Timed up and go test at tap test and shunt surgery in idiopathic normal pressure hydrocephalus

Yamada, Shigeki; Ishikawa, Masatsune; Miyajima, Masakazu; Nakajima, Madoka; Atsuchi, Masamichi; Kimura, Teruo; Tokuda, Takahiko; Kazui, Hiroaki; Mori, Etsuro

doi:10.1212/cpj.0000000000000334

Cited by 35 publications

(34 citation statements)

References 42 publications

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“…The functional assessment was performed in the Rehabilitation Medicine Department of Elias University Hospital in Bucharest and included the Timed Up and Go test – 3 meters version (TUG) (3 times means) [ 11 ], the 10m walking test at the self-chosen comfortable speed [ 15 ] and the Berg Balance Scale [ 16 ]. The study compares 24h pre-surgery assessment results with one-month follow-up after surgery.…”

Section: Methodsmentioning

confidence: 99%

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The Effects of Ventriculoperitoneal Shunt on Gait Performance

2019

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Most studies on patients with normal pressure hydrocephalus (NPH) regard pre-post Tap test and long-term follow-up after shunt surgery. Quantitative and qualitative assessment tools specific to rehabilitation medicine can provide an objective measurement of the benefit of the neurosurgical intervention at 1-month follow-up. The aim of this retrospective study was to assess the early benefit of the ventriculoperitoneal shunt with low or medium pressure valve on the gait capacity of persons with NPH, one month after surgery. This is a retrospective study reviewing 19 inpatients with NPH who underwent neurosurgery for ventriculoperitoneal shunt with low or medium pressure valve, one month after a positive result on a tap test, in a 5-year period. The assessments regarding the gait abilities were performed 24 hours before the surgical intervention and one month after surgery. Assessment tools used were: the 3 meters Timed Up and Go Test (TUG), the 10 Meters Walking Test (10MWT) and the Berg Balance Scale. A positive response to the tap test predicted improvements of gait and balance in patients with NPH after shunt surgery. Best results in regards to gait and balance are achieved when early diagnosis and intervention are performed. Complex comorbidities generate and enhance significant and persistent gait impairment.

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Section: Methodsmentioning

confidence: 99%

“…A pre-post TT difference of 3.985 seconds in TUG is a predictor of positive response to the surgical intervention in NPH [ 10 ]. A TUG time shortened by 5 seconds or more after a TT predicts a 40-60% expectancy of improvement in TUG time at 12 months after shunt surgery, by more than 10 seconds or 5 seconds, respectively [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Ventriculoperitoneal Shunt on Gait Performance

2019

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“…The TUG does not require a trained physical therapist and can be administered by clinical staff in approximately 3 minutes. It is a reliable predictor of shunt outcome in NPH patients [38][39][40]. In our analysis, the TUG was significantly related to detailed measures of balance, endurance, and gait velocity.…”

Section: Discussionmentioning

confidence: 60%

Standardized regression-based clinical change score cutoffs for normal pressure hydrocephalus

et al. 2020

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Background: Presently, for patients presenting with suspected Normal Pressure Hydrocephalus (NPH) who undergo temporary drainage of cerebrospinal fluid (CSF) there is no defined model to differentiate chance improvement form clinical significance change at the individual patient level. To address this lack of information we computed standard regression based clinical change models for the 10 Meter Walk Test, Timed Up & Go, Dual Timed Up & Go, 6-Minute Walk Test, Mini-Balance Evaluation Systems Test, Montreal Cognitive Assessment, and Symbol Digit Modalities using data from patients with suspected NPH that underwent temporary drainage of CSF. These clinically significant change modes can classify clinically significant improvement following temporary drainage of CSF at the individual patient level. This allows for physicians to differentiate a clinically significant improvement in symptoms from chance improvement. Methods: Data was collected from 323 patients, over the age of 60, with suspected NPH that underwent temporary drainage of CSF with corresponding gait and cognitive testing. McSweeney Standardized Regression Based Clinical Change Models were computed for standard gait and cognitive measures: Timed Up & Go, Dual Timed Up & Go, 10 Meter Walk Test, MiniBESTest, 6-Minute Walk Test, Montreal Cognitive Assessment, and Symbol Digit Modalities Test. To assess the discriminate validity of the measures we used correlations, Chi 2 , and regression analyses. Results: The clinical change models explained 69-91.8% of the variability in post-drain performance (p < 0.001). As patient scores became more impaired, the percent change required for improvement to be clinically significant increased for all measures. We found that the measures were not discriminate, the Timed Up & Go was highly related to the 10 Meter Walk Test (r = 0.85, R 2 = 0.769-0.738, p < 0.001), MiniBESTest (r = − 0.67, R 2 = 0.589-0.734, p < 0.001), and 6 Minute Walk Test (r = − 0.77, R 2 = 0.71-0.734, p < 0.001). Conclusion: Standardized Regression Based Clinically Significant Change Models allow for physicians to use an evidence-based approach to differentiate clinically significant change from chance improvement at the individual patient level. The Timed Up & Go was shown to be predictive of detailed measures of gait velocity, balance, and endurance.

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“…The international idiopathic NPH guideline treats aqueductal stenosis, long-standing overt ventriculomegaly syndrome, and non-communicating hydrocephalus as other hydrocephalus disorders, and clearly exclude them from the category of idiopathic NPH ( 25 ). Although there are numerus articles reporting good outcomes of shunt surgery for idiopathic NPH ( 10 – 17 ), many neurosurgeons and neurologists still have the negative impression that idiopathic NPH is difficult to treat with a shunt surgery ( 26 , 27 ). This divergence of opinions might be due to confusing classifications of idiopathic and adult-onset congenital NPH.…”

Section: Discussionmentioning

confidence: 99%

“…Recent clinical studies in robust diagnostic criteria for idiopathic NPH have shown the beneficial effects of shunting procedures for a patient with idiopathic NPH ( 10 – 17 ). However, some conservative experts strongly believe that shunt implantation is not effective for a patient with idiopathic NPH from their bitter experiences.…”

Section: Introductionmentioning

confidence: 99%

Fluid Distribution Pattern in Adult-Onset Congenital, Idiopathic, and Secondary Normal-Pressure Hydrocephalus: Implications for Clinical Care

2017

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ObjectiveIn spite of growing evidence of idiopathic normal-pressure hydrocephalus (NPH), a viewpoint about clinical care for idiopathic NPH is still controversial. A continuous divergence of viewpoints might be due to confusing classifications of idiopathic and adult-onset congenital NPH. To elucidate the classification of NPH, we propose that adult-onset congenital NPH should be explicitly distinguished from idiopathic and secondary NPH.MethodsOn the basis of conventional CT scan or MRI, idiopathic NPH was defined as narrow sulci at the high convexity in concurrent with enlargement of the ventricles, basal cistern and Sylvian fissure, whereas adult-onset congenital NPH was defined as huge ventricles without high-convexity tightness. We compared clinical characteristics and cerebrospinal fluid distribution among 85 patients diagnosed with idiopathic NPH, 17 patients with secondary NPH, and 7 patients with adult-onset congenital NPH. All patients underwent 3-T MRI examinations and tap-tests. The volumes of ventricles and subarachnoid spaces were measured using a 3D workstation based on T2-weighted 3D sequences.ResultsThe mean intracranial volume for the patients with adult-onset congenital NPH was almost 100 mL larger than the volumes for patients with idiopathic and secondary NPH. Compared with the patients with idiopathic or secondary NPH, patients with adult-onset congenital NPH exhibited larger ventricles but normal sized subarachnoid spaces. The mean volume ratio of the high-convexity subarachnoid space was significantly less in idiopathic NPH than in adult-onset congenital NPH, whereas the mean volume ratio of the basal cistern and Sylvian fissure in idiopathic NPH was >2 times larger than that in adult-onset congenital NPH. The symptoms of gait disturbance, cognitive impairment, and urinary incontinence in patients with adult-onset congenital NPH tended to progress more slowly compared to their progress in patients with idiopathic NPH.ConclusionCerebrospinal fluid distributions and disease progression were significantly different among the patients with adult-onset congenital NPH, idiopathic NPH and secondary NPH. This finding indicates that the pathogenesis of adult-onset congenital NPH may differ from those of idiopathic and secondary NPH. Therefore, adult-onset congenital NPH should be definitively distinguished from the categories of idiopathic and secondary NPH.

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Timed up and go test at tap test and shunt surgery in idiopathic normal pressure hydrocephalus

Abstract: An improvement of 5 seconds was a useful threshold of TUG time at the tap test for predicting a ≥10-second improvement 12 months after shunt surgery, rather than the percent improvement of TUG time.

Cited by 35 publications

References 42 publications

The Effects of Ventriculoperitoneal Shunt on Gait Performance

The Effects of Ventriculoperitoneal Shunt on Gait Performance

Standardized regression-based clinical change score cutoffs for normal pressure hydrocephalus

Fluid Distribution Pattern in Adult-Onset Congenital, Idiopathic, and Secondary Normal-Pressure Hydrocephalus: Implications for Clinical Care

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