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Features of gait most responsive to tap test in normal pressure hydrocephalus
Lisa D Ravdin1, Heather L Katzen, Anna E Jackson
1Department of Neurology and Neuroscience, New York Presbyterian Hospital, Weill Medical College of Cornell University, Cornell Memory Disorders Program, 428 East 72 Street, Suite 500, New York, NY 10021, United States. ldravdin@med.cornell.edu
Objective:
To identify components of gait associated with a positive tap test (TT) in patients with idiopathic normal pressure hydrocephalus (iNPH).
Patients And Methods:
Thirty-three patients with iNPH underwent clinical evaluation pre- and post-TT and were classified as responders (Rs) or non-responders (NRs). Elements of gait were assessed with a formal standardized Gait Scale and compared between groups.
Results:
Analysis of pre/post-TT group differences revealed an interaction for Total Gait Score and Walking Score, with improvements in responders only. Total Gait Scores improved by 29% in the Rs and 4.85% in the NRs. Rs showed significant post-TT improvements on a timed 10m walk, turning, and balance. Tandem walking, turning, truck balance and start stop hesitation showed trends toward improvement.
Conclusions:
The classic features of gait often used in determining diagnosis of NPH (wide based stride, reduced foot-floor clearance, and small steps) were not helpful in identifying responders to the TT. Walking speed, steps for turning, and tendency towards falling were most likely to improve post-TT. These straightforward measures can readily be adapted into clinical practice to assist in determination of shunt candidacy.
