Yasutaka Nikaido1, Hideyuki Urakami2, Yohei Okada3,4, Toshihiro Akisue5, Yuki Kawami5,6, Naoya Ishida2, Yoshinaga Kajimoto7, Ryuichi Saura8. 1. Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. yasutaka.nikaido@ompu.ac.jp. 2. Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. 3. Graduate School of Health Sciences, Kio University, Nara, Japan. 4. Neurorehabilitation Research Center of Kio University, Nara, Japan. 5. Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan. 6. Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Hyogo, Japan. 7. Division of Surgery, Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Osaka, Japan. 8. Division of Comprehensive Medicine, Department of Physical and Rehabilitation Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Abstract
BACKGROUND: Gait-balance disturbances are core symptoms of idiopathic normal pressure hydrocephalus (iNPH). However, the rehabilitation effects of cerebrospinal fluid (CSF) shunting along with other treatment or no further treatment (natural course [NC]) for iNPH are unknown. OBJECTIVES: This study evaluated whether dynamic equilibrium gait training (DEGT) can improve gait-balance functions after CSF shunting of patients with iNPH compared to standard exercise (SE) and NC. Furthermore, it investigated the incidence of falls. METHODS: A total of 70 patients with iNPH who underwent CSF shunting were randomly assigned to 6 weeks of DEGT (n = 23), 6 weeks of SE (n = 23), or NC (n = 24). Evaluation was performed at baseline (preoperatively) and at 1 week, 7 weeks (postintervention), and 6 months postoperatively (follow-up). Outcomes were measured using the functional gait assessment (FGA), 10-m walk test, timed up-and-go test, life-space assessment (LSA), and fall incidence. RESULTS: A total of 65 participants completed the study. During the intention-to-treat analysis, the DEGT group demonstrated significant recovery of gait-balance functions according to only the FGA at postintervention and follow-up compared to the SE and NC groups; however, recovery of the SE group did not differ from that of the NC group. The DEGT group had a significantly lower fall incidence than the other groups at follow-up. Significantly better LSA results were observed for all groups at follow-up compared to baseline; however, no difference in LSA results were observed between groups. CONCLUSIONS: DEGT in addtion to CSF shunting can facilitate the recovery of gait-balance function and reduce the fall incidence of iNPH patients.
BACKGROUND: Gait-balance disturbances are core symptoms of idiopathic normal pressure hydrocephalus (iNPH). However, the rehabilitation effects of cerebrospinal fluid (CSF) shunting along with other treatment or no further treatment (natural course [NC]) for iNPH are unknown. OBJECTIVES: This study evaluated whether dynamic equilibrium gait training (DEGT) can improve gait-balance functions after CSF shunting of patients with iNPH compared to standard exercise (SE) and NC. Furthermore, it investigated the incidence of falls. METHODS: A total of 70 patients with iNPH who underwent CSF shunting were randomly assigned to 6 weeks of DEGT (n = 23), 6 weeks of SE (n = 23), or NC (n = 24). Evaluation was performed at baseline (preoperatively) and at 1 week, 7 weeks (postintervention), and 6 months postoperatively (follow-up). Outcomes were measured using the functional gait assessment (FGA), 10-m walk test, timed up-and-go test, life-space assessment (LSA), and fall incidence. RESULTS: A total of 65 participants completed the study. During the intention-to-treat analysis, the DEGT group demonstrated significant recovery of gait-balance functions according to only the FGA at postintervention and follow-up compared to the SE and NC groups; however, recovery of the SE group did not differ from that of the NC group. The DEGT group had a significantly lower fall incidence than the other groups at follow-up. Significantly better LSA results were observed for all groups at follow-up compared to baseline; however, no difference in LSA results were observed between groups. CONCLUSIONS: DEGT in addtion to CSF shunting can facilitate the recovery of gait-balance function and reduce the fall incidence of iNPH patients.
Authors: Hubertus Axer; Martina Axer; Heinrich Sauer; Otto W Witte; Georg Hagemann Journal: Clin Neurol Neurosurg Date: 2010-01-20 Impact factor: 1.876