Ravdin Lisa D, Katzen Heather L, Jackson Anna E, Tsakanikas Diamanto, Assuras Stephanie, Relkin Norman R
Department of Neurology and Neuroscience, New York Presbyterian Hospital, Weill Medical College of Cornell University, Cornell Memory Disorders Program, 428 East 72 Street, Suite 500, New York, NY 10021, United States.
Clin Neurol Neurosurg. 2008 May;110(5):455-61. doi: 10.1016/j.clineuro.2008.02.003. Epub 2008 Mar 21.
To identify components of gait associated with a positive tap test (TT) in patients with idiopathic normal pressure hydrocephalus (iNPH).
Thirty-three patients with iNPH underwent clinical evaluation pre- and post-TT and were classified as responders (Rs) or non-responders (NRs). Elements of gait were assessed with a formal standardized Gait Scale and compared between groups.
Analysis of pre/post-TT group differences revealed an interaction for Total Gait Score and Walking Score, with improvements in responders only. Total Gait Scores improved by 29% in the Rs and 4.85% in the NRs. Rs showed significant post-TT improvements on a timed 10m walk, turning, and balance. Tandem walking, turning, truck balance and start stop hesitation showed trends toward improvement.
The classic features of gait often used in determining diagnosis of NPH (wide based stride, reduced foot-floor clearance, and small steps) were not helpful in identifying responders to the TT. Walking speed, steps for turning, and tendency towards falling were most likely to improve post-TT. These straightforward measures can readily be adapted into clinical practice to assist in determination of shunt candidacy.
确定特发性正常压力脑积水（iNPH）患者中与阳性叩击试验（TT）相关的步态组成部分。
33例iNPH患者在TT前后接受临床评估，并分为反应者（Rs）或无反应者（NRs）。采用正式的标准化步态量表评估步态要素，并在组间进行比较。
TT前后组间差异分析显示，总步态评分和步行评分存在交互作用，仅反应者有改善。反应者的总步态评分提高了29%，无反应者提高了4.85%。反应者在定时10米步行、转身和平衡方面TT后有显著改善。串联步行、转身、躯干平衡和起停犹豫有改善趋势。
常用于确定NPH诊断的经典步态特征（宽基步态、足部离地间隙减小和步幅小）对识别TT反应者无帮助。步行速度、转身步数和跌倒倾向在TT后最有可能改善。这些简单的测量方法可很容易地应用于临床实践，以协助确定分流手术的候选者。
