The Effects of a Cerebrospinal Fluid Tap Test on Gait, Balance and Turning in Elderly Patients with Idiopathic Normal Pressure Hydrocephalus

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a disease that is clinically characterized by gait disturbance and balance impairment. Our purpose was to evaluate the effects of cerebrospinal fluid tap test procedures on gait, turning and balance parameters in the first 24 hours following the procedure in patients. Methods: Twenty-eight patients with a median age of 78 years participated in the study. All patients underwent assessment of gait characteristics, turning and balance before and after a tap test. Gait characteristics and turning were measured using the G-walk sensor system. Balance-related issues were assessed using three standardized tests in the Biodex Balance System: postural stability and fall risk tests, and the modified clinical test of sensory integration and balance. Results: The patients' mean walking speed increased after the tap test (p < 0.05), but left stride length, right stride length, and cadence did not show statistically significant improvement (p > 0.05). In the balance assessment, significant differences between pre- and post-scores were found on all tests (p < 0.01), except for the eyes-closed firm test (p > 0.05). Regression analyses revealed that baseline walking speed (p <0.05) was significantly associated with positive tap test response. Conclusion: The cerebrospinal fluid tap test procedure has positive effects on walking and turning activities, balance, and the risk of falling in older patients with iNPH in the first 24 hours following the procedure. Slow walking speed may predict positive tap test response. For patients unsuitable for shunt surgery, a tap test may be an effective method to reduce the risk of falls and improve factors that may cause falls.