Rehabilitation effects in idiopathic normal pressure hydrocephalus: a randomized controlled trial

Background 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. Objectives 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. Methods 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. Results 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. Conclusions DEGT in addtion to CSF shunting can facilitate the recovery of gait–balance function and reduce the fall incidence of iNPH patients.