- Title
- iNPH QUEST Study: quantifying a battery of gait, cognitive and radiological examinations to improve identification of shunt candidates from the cerebrospinal fluid tap test
- Creator
- Gallagher, Ryan
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Idiopathic normal Pressure hydrocephalus (iNPH), a condition resulting in abnormalities of gait, cognition and continence, is treated by the placement of a ventricular peritoneal (VP) shunt to drain cerebrospinal fluid (CSF). To identify surgical candidates the CSF tap test (TT) was devised to mimic VP shunt insertion. The CSF TT involves drainage of a small volume of CSF to assess for symptom improvement. Additionally, measurements of CSF flow on MRI imaging have been devised to identify VP shunt candidates. Limited research has investigated assessing what outcome measures can identify change from a CSF TT. Neither the tests capable of definitively identifying change from a CSF TT nor the degree of change required on any test constituting a clinically important difference have been extensively investigated. Additionally, whether any measure on MRI CSF flow studies can identify change using outcome measures has not been explored. This thesis aims to: 1. Identify a battery of standardised gait and balance outcome measures which can identify change from a CSF TT. 2. Identify a battery of standardised upper limb and cognitive outcome measures which can identify change from a CSF TT. 3. Develop minimally clinically important differences (MCIDs) for a battery of outcome measures. 4. Identify radiological markers on MRI CSF flow studies that are prognostic of response to CSF drainage. The ability of the Timed up and go (TUG), Timed up and go cognition (TUG-C), performance oriented mobility assessment (Tinetti), Berg balance scale (BBS), 10 metre walk test (10MWT), Montreal cognitive assessment (MoCA) and 9 hole peg test (9HPT) to identify change from a CSF TT was assessed. These studies demonstrated that the TUG, TUG-C, Tinetti and BBS could identify change from a CSF TT. Calculated MCIDs were 3.63sec for the TUG, 2.60sec for the TUG-C, 4 points for the Tinetti and 4 points for the BBS represent MCIDs for improvement from a CSF TT. Additionally, we have shown that the measurements of the sagittal sinus circumference and area can differentiate improvement in gait as a result of CSF drainage. Further research is required to evaluate the utility of these MCID values in identifying improvement following VP shunt insertion.
- Subject
- physiotherapy; normal pressure hydrocephalus; tap test; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1408424
- Identifier
- uon:35838
- Rights
- Copyright 2019 Ryan Gallagher
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 453 KB | Adobe Acrobat PDF | View Details Download |