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Japanese

Assessment of Relationship between In-hospital Rehabilitation Period after Cerebrospinal Shunt Surgery and Improvement of Gait Disturbance in Idiopathic Normal Pressure Hydrocephalus Patients with Severe Gait Disturbance Hachirou Moriguchi 1 , Aoi Yokouchi 1 , Masatsune Ishikawa 2,3 , Shigeki Yamada 2,4 1Department of Rehabilitation, Rakuwakai Otowa Hospital 2Department of Neurosurgery, Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital 3Rakuwa Villa Ilios 4Department of Neurosurgery, Shiga University of Medical Science Keyword: 特発性正常圧水頭症 , idiopathic normal-pressure hydrocephalus , 髄液シャント術 , CSF shunt surgery , 歩行障害 , gait disturbance pp.648-656
Published Date 2020/7/17
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Objective:Currently, there is no reliable evidence on the usefulness of rehabilitation for idiopathic, normal-pressure hydrocephalus (iNPH) patients after cerebrospinal shunt surgery. Therefore, in this study we investigated the association between the duration of rehabilitation and outcomes.

Methods:We evaluated the changes before and after cerebrospinal shunt surgery and rehabilitation by applying the 3-m timed up-and-go test (TUG), 10-m straight walk test, 180-degree turn, 30-seconds chair-stand test (CS-30), mini-mental state examination (MMSE), and frontal assessment battery (FAB) in 81 patients with iNPH. Clinical outcomes were classified as excellent, good, or unsatisfactory.

Results:At discharge, TUG, 180-degree turn, and CS-30 were significantly improved in 38 patients who had been in rehabilitation for ≥ 2 weeks, compared to those with < 2 weeks-rehabilitation after shunt surgery. However, there was no significant difference between MMSE and FAB tests in the two groups. Rehabilitation for ≥ 2 weeks significantly improved the patient outcome, especially for those patients with severe gait disturbance before treatment. In 53 patients whose initial TUG time was ≥ 13.5 s, rehabilitation for ≥ 2 weeks was effective, and resulted in an excellent outcome (odds ratio:4.52, 95% confidence interval:1.22-18.7, P value:0.012).

Conclusion:In-hospital rehabilitation after cerebrospinal shunt surgery was useful for patients with iNPH and severe disability in daily activities. Therefore, we suggest that these patients require in-hospital rehabilitation after shunt surgery until sufficient improvement of gait disturbance is achieved, in order to maximize activities of daily living.


Copyright © 2020, The Japanese Association of Rehabilitation Medicine. All rights reserved.

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電子版ISSN 印刷版ISSN 1881-3526 日本リハビリテーション医学会

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