The effects of stepwise balance and mobility exercise on standing balance, physical activity, and quality of life in patients with idiopathic normal pressure hydrocephalus
Keywords:
idiopathic normal pressure hydrocephalus, tailored exercise, standing balance, physical activity, quality of lifeAbstract
Background: Postural control and balance disturbances in idiopathic normal pressure hydrocephalus (iNPH) are crucial as they worsen gait and impact daily activities. Although traditional exercises are recommended, limited research has compared the effectiveness of tailored programs for this group. This study aimed to evaluate the effectiveness of stepwise balance and mobility exercises on standing balance, physical activity, and quality of life (QoL) in patients with iNPH.
Materials and Methods: A single group with pre- and post-test design for pilot testing was conducted on eight patients with iNPH who underwent CSF shunt surgery and participated in a stepwise exercise program with basic education. Standing balance was assessed using the center of mass and center of pressure from the Force Distribution Measurement platform and Inertial Measurement Units. The International Physical Activity Questionnaires (IPAQ)-short form and EuroQol 5-Dimension 5-Level (EQ-5D-5L) were used to measure physical activity and QoL. Assessments at baseline and 4 weeks post-intervention were compared with the Wilcoxon signed-rank test.
Results: Significant improvements were observed in the angle between Y and major axis during standing with eyes open (p = 0.017), total metabolic equivalents (METs) on the IPAQ (p = 0.012), and EQ-5D-5L utility score (p = 0.018) after the intervention, while other variables remained unchanged.
Conclusion: Stepwise balance and mobility exercise have a positive effect on standing balance, physical activity, and QoL in patients with iNPH following CSF shunt surgery.
References
Micchia K, Formica C, De Salvo S, Muscarà N, Bramanti P, Caminiti F, et al. Normal pressure hydrocephalus: Neurophysiological and neuropsychological aspects: a narrative review. Medicine (Baltimore) 2022;101:e28922.
Bonney PA, Briggs RG, Wu K, Choi W, Khahera A, Ojogho B, et al. Pathophysiological mechanisms underlying idiopathic normal pressure hydrocephalus: a review of recent insights. Front Aging Neurosci 2022;14:866313.
Mori E, Ishikawa M, Kato T, Kazui H, Miyake H, Miyajima M, et al. Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir (Tokyo) 2012;52:775-809.
Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 1965;2:307-27.
Nikaido Y, Akisue T, Kajimoto Y, Ikeji T, Kawami Y, Urakami H, et al. The effect of CSF drainage on ambulatory center of mass movement in idiopathic normal pressure hydrocephalus. Gait Posture 2018;63:5-9.
Stolze H, Kuhtz-Buschbeck JP, Drücke H, Jöhnk K, Diercks C, Palmié S, et al. Gait analysis in idiopathic normal pressure hydrocephalus--which parameters respond to the CSF tap test? Clin Neurophysiol 2000;111:1678-86.
Hallqvist C, Grönstedt H, Arvidsson L. Gait, falls, cognitive function, and health-related quality of life after shunt-treated idiopathic normal pressure hydrocephalus-a single-center study. Acta Neurochir (Wien) 2022;164:2367-73.
Hellström P, Edsbagge M, Archer T, Tisell M, Tullberg M, Wikkelsø C. The neuropsychology of patients with clinically diagnosed idiopathic normal pressure hydrocephalus. Neurosurgery 2007;61:1219-26; discussion 27-8.
Modesto PC, Pinto FCG. Home physical exercise program: Analysis of the impact on the clinical evolution of patients with normal pressure hydrocephalus. Arq Neuropsiquiatr 2019;77:860-70.
Rydja J, Kollén L, Hellström P, Owen K, Lundgren Nilsson Å, Wikkelsø C, et al. Physical exercise and goal attainment after shunt surgery in idiopathic normal pressure hydrocephalus: a randomised clinical trial. Fluids Barriers CNS 2021;18:51.
Rydja J, Kollén L, Ulander M, Tullberg M, Lundin F. Physical capacity and activity in patients with idiopathic normal pressure hydrocephalus. Front Neurol 2022;13:845976.
Collado-Mateo D, Lavín-Pérez AM, Peñacoba C, Del Coso J, Leyton-Román M, Luque-Casado A, et al. Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review. Int J Environ Res Public Health 2021;18.
Hnin HH, Bovonsunthonchai S, Witthiwej T, Vachalathiti R, Ariyaudomkit R. Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients. Dement Neuropsychol 2021;15:79-87.
Jaraj D, Rabiei K, Marlow T, Jensen C, Skoog I, Wikkelsø C. Prevalence of idiopathic normal-pressure hydrocephalus. Neurology 2014;82:1449-54.
Zubala A, MacGillivray S, Frost H, Kroll T, Skelton DA, Gavine A, et al. Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews. PLoS One 2017;12:e0180902.
Jaywant A, Toglia J, Gunning FM, O'Dell MW. Subgroups defined by the montreal cognitive assessment differ in functional gain during acute inpatient stroke rehabilitation. Arch Phys Med Rehabil 2020;101:220-6.
Abram K, Bohne S, Bublak P, Karvouniari P, Klingner CM, Witte OW, et al. The effect of spinal tap test on different sensory modalities of postural stability in idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Dis Extra 2016;6:447-57.
Nikaido Y, Akisue T, Urakami H, Kajimoto Y, Kuroda K, Kawami Y, et al. Postural control before and after cerebrospinal fluid shunt surgery in idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2018;172:46-50.
Park E, Lee S, Jung TD, Park KS, Lee JT, Kang K. Changes in postural stability after cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus. Front Neurol 2024;15:1361538.
Lundin F, Ledin T, Wikkelsø C, Leijon G. Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery: a controlled study using computerized dynamic posturography (EquiTest). Clin Neurol Neurosurg 2013;115:1626-31.
Bäcklund T, Frankel J, Israelsson H, Malm J, Sundström N. Trunk sway in idiopathic normal pressure hydrocephalus-Quantitative assessment in clinical practice. Gait Posture 2017;54:62-70.
Grimm EK, Swartz AM, Hart T, Miller NE, Strath SJ. Comparison of the IPAQ-Short Form and accelerometry predictions of physical activity in older adults. J Aging Phys Act 2012;20:64-79.
Nikaido Y, Urakami H, Okada Y, Akisue T, Kawami Y, Ishida N, et al. Rehabilitation effects in idiopathic normal pressure hydrocephalus: a randomized controlled trial. J Neurol 2023;270:357-68.
Petersen J, Hellström P, Wikkelsø C, Lundgren-Nilsson A. Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus. J Neurosurg 2014;121:776-84.
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