The effects of cerebrospinal fluid tap-test on idiopathic normal pressure hydrocephalus: an inertial sensors based assessment.
Alberto Ferrari, David Milletti, Giulia Giannini and 8 others
PMID 31948485WHAT IT FOUND
After the spinal fluid tap test, cadence improved on both walking tests and stride length improved on the 18 m walk.
The Timed Up and Go got faster only at 72 h; the 18 m walk time did not change clearly.
Key findings
01Cadence improved after the tap test on both the Timed Up and Go and the 18 m walk.
02Stride length improved on the 18 m walk but not on the Timed Up and Go, and total time improved on the Timed Up and Go at 72 h only.
03Vascular encephalopathy did not explain the gait changes after the tap test.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was single centre, observational and pre-post, so it did not compare the tap test with a control treatment. Patients unable to walk at baseline were excluded, so it does not show what happens in patients who cannot walk. The 18 m walk at 72 h was completed by only 15 patients. The evidence for that time point is weaker. The imaging cut-off separating pure iNPH from vascular encephalopathy was based on expert opinion, not a validated threshold. Some patients could not complete clinical scale tasks, so scale findings are not available for everyone. The model residuals showed large individual variability, and unexplained variation in Timed Up and Go total time may have involved cognition. The study measured changes after the tap test, not whether shunt surgery helped.
The easy way to misread this
Do not read gait improvement after the spinal fluid tap test as proof that shunt surgery will work. The study measured gait after the tap test, not shunt surgery results.