Files and links (1)
Free to read and download, Open Access
Background: Idiopathic Normal Pressure Hydrocephalus (iNPH) occurs when there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles. The most common treatment option is ventriculoperitoneal shunts (VPS) to drain the excess CSF into the peritoneal cavity. To advise the implementation of a VPS, physical therapists play an important role in the evaluation process of iNPH patients after a lumbar puncture. The purpose of this case report is to critically analyze the use of PT evaluation in patients with idiopathic normal pressure hydrocephalus to assist in the development of a formalized assessment protocol. Case Description: Patient A and Patient B performed the 10-meter walk test (10MWT) to evaluate their comfortable gait speed (CGS), fast gait speed (FGS), and dual-task gait speed (DTGS). Patient A demonstrated at least 20% improvement across all categories of the 10MWT and received a VPS. Patient B demonstrated minimal improvement, triggering a recommendation for a repeat test. At the second lumbar tap test, she demonstrated > 20% improvement and received a VPS. Critical Analysis: Three crucial components of the current protocol are the elapsed time between the tap test and the PT re-evaluation, the amount of CSF removed during the tap test, and the percentage improvement 10-minute walk test that is considered clinically significant. Across different studies, there is a high level of variability with the measurement and evaluation of these components. Discussion: Physical therapists can have a positive outcome with their involvement in iNPH evaluations. The addition of formal cognitive testing, balance measures, and longitudinal studies could further improve the impact that physical therapists may have on the evaluation of iNPH patients.