I: Effacement of sulci at midline vertex.
The presence of a narrow CSF area in high convexity/midline areas on radiological imaging, and disproportionately enlarged subarachnoid spaces particularly in the Sylvian fissure and basal cisterns, are termed ‘Disproportionally Enlarged Subarachnoid Spaces Hydrocephalus’ (DESH). This is an indirect sign that CSF flow between the basal cisterns and the arachnoid granulations is being blocked. The existence of this symptom is thought to be the most sensitive indicator for shunt surgery, while its absence indicates brain atrophy [74]. So far, no characteristic neuropathological lesion of NPH has been detected [75, 76, 77].
Neuroimaging tests are necessary but not sufficient to diagnose NPH. Invasive tests such as lumbar puncture (LP). and External Lumbar Drainage (ELD) are needed in addition to non-invasive procedures like radiological imaging to improve diagnostic and prognostic accuracy in these patients. Both International and Japanese guidelines recommend diagnostic LP and/or ELD to all patients with suspected NPH. While there is a response to CSF intake in the presence of NPH, there is no response to CSF intake in the absence or minimal level of NPH. CSF drainage also has predictive value for shunt surgery. Patients whose symptoms are relieved by CSF drainage are expected to respond positively to shunt surgery as well. With LP taking 30–50 mL of CSF, changes in gait and cognitive functions are expected after 30 minutes to 4 hours (rarely a few days). If there is a positive response to the tap test, shunt surgery may be recommended, but failure to respond does not exclude the shunt response, because even in patients with normal CSF pressure in the LP, recovery was observed in approximately 50% of them following shunt surgery [78, 79, 80, 81, 82]. ELD may be considered in patients who do not respond to the Tap test but are still clinically suspected of having NPH. With ELD, controlled CSF drainage of approximately 10 mL/h for 2–3 days or 150 to 200 mL per day for 2 to 7 days is performed. The patient’s gait and neuropsychological tests are recorded daily before the procedure, during CSF drainage, and after catheter removal.
It is difficult to explain the detection of CSF pressure at normal levels in NPH dynamics. Although normal CSF pressure can be detected with a single LP, in fact, 24-hour monitoring might occasionally reveal abnormally high pressures or consistently high/normal pressures. Although CSF pressure has been found to be normal in a single LP, there is a consensus that episodes of increased CSF pressure occur in NPH. For the development of iNPH or sNPH, it is predicted that the baseline ICP is high, at least during the disease stages, and that this high pressure decreases with dilatation of the ventricles. Long-term intracranial pressure (ICP) measurements, such as those taken by some centers for 24 to 72 hours, are not advised for routine usage, both because their predictive values have not yet been adequately documented and because they necessitate specialized equipment and expertise.
10. Differential diagnosis
Regression in motor and cognitive functions, as well as urine incontinence, are common with aging. The addition of other neurodegenerative diseases, such as those that increase with age, and some surgery (cervical/lumbar spinal stenosis) and internal diseases (hypothyroidism, vitamin B12 deficiency) make the differential diagnosis difficult. It may not be easy to distinguish Alzheimer’s disease (AD) and Parkinson’s disease, which exhibit similar clinical symptoms such as gait disturbance and dementia, from NPH. Also, having vascular or Alzheimer’s dementia simultaneously in three-quarters (75%) of their patients with NPH makes the situation even more complicated. On the other hand, because each of the cardinal symptoms of NPH has a variety of etiologies, it might mimic a variety of neurodegenerative diseases. Patients with isolated NPH are extremely uncommon in clinical practice due to the numerous comorbidities that often accompany the symptoms of NPH. The clinical triad peculiar to this disease is actually non-classical, as similar symptoms can be found in a variety of disorders. Therefore, a comprehensive differential diagnosis table ranging from psychiatric disorders to neurological diseases should be considered when distinguishing NPH from other diseases in elderly patients. The differential diagnosis of gait disorders includes peripheral neuropathy, inner ear disorders, spinal cord diseases, alcohol use, and deficiencies of vitamins such as B6 and B12. Clinical and neuroimaging data are very important in the differential diagnosis. Early and accurate determination of the differential diagnosis will save both the clinician and the patient from a series of invasive and noninvasive tests.
Findings that make a diagnosis of NPH less likely include the following:
ICP: Above 25 cm H2O.
AGE: Patients younger than 40 years old.
SYMPTOM: Asymmetrical or transient symptoms.
CORTICAL DYSFUNCTION: Having deficits such as aphasia, paresis.
DEMENTIA: The absence of gait disturbance accompanying the dementia clinic.
CLINICAL PROCESS: No progression of symptoms.
Some of the diseases frequently encountered in the differential diagnosis are Alzheimer’s disease (AD) and Parkinson’s disease. Similar to Parkinson’s disease, episodes of hesitation and freezing may occur in the gait of NPH patients. However, resting tremors and the typically unilateral symptoms of Parkinson’s disease are uncommon in NPH. NPH patients’ failure to respond to anti-parkinsonian medicines may also help with diagnosis.
The subject AD, another common disease in differential diagnosis, is quite complex and difficult. AD is thought to account for 50–60% of all dementias in the elderly [83, 84, 85]. It is not always possible to distinguish between patients with NPH and those with AD based solely on their medical history and physical examination. Thanks to data gained from MRI and neuropsychological tests, distinguishing AD from NPH is now easier than in past years. The mental disorder in NPH is a subcortical type. While the severity of cognitive impairment is mild or moderate in patients with NPH, mental disorders in AD patients are both the first symptom and advanced. Again, dementia signs occur with more severe symptoms in AD than in NPH. This condition was confirmed by the presence of hippocampal atrophy on CT or MRI [86, 87, 88, 89]. Again, motor symptoms such as gait disturbance are rare in AD. In AD, long-term, short-term, and sensory memories are all impaired, while in NPH memory is partially preserved. In NPH, brain dysfunction mainly arises in the frontal cortex, whereas in AD, the major dysfunction originates from the medial temporal lobe, thus, medial temporal lobe atrophy on MRI suggests AD [90]. On the other hand, when considering the response to shunt surgery, it is critical to distinguish these two diseases, which overlap in terms of clinical symptoms. From this standpoint, many studies have investigated biomarkers in CSF to both improve diagnosis and predict shunt efficacy. The specific combination of low Aβ-42 and increased P-tau detected in the CSF has actually been accepted as the biological signature of AD [91]. In contrast, Graff-Radford [92] reported that CSF markers are not useful in distinguishing between the NPH patients from the patients with comorbid AD. Complete blood count, biochemical profile, neuropsychological tests, MRI of the cervical, thoracic or lumbar spine in addition to cranial MRI, electromyography/nerve conduction velocity study and urology consultation can be performed to comprehensively evaluate the differential diagnosis.
11. Treatment
Although NPH is a clinically well-known disease, the indications for shunt surgery and the estimation of surgical outcomes are not clear. Although many devoted articles have been published to identify the most suitable candidates for surgical treatment, there is still no consensus on who is the best candidate for surgery and how to select these patients. Reliable indications of good surgical response are still lacking, particularly with regard to the shunt procedure. In the presence of short history, a known cause of hydrocephalus, predominance of gait disturbances, and CT or MRI findings for hydrodynamic hydrocephalus, it is not difficult to decide on surgery and recommend a shunt to the patient. Today, identifying patients with NPH and applying effective treatment methods still pose challenges for neurosurgeons. However, despite all these difficulties, if diagnosed and treated early, the unusual appearance of these symptoms affecting elderly individuals can be prevented and significant improvements in their life quality can be achieved.
Advanced diagnostic and therapeutic methods and clinical successes have shown that surgical treatment for NPH is superior to conservative treatment. Even if one or two main symptoms are present, NPH should be diagnosed and treated, as waiting for the clinical triad to occur for diagnosis can drastically diminish the response to shunt surgery. This is because the longer NPH patients go without treatment, the worse their prognosis becomes and the shorter their life expectancy becomes.
Using a catheter to alter the flow path of CSF is now the recognized therapeutic procedure all around the world. Shunt surgery is indicated for patients who respond to CSF drainage or who have CSF hydrodynamic variables consistent with NPH [75, 93, 94, 95].
However, it is crucial to identify other diseases that mimic NPH before deciding on surgical treatment as it will directly affect the quality of life of patients. There is no evidence that the time spent identifying and treating these disorders in the differential diagnosis lowers the chances of response to shunt surgery. The most essential component that promotes surgical success is a more thorough evaluation performed without haste. Moreover, it should be noted that not all patients with NPH are candidates for shunt surgery. For each patient, the benefit–risk ratio should be assessed separately. Before the surgical operation, possible complications of shunt surgery (infection, embolization, shunt failure, subdural hematoma, and effusion) should be considered and patients should be informed about the surgical risks as well as the potential benefit. Patients should be informed about the problems they will encounter in their daily lives (such as gait disturbance, dementia, incontinence) and potential complications of shunt surgery if they are not operated on. Providing information on the following issues prior to surgical consent will improve the patient’s and their relatives’ compliance with post-surgery treatment.
After surgical treatment, iNPH has a potential cure rate of 30-50% and sNPH of 50-70%.
The least reversible symptom with surgical treatment is dementia.
The complication rate of surgical treatment varies between 20% and 40%, but serious complications do not exceed 5-8%.
The passage of CSF from one compartment to another by bypassing the natural flow pathways with the aid of a catheter remains the main treatment method for NPH. This shunt procedure is based on the notion that it will minimize the elevated transmantle pressure caused by ventriculomegaly, therefore relieving the symptoms associated with NPH [14]. Today, ventriculoperitoneal (VP) shunts are the most commonly used ones for this purpose. Shunt valves and configuration are dependent on surgeon experience and patient preference. There is no objective evidence that one type of shunt is superior to another. Low-pressure shunts were frequently employed in the past, and the clinical response was better. However, because complications including excessive drainage and subdural hematoma are more common with these shunts, they have been phased out except in rare circumstances. Today, medium pressure shunts or adjustable shunts are more preferred. Adjustable shunts have the advantage of allowing the pressure setting to be gradually lowered or raised until the patient’s symptoms improve. In this way, complications that may arise as a result of under or excess drainage can be avoided by changing the pressure without surgery. Another advantage is that it can be administered safely in patients who are on anticoagulation therapy for cardiac or neurological disorders [96].
In Japan, patients with iNPH are mainly treated with lumbar peritoneal shunts. In recent years, this surgical procedure has been widely used all over the world. In terms of effectiveness, one type of shunt has no superiority over the other. However, although the complication rate associated with the device itself is higher in lumbar peritoneal shunts than in ventriculoperitoneal shunts, the fact that lumbar peritoneal shunts are minimally invasive, do not have the fatal complications seen in ventriculoperitoneal shunts, and are more economical has allowed them to be a step forward in treatment [97]. Endoscopic third ventriculostomy has not been proven to be effective in the treatment of iNPH. In patients who are debilitated and shunt surgery is contraindicated, serial lumbar punctures are not recommended as an alternate treatment, except for a limited period of time.
Although it is difficult to draw definitive conclusions, three decades of publications on NPH and surgical experience have summarized the factors that can help predict post-shunt outcomes as follows [98].
Factors predicting a good surgical outcome.
Clinical gait disturbances appearing before cognitive deficits.
Short duration of mental deterioration history.
Mild or moderate level of mental disorder.
Presence of hydrocephalus with known etiology such as subarachnoid hemorrhage, meningitis.
Detection of significant improvement in clinical findings after CSF drainage.
Occurrence of 50% or more B waves in continuous intracranial pressure monitoring.
Absence of significant white matter lesions on MRI.
Factors predicting poor surgical outcomes.
Dementia being the first symptom among clinical findings.
Detection of clinical signs of severe dementia.
Detection of significant cerebral atrophy or diffuse white matter involvement on MRI.
Although some studies have indicated a high success (recovery) rate of roughly 80-90% in the improvement of clinical symptoms following surgery [99, 100], the overall rate has been reported to be 65-70% for sNPH cases and 30-50% for iNPH cases [50, 82, 101]. This discrepancy in surgical outcomes could be attributed to the presence of other NPH-related neurodegenerative and/or cerebrovascular disorders. Therefore, meticulousness in differential diagnosis and early treatment of comorbidities can eliminate this inconsistency.
However, the reasons why patients treated with shunts do not respond to shunt surgery are not fully understood. Before concluding that the surgical treatment was unsuccessful, it should be suspected that the failure was due to candidate selection or that the shunt was ineffective in cases where the desired clinical improvement was not achieved after surgery, particularly in patients whose ventricular size did not decrease after shunt or in those who only experienced temporary improvement after surgery [102].
Acknowledgments
I would especially like to thank my colleague İsmail KAYA for his help in English editing of the chapter.
\n',keywords:"normal pressure hydrocephalus, elderly individuals, neurodegenerative diseases, cognitive deficits, early surgical treatment",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/77725.pdf",chapterXML:"https://mts.intechopen.com/source/xml/77725.xml",downloadPdfUrl:"/chapter/pdf-download/77725",previewPdfUrl:"/chapter/pdf-preview/77725",totalDownloads:156,totalViews:0,totalCrossrefCites:0,dateSubmitted:"June 17th 2021",dateReviewed:"July 3rd 2021",datePrePublished:"July 29th 2021",datePublished:"January 19th 2022",dateFinished:"July 29th 2021",readingETA:"0",abstract:"Inadequate absorption of cerebrospinal fluid (CSF) at the arachnoid granulation level during circulation results in an increase in CSF in the ventricle and certain neuropsychiatric clinical findings. This syndrome, which often presents with ventricular dilatation, progressive cognitive decline, walking difficulties, and urinary incontinence symptoms in elderly individuals, is called Normal Pressure Hydrocephalus (NPH). It is projected that as people’s quality of life improves and their life expectancy rises, more old people would develop this condition. Although a clear clinical triad has been defined, the identification of patients with NPH and the application of effective treatment modalities still pose a number of challenges for neurosurgeons today. However, despite all these difficulties, if diagnosed and treated early, the unusual appearance of these symptoms affecting elderly individuals can be prevented and significant improvements in quality of life can be achieved.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/77725",risUrl:"/chapter/ris/77725",signatures:"Hüseyin Yakar",book:{id:"11018",type:"book",title:"Cerebrospinal Fluid",subtitle:null,fullTitle:"Cerebrospinal Fluid",slug:"cerebrospinal-fluid",publishedDate:"January 19th 2022",bookSignature:"Pınar Kuru Bektaşoğlu and Bora Gürer",coverURL:"https://cdn.intechopen.com/books/images_new/11018.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83969-696-1",printIsbn:"978-1-83969-695-4",pdfIsbn:"978-1-83969-697-8",isAvailableForWebshopOrdering:!0,editors:[{id:"95341",title:"Prof.",name:"Bora",middleName:null,surname:"Gürer",slug:"bora-gurer",fullName:"Bora Gürer"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"354970",title:"Assistant Prof.",name:"Hüseyin",middleName:null,surname:"Yakar",fullName:"Hüseyin Yakar",slug:"huseyin-yakar",email:"hsyakar@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Classification",level:"1"},{id:"sec_3",title:"3. Incidence-prevalence",level:"1"},{id:"sec_4",title:"4. Pathophysiology",level:"1"},{id:"sec_5",title:"5. Clinic",level:"1"},{id:"sec_6",title:"6. Gait disorder",level:"1"},{id:"sec_7",title:"7. Cognitive disorder",level:"1"},{id:"sec_8",title:"8. Urinary incontinence",level:"1"},{id:"sec_9",title:"9. Diagnosis",level:"1"},{id:"sec_10",title:"10. Differential diagnosis",level:"1"},{id:"sec_11",title:"11. Treatment",level:"1"},{id:"sec_12",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci. 1965; 2: 307-327'},{id:"B2",body:'Hakim S, Venegas JG, Burton JD. The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: mechanical interpretation and mathematical model. 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Acta Neurologica Scandinavica. 2012;126(3):145-153.'},{id:"B99",body:'Vanneste JAL. Diagnosis and management of normal-pressure hydrocephalus. Neurol. 2000;247:5-14'},{id:"B100",body:'Black PML, Ojemann RG, Tzouras A (1985) CSF shunts for dementia, incontinence, and gait disturbance. Clin Neurosurg 32:632-651'},{id:"B101",body:'Poca MA, Solana E, Martínez-Ricarte FR, Romero M, Gándara D,Sahuquillo J. Idiopathic normal pressure: Results of a prospective cohort of 236 shunted patients. Acta Neurochirurgica. Supplement. 2012;114:247-253.'},{id:"B102",body:'Williams MA, Razumovsky AY, Hanley DF. Evaluation of shunt function in patients who are never better, or better then worse after shunt surgery for NPH. Acta Neurochir. 1998;71:368-370'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Hüseyin Yakar",address:"hsyakar@gmail.com",affiliation:'
Department of Neurosurgery, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
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The Open Access model is applied to all of our publications and is designed to eliminate subscriptions and pay-per-view fees. This approach ensures free, immediate access to full text versions of your research.
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Permanent and unrestricted online access to your work
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For Authors who are still unable to obtain funding from their institutions or research funding bodies for individual projects, IntechOpen does offer the possibility of applying for a Waiver to offset some or all processing feed. Details regarding our Waiver Policy can be found here.
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Indexing and listing across major repositories, see details ...
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Dissemination and Promotion
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Proven world leader in Open Access book publishing with over 10 years experience
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+5,700 OA books published
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Most competitive prices in the market
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Optimized processes that assure your research is made available to the scientific community without delay
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+184,650 citations in Web of Science databases
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As a gold Open Access publisher, an Open Access Publishing Fee is payable on acceptance following peer review of the manuscript. In return, we provide high quality publishing services and exclusive benefits for all contributors. IntechOpen is the trusted publishing partner of over 140,000 international scientists and researchers.
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The Open Access Publishing Fee (OAPF) is payable only after your book chapter, monograph or journal article is accepted for publication.
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1,400 GBP Chapter - Edited Volume
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850 GBP Chapter - Book Series Topic (Annual Volume)
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10,000 GBP Monograph - Long Form
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850 GBP Journal Article (Across Portfolio)
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During the launching phase journals do not charge an APC, rather they will be funded by IntechOpen.
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*These prices do not include Value-Added Tax (VAT). Residents of European Union countries need to add VAT based on the specific rate in their country of residence. Institutions and companies registered as VAT taxable entities in their own EU member state will not pay VAT as long as provision of the VAT registration number is made during the application process. This is made possible by the EU reverse charge method.
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Services included are:
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An online manuscript tracking system to facilitate your work
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Personal contact and support throughout the publishing process from your dedicated Author Service Manager
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Assurance that your manuscript meets the highest publishing standards
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English language copyediting and proofreading, including the correction of grammatical, spelling, and other common errors
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XML Typesetting and pagination - web (PDF, HTML) and print files preparation
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Discoverability - electronic citation and linking via DOI
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Permanent and unrestricted online access to your work
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What isn't covered by the Open Access Publishing Fee?
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If your manuscript:
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Exceeds the number of pages defined by the publishing guidelines, an additional fee per page may be required
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If a manuscript requires Heavy Editing or Language Polishing, this will incur additional fees.
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Your Author Service Manager will inform you of any items not covered by the OAPF and provide exact information regarding those additional costs before proceeding.
\n\n
Open Access Funding
\n\n
To explore funding opportunities and learn more about how you can finance your IntechOpen publication, go to our Open Access Funding page. IntechOpen offers expert assistance to all of its Authors. We can support you in approaching funding bodies and institutions in relation to publishing fees by providing information about compliance with the Open Access policies of your funder or institution. We can also assist with communicating the benefits of Open Access in order to support and strengthen your funding request and provide personal guidance through your application process. You can contact us at funders@intechopen.com for further details or assistance.
\n\n
For Authors who are still unable to obtain funding from their institutions or research funding bodies for individual projects, IntechOpen does offer the possibility of applying for a Waiver to offset some or all processing feed. Details regarding our Waiver Policy can be found here.
\n\n
Added Value of Publishing with IntechOpen
\n\n
Choosing to publish with IntechOpen ensures the following benefits:
\n\n
\n\t
Indexing and listing across major repositories, see details ...
\n\t
Long-term archiving
\n\t
Visibility on the world's strongest OA platform
\n\t
Live Performance Metrics to track readership and the impact of your chapter
\n\t
Dissemination and Promotion
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Benefits of Publishing with IntechOpen
\n\n
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Proven world leader in Open Access book publishing with over 10 years experience
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+5,700 OA books published
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Most competitive prices in the market
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Fully compliant with OA funding requirements
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Optimized processes that assure your research is made available to the scientific community without delay
\n\t
Personal support during every step of the publication process
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+184,650 citations in Web of Science databases
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Currently strongest OA platform with over 175 million downloads
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Therefore, any experiment can be performed in the set \n\nC\n\n of complex probabilities which is the summation of the set \n\nR\n\n of real probabilities and the set \n\nM\n\n of imaginary probabilities. The purpose here is to include additional imaginary dimensions to the experiment taking place in the “real” laboratory in \n\nR\n\n and hence to evaluate all the probabilities. Consequently, the probability in the entire set \n\nC\n=\nR\n+\nM\n\n is permanently equal to one no matter what the stochastic distribution of the input random variable in \n\nR\n\n is; therefore the outcome of the probabilistic experiment in \n\nC\n\n can be determined perfectly. This is due to the fact that the probability in \n\nC\n\n is calculated after subtracting from the degree of our knowledge the chaotic factor of the random experiment. Consequently, the purpose in this chapter is to join my complex probability paradigm to the analytic prognostic of buried petrochemical pipelines in the case of linear damage accumulation. Accordingly, after the calculation of the novel prognostic model parameters, we will be able to evaluate the degree of knowledge, the magnitude of the chaotic factor, the complex probability, the probabilities of the system failure and survival, and the probability of the remaining useful lifetime; after that a pressure time t has been applied to the pipeline, which are all functions of the system degradation subject to random and stochastic influences.",book:{id:"7751",slug:"fault-detection-diagnosis-and-prognosis",title:"Fault Detection, Diagnosis and Prognosis",fullTitle:"Fault Detection, Diagnosis and Prognosis"},signatures:"Abdo Abou Jaoude",authors:[{id:"248271",title:"Dr.",name:"Abdo",middleName:null,surname:"Abou Jaoudé",slug:"abdo-abou-jaoude",fullName:"Abdo Abou Jaoudé"}]}],onlineFirstChaptersFilter:{topicId:"163",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:287,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. 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\r\n\tGlobally, the ecological footprint is growing at a faster rate than GDP. This phenomenon has been studied by scientists for many years. However, clear strategies and actions are needed now more than ever. Every day, humanity, from individuals to businesses (public and private) and governments, are called to change their mindset in order to pursue a virtuous combination for sustainable development. Reasoning in a sustainable way entails, first and foremost, managing the available resources efficiently and strategically, whether they are natural, financial, human or relational. In this way, value is generated by contributing to the growth, improvement and socio-economic development of the communities and of all the players that make up its value chain. In the coming decades, we will need to be able to transition from a society in which economic well-being and health are measured by the growth of production and material consumption, to a society in which we live better while consuming less. In this context, digitization has the potential to disrupt processes, with significant implications for the environment and sustainable development. There are numerous challenges associated with sustainability and digitization, the need to consider new business models capable of extracting value, data ownership and sharing and integration, as well as collaboration across the entire supply chain of a product. In order to generate value, effectively developing a complex system based on sustainability principles is a challenge that requires a deep commitment to both technological factors, such as data and platforms, and human dimensions, such as trust and collaboration. Regular study, research and implementation must be part of the road to sustainable solutions. Consequently, this topic will analyze growth models and techniques aimed at achieving intergenerational equity in terms of economic, social and environmental well-being. It will also cover various subjects, including risk assessment in the context of sustainable economy and a just society.
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