Marcha na hidrocefalia de pressão normal: características e efeitos do tap-test

Souza, Ricardo Krause Martinez de; Rocha, Samanta Fabrício Blattes da; Martins, Rodrigo Tomazini; Kowacs, Pedro André; Ramina, Ricardo

doi:10.1590/0004-282X20180037

Ricardo Krause Martinez de Souza Correspondence: Ricardo Krause Martinez de Souza; Rua Marechal Deodoro, 2152; 80045-235 Curitiba PR, Brasil; E-mail: ricardo.neurologia@gmail.com

Instituto de Neurologia de Curitiba, Divisão de Demências e Outros Distúrbios Cognitivos e Comportamentais, Curitiba PR, Brasil

Samanta Fabrício Blattes da Rocha

Instituto de Neurologia de Curitiba, Serviço de Neuropsicologia, Curitiba PR, Brasil

Rodrigo Tomazini Martins

Box Hill Hospital (Eastern Health), Neurosciences Department, Melbourne VIC, Australia

Instituto de Neurologia de Curitiba, Departamento de Neurologia, Curitiba PR, Brasil

Pedro André Kowacs

Instituto de Neurologia de Curitiba, Departamento de Neurologia, Curitiba PR, Brasil

Ricardo Ramina

Instituto de Neurologia de Curitiba, Departamento de Neurocirurgia, Curitiba PR, Brasil

Correspondence: Ricardo Krause Martinez de Souza; Rua Marechal Deodoro, 2152; 80045-235 Curitiba PR, Brasil; E-mail: ricardo.neurologia@gmail.com

Conflicts of interest: There is no conflict of interest to declare.

Figuras (3)
Tabelas (2)

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Figure 1
Patients with suspicion of normal pressure hydrocephalus: inclusion and exclusion criteria.

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Figure 2
(A) Schematic viewed from above for the evaluation of gait parameters in patients with IHPN, (B) broad-based gait, (C) decreased step length, (D) toes turned outward.

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Figure 2
(A) Schematic viewed from above for the evaluation of gait parameters in patients with IHPN, (B) broad-based gait, (C) decreased step length, (D) toes turned outward.

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Figure 3
Evaluation of gait characteristics before and after the tap test based on results shown in .

TT: tap test; }: the graphic signal expresses the statistical result with the effect of the TT; NS: not statistically significant; T: trend; S: statistically significant.

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Table 1
Classification of gait and posture⁴4. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus [discussion ii-v.]. Neurosurgery. 2005 Sep;57(3 Suppl):S4-16. https://doi.org/10.1227/01.NEU.0000168185.29659.C5
https://doi.org/10.1227/01.NEU.000016818... ^,¹⁴14. Bugalho P, Guimarães J. Gait disturbance in normal pressure hydrocephalus: a clinical study. Parkinsonism Relat Disord. 2007 Oct;13(7):434-7. https://doi.org/10.1016/j.parkreldis.2006.08.007
https://doi.org/10.1016/j.parkreldis.200... ^,¹⁵15. Castro CL, Santos JA, Leifeld PS, Bizzo LV, Silva LC, Almeida TF et al. Estudo da marcha em idosos: resultados preliminares. Acta Fisiatrica. 2000;7(3):103-7.^,¹⁶16. Jankovic J, Nutt JG, Sudarsky L. Classification, diagnosis, and etiology of gait disorders. Adv Neurol. 2001;87:119-33.^,¹⁷17. Kiefer M, Unterberg A. The differential diagnosis and treatment of normal-pressure hydrocephalus. Dtsch Arztebl Int. 2012 Jan;109(1-2):15-25. https://doi.org/10.3238/arztebl.2012.0015
https://doi.org/10.3238/arztebl.2012.001... ^,¹⁸18. Mashimo AM, Caromano FA. A marcha em idosos saudáveis. Arq Cienc Saúde. 2002;6(2):117-21. https://doi.org/10.25110/arqsaude.v6i2.2002.1166
https://doi.org/10.25110/arqsaude.v6i2.2... ^,¹⁹19. Stolze H, Kuhtz-Buschbeck JP, Drücke H, Jöhnk K, Illert M, Deuschl G. Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease. J Neurol Neurosurg Psychiatry. 2001 Mar;70(3):289-97. https://doi.org/10.1136/jnnp.70.3.289
https://doi.org/10.1136/jnnp.70.3.289... ^,²⁰20. Thompson PD. Frontal lobe ataxia. Handb Clin Neurol. 2012;103:619-22. https://doi.org/10.1016/B978-0-444-51892-7.00044-9
https://doi.org/10.1016/B978-0-444-51892... .

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Table 2
Evaluation of gait characteristics before and after the tap test.

Parameters	Description
En bloc turning	Requiring three or more steps for turning 180 degrees.
Dynamic balance or imbalance	Patient is asked to walk 8 steps putting one foot in front of the other (tandem gait). Imbalance was considered to be present when correction steps were needed on two or more attempts.
En bloc gait	Reduced rotation of the pelvic and scapular girdles and decreased mobility of the upper limbs.
Festination	Accelerated gait at least once in the total path.
^* * Assessment of postural reflexes. The examiner must stand behind the patient, pull the patient's shoulders suddenly and briskly and then analyze if there is retropulsion. The examiner should always be prepared to hold the patient when performing this test, otherwise, a person with a loss of postural reflexes may fall. The patient must be informed of the details of the test beforehand. A score of higher than 1 was considered impaired postural reflexes; SD: standard deviation; Postural Reflex	Score	Shoulder tug test
	0	Patient stands without taking a step
	1	Patient takes a step and remains stable
	2	Patient takes more than one step and keeps his/her balance
	3	Patient takes several steps and needs to be held
	4	Patient falls backward without taking a step
Freezing	Characterized by at least one episode of sudden deceleration or a break (feet almost stuck to floor) in gait during free walking.
Hesitant gait	Hesitation at the beginning and end of the course.
“Magnetism” or shuffling gait	Step height decreased during free walking.
Broad-based gait	Distance between toes > 1 own foot length. (Figure 2 B)
Decreased step length (petit pas)	Distance from heel of front foot to toes of rear foot < 1 own foot length. (Figure 2 C)
Foot angle	Toes turned outward on walking. (Figure 2 D)
Trunk flexion	A healthy person remains standing upright with his/her head up, chest out and abdomen held in.
Lateral flexion of the trunk	Flexion of the trunk to one side while walking spontaneously.
Gait cadence (Reference value for normality)	Gender	Age: 60–69 years	Age: 70–79 years
	Female	148 steps per minute (SD ± 23.07)	129.5 steps per minute (SD ± 21.79)
	Male	^ value for females was used; Gait cadence: number of steps per minute; Reference normality values of the preceding decade were used for patients older than 80 years. Not given	119.4 steps per minute (SD ± 11.07)

Before TT / After TT	Unchanged / Unchanged		Changed / Changed		Changed / Unchanged		Unchanged / Changed		p-value^* * McNemar test, p < 0.05
Characteristics Gait	Freq.	%	Freq.	%	Freq.	%	Freq.	%	p-value^* * McNemar test, p < 0.05
Speed gait	0	0	6	24	19	76	0	0	< 0.01
Broad-based	14	56	8	32	2	8	1	4	1.0
En bloc gait	11	44	9	36	5	20	0	0	0.063
Decreased step length	6	24	7	28	12	48	0	0	< 0.01
Decreased step height	6	24	10	40	9	36	0	0	< 0.01
Lateral flexion of the trunk	19	76	5	20	1	4	0	0	1.0
Postural reflex	22	88	3	12	0	0	0	0	1.0
Festination	25	100							-
Hesitant gait	21	84	2	8	2	8	0	0	0.50
En bloc turning	6	24	8	32	11	44	0	0	< 0.01
Imbalance	17	68	7	28	1	4	0	0	1.0
Freezing	24	96	0	0	1	4	0	0	1.0
Decreased cadence	5	20	8	32	12	48	0	0	< 0.01
Trunk flexion	20	80	4	16	1	4	0	0	1.0
Toes turned outward on walking	19	76	5	20	1	4	0	0	1.0

[1] Correspondence: Ricardo Krause Martinez de Souza; Rua Marechal Deodoro, 2152; 80045-235 Curitiba PR, Brasil; E-mail: ricardo.neurologia@gmail.com

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Marcha na hidrocefalia de pressão normal: características e efeitos do tap-test

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