Recovery Process of Gait Disturbance after Ventriculo-Peritoneal Shunt in Patients with Idiopathic Normal Pressure Hydrocephalus

Abstract

Abstract.To clarify the characteristics of the recovery process of gait disturbances after ventriculoperitoneal shunt (VP shunt) surgery in patients with idiopathic normal pressure hydrocephalus (iNPH), we investigated three areas in two severely disabled patients: longitudinal changes of the severity of postural instability of motor aspects of the Unified Parkinson's disease Rating Scale (UPDRS); time taken in the "timed up and go (TUG)" test; and the prevalence of freezing episodes and the severity of bradykinesia. We also compared the computed tomography findings before and after VP shunt. Gait disturbances in the early stage after VP shunt fall under the frontal gait disorder of Nutt's classification or the mixed gait apraxia of Liston's classification. Disequilibrium clearly improved gradually after VP shunt, however, gait ignition failure and hypokinesia showed no significant improvement in our study. In the early stage after VP shunt, complementing disequilibrium using high-heeled shoes was highly effective at improving the time taken in TUG. The improvements in radiographic findings were reported after VP shunt.

Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus

“…Previous studies aimed to assess the recovery process of gait disturbances after VP-shunt surgery in patients with iNPH using several tests in a controlled setting ( 20 , 33 , 34 ). For the first time, we aimed to get a more reliable evaluation concerning the response of patients with iNPH to VP-shunt placement by comparing the gait pattern of patients with iNPH preoperatively and postoperatively in the home environment.…”