The Rehabilitation in Normal Pressure Hydrocephalus (NPH)

• Published in: Japanese Journal of National Medical Services Vol. 38; no. 9; pp. 869 - 874
• Main Authors: SASO, Shunichi, NARIKAWA, Hiroharu, KIMURA, Ltaru
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 1984
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.38.869

Normal pressure hydrocephalus (NPH) initially described by Adams et al. (1965) represents clinically bizarre gait disturbance, progressive dementia and urinary inconti-nentia. This syndrome develops following cerebrovascular diseases (CVD) such as suba-rachnoidal hemorrhage. In the practice of rehabilitation program for the patients with chronic or subchronic stage of CVD, NPH may be one of the most annoying “negative factor”. The purpose of this report is to analyze and clarify the characteristic pathophys-iology of this gait disturbance. We examined motor function of the lower extremities in 43 patients with CVD presenting NPH syndrome (Group with NPH), utilizing the ADL scoring, gross power grading by Ueda and assessment of the ventricular system on CT scan films. These were compared to the results in patients with CVD without showing NPH (Group without NPH). (1) Motor function of the lower extremities such as gait was more severely involved in Group with NPH when compared to Group without NPH. There was no significant difference in motor function of the upper extremities between these two groups. (2) Effect of rehabilitation for motor function was less in the group showing high grade ventricular dilatation on CT scan than group with mild hydrocephalus. Effectiveness may be closely related to coexisting “dementia” in the group with high grade hydrocephalus. The patients with dementia showing below 10 points on Hasegawa-shiki dementia scoring will not be able to carry out effective rehabilitation program, at this moment. (3) The presence of periventricular lucency (PVL) on CT scan was another deeply involved “negative factor” for rehabilitation. (4) Gait disturbance closely related to the severity of ventricular dilatation and PVL may lead us the assumption, as Fisher (1982) described, that motor function in gait could be due to subcortical involvement rather than due to cortical damage in nature. Further analysis of the mechanism of this gait disturbance will be discussed in the following reports utilizing Cybex II and “POLGON” gait analyzer.