Nikaido Yasutaka, Urakami Hideyuki, Okada Yohei, Akisue Toshihiro, Kawami Yuki, Ishida Naoya, Kajimoto Yoshinaga, Saura Ryuichi
Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Graduate School of Health Sciences, Kio University, Nara, Japan.
J Neurol. 2023 Jan;270(1):357-368. doi: 10.1007/s00415-022-11362-x. Epub 2022 Sep 7.
Gait-balance disturbances are core symptoms of idiopathic normal pressure hydrocephalus (iNPH). However, the rehabilitation effects of cerebrospinal fluid (CSF) shunting along with other treatment or no further treatment (natural course [NC]) for iNPH are unknown.
This study evaluated whether dynamic equilibrium gait training (DEGT) can improve gait-balance functions after CSF shunting of patients with iNPH compared to standard exercise (SE) and NC. Furthermore, it investigated the incidence of falls.
A total of 70 patients with iNPH who underwent CSF shunting were randomly assigned to 6 weeks of DEGT (n = 23), 6 weeks of SE (n = 23), or NC (n = 24). Evaluation was performed at baseline (preoperatively) and at 1 week, 7 weeks (postintervention), and 6 months postoperatively (follow-up). Outcomes were measured using the functional gait assessment (FGA), 10-m walk test, timed up-and-go test, life-space assessment (LSA), and fall incidence.
A total of 65 participants completed the study. During the intention-to-treat analysis, the DEGT group demonstrated significant recovery of gait-balance functions according to only the FGA at postintervention and follow-up compared to the SE and NC groups; however, recovery of the SE group did not differ from that of the NC group. The DEGT group had a significantly lower fall incidence than the other groups at follow-up. Significantly better LSA results were observed for all groups at follow-up compared to baseline; however, no difference in LSA results were observed between groups.
DEGT in addtion to CSF shunting can facilitate the recovery of gait-balance function and reduce the fall incidence of iNPH patients.
步态平衡障碍是特发性正常压力脑积水（iNPH）的核心症状。然而，脑脊液（CSF）分流联合其他治疗或不进行进一步治疗（自然病程[NC]）对iNPH的康复效果尚不清楚。
本研究评估与标准运动（SE）和NC相比，动态平衡步态训练（DEGT）能否改善iNPH患者脑脊液分流后的步态平衡功能。此外，还调查了跌倒发生率。
共有70例接受脑脊液分流的iNPH患者被随机分为DEGT组（n = 23）、SE组（n = 23）或NC组（n = 24），分别进行6周的DEGT、6周的SE或不干预。在基线（术前）、1周、7周（干预后）和术后6个月（随访）进行评估。使用功能性步态评估（FGA）、10米步行试验、计时起立行走试验、生活空间评估（LSA）和跌倒发生率来测量结果。
共有65名参与者完成了研究。在意向性分析中，与SE组和NC组相比，DEGT组仅在干预后和随访时根据FGA显示步态平衡功能有显著恢复；然而，SE组的恢复情况与NC组没有差异。随访时，DEGT组的跌倒发生率明显低于其他组。与基线相比，所有组在随访时的LSA结果均明显更好；然而，各组之间的LSA结果没有差异。
脑脊液分流联合DEGT可促进iNPH患者步态平衡功能的恢复并降低跌倒发生率。
