http://www.cyberpt.com/ptforum/ Copyright (c) 2006-2013 Web Wiz Forums - All Rights Reserved. Sun, 19 Apr 2026 13:24:09 +0000 Sun, 27 Sep 2009 22:49:56 +0000 http://blogs.law.harvard.edu/tech/rss Web Wiz Forums 11.03 360 www.cyberpt.com/ptforum/RSS_post_feed.asp?TID=494 http://www.cyberpt.com/ptforum/forum_images/pt_logo.gif http://www.cyberpt.com/ptforum/ http://www.cyberpt.com/ptforum/forum_posts.asp?TID=494&PID=579&title=normal-pressure-hydrocephalus#579 Author: Jerram
Subject: 494
Posted: Sep 27 2009 at 10:49pm

I'm currently seeing a 60 y/o gentleman with normal pressure hydrocephalus (NPH) on an outpatient basis.
Hehas been diagnosed for about 3 years now and was recently admittedafter his shunt malfunctioned and he had a revision done. The revisionhelped significantly and now he's home. I've been seeing him for abouta month and I'm realizing that we are plateauing. I started researchingthe literature for some guidelines on PT approach in this populationand there is very little. Most of the articles refer to acute caremanagement, gait characteristics of NPH vs. Parkinson's disease, andNPH pre/post lumbar drain testing prior to shunt placement. Nothing Ican find really makes recommendations for chronic management.

Asfor the specifics of his case, he demos fairly common gaitcharacteristics: small step length (festinating when fatigued) thatworsens in doorways and turns and in dynamic situations. Also reducedarm swing unilaterally with ipsilateral pelvic protraction. He iseasily distractible, and like many of my PD patients, cannot multitaskvery well. His carry over early on was good, most notably he was ableto stop himself at the first sign of festination and begin his gaitcycle again with focus on a good first step. This has cut downsignificantly his furniture walking and wall grabbing tendencies. Now,he always begins stepping well, including a fair amount of left armswing. But soon, he is taking short steps on the left again, the trunkgets rotated anteriorly on the left, and he has to stop and start overafter about 75'...and that is when walking in a straight line on levelsurface! Strength is near normal and tone is normal. There is mildneuropathic sensory loss in the feet due to diabetes. Endurance seemslimited and has definitely been a target area. I've encouraged use ofthe recumbent bike at home because his fear of falling and tendency forincreased instability with fatigue limit his ability to push himselfwith walking distance for the purpose of increasing the stamina. So mymain goals are to improve his stability in a wider variety ofenvironments, improve functional endurance, and to improve his specificability to self-manage his home environment which is small and has lotsof turns. Mostly, I've used strategies that have been successful withmoderately impaired PD patients but we are hitting a wall and from whatI understand from the research I have found, the two diseases appearsimilar, but probably impair motor planning in different ways.Therefore, some say verbal cueing doesn't work well in this group (likeit does work fairly well in PD). We tried using a metronome in a coupleof sessions but I'm not formally trained with it. Pretty mixed results.

So again, 2 part question: 1) What evidence based (or expertopinion based) guidelines exist for chronic management of NPH? Anyarticles even that address this issue? 2) What do you think about thisparticular patient as I've described him?

Thanks in advance for your feedback.

Jerram]]> Sun, 27 Sep 2009 22:49:56 +0000 http://www.cyberpt.com/ptforum/forum_posts.asp?TID=494&PID=579&title=normal-pressure-hydrocephalus#579