Predicting post-surgical outcomes in idiopathic normal pressure hydrocephalus using clinically important changes from the cerebrospinal fluid tap test.

OBJECTIVE: Patients diagnosed with idiopathic Normal Pressure Hydrocephalus (iNPH) typically experience symptom improvements after undergoing a cerebrospinal fluid-tap test (CSF-TT), These improvements are recognized as indicative of potential improvements following surgical intervention. As gait disturbance is the most common iNPH symptom, gait improvements are of predominant interest. The purpose of this study was to examine if clinically important changes in gait and balance from CSF-TT predict meaningful changes following surgery. METHOD: The study involved analysis of data collected in a prospective observational study for 34 iNPH patients who underwent a CSF-TT and subsequent surgery. Linear regression, logistic regression and classification trees were used for predictive modelling comparing changes from CSF-TT with post-surgical changes in Tinetti, Timed Up and Go (TUG) and Berg Balance Scale (BBS) outcomes. RESULTS: Predictive models for minimal clinically important differences (MCIDs) from CSF-TT to surgery were significant for Tinetti (odds ratio = 1.42, p = 0.02) and BBS (odds ratio = 1.57, p < 0.01). Four items on Tinetti and two items on BBS were identified with a predictive accuracy of 79% and 76% respectively. BBS has the highest sensitivity (85%) and negative predictive value (77%). TUG had a 100% specificity and 100% positive predictive value. The predictive model using MCIDs for TUG was not significant (odds ratio = 1.13, p = 0.06). CONCLUSION: Clinically important changes from CSF-TT are useful in predicting post-surgical outcomes in iNPH patients. Tinetti and BBS, both have predictive value using MCID scores as cut off values, of which BBS is a stronger outcome measure for prediction.

Ten-Second Tandem Stance Test: A Potential Tool to Assist Walking Aid Prescription and Falls Risk in Balance Impaired Individuals.

Objective: To assess the utility of a 10-second tandem stance test in predicting gait impairment and the need for a mobility aid. Design: Cross-sectional study. Setting: Public hospital ambulatory and hospitalized care. Participants: Participants were drawn from referrals to the physiotherapy service and patients identified by health care staff as needing mobility assessment. Eighty-seven people were referred to the study. Sixty-one individuals (N=61) consented to participate; mean age was 76±9.8 years and 61% were female. All participants were community dwelling. Intervention: The 10-second tandem stance test and gait parameters were measured while walking with no walking aid, a walking stick, and a 4-wheeled walker were assessed. Main Outcome Measures: Associations between the 10-second tandem stance test performance with prescribed walking aids (primary outcome variable), gait parameters (gait cycle time, cadence, stance phase, swing phase, double support, stride length, speed, peak angle velocity, maximal heel clearance), falls history, falls risk (Falls Risk for Older People in the Community [FROP-Com]), and walking aid use. Results: Inability to maintain tandem stance for 10 seconds significantly increased the odds of requiring a prescribed walking aid (odds ratio [OR], 5.19; P=.01). Tandem stance test time was positively correlated with stride length, gait speed, peak angle velocity, and maximal heel clearance during the gait cycle. Correlation between tandem stance time and number of falls was weak but significant (ρ=-0.31, P=.01), and FROP-Com score for falls risk was negative and moderate for nonpreferred foot behind (ρ=-0.58, P<.01). The 10-second tandem stance with nonpreferred foot behind was associated with falling in previous 12 months (P=.04). Walking aid use history in subgroups with the individuals who cannot maintain the tandem stance with nonpreferred foot behind for 10 seconds was associated with falling in previous 12 months (OR, 55.00; 95% CI, 2.44-1238.46; P=.01). Conclusions: The 10-second tandem stance test was associated with professionally prescribed walking aids, gait parameters with prescribed walking aids, falls, and walking aid use history, indicating the test may be useful to guide the prescription of walking aids.

Determining the benefits of transcranial direct current stimulation on functional upper limb movement in chronic stroke.

Transcranial direct current stimulation (tDCS) has been proposed as a tool to enhance stroke rehabilitation; however, evidence to support its use is lacking. The aim of this study was to investigate the effects of anodal and cathodal tDCS on upper limb function in chronic stroke patients. Twenty five participants were allocated to receive 20 min of 1 mA of anodal, cathodal or sham cortical stimulation in a random, counterbalanced order. Patients and assessors were blinded to the intervention at each time point. The primary outcome was upper limb performance as measured by the Jebsen Taylor Test of Hand Function (total score, fine motor subtest score and gross motor subtest score) as well as grip strength. Each outcome was assessed at baseline and at the conclusion of each intervention in both upper limbs. Neither anodal nor cathodal stimulation resulted in statistically significantly improved upper limb performance on any of the measured tasks compared with sham stimulation (P>0.05). When the data were analysed according to disability, participants with moderate/severe disability showed significantly improved gross motor function following cathodal stimulation compared with sham (P=0.014). However, this was accompanied by decreased key grip strength in the unaffected hand (P=0.003). We are unable to endorse the use of anodal and cathodal tDCS in the management of upper limb dysfunction in chronic stroke patients. Although there appears to be more potential for the use of cathodal stimulation in patients with severe disability, the effects were small and must be considered with caution as they were accompanied by unanticipated effects in the unaffected upper limb.

Corrigendum: No Effect of Anodal Transcranial Direct Current Stimulation Over the Motor Cortex on Response-Related ERPs during a Conflict Task.

[This corrects the article on p. 384 in vol. 10, PMID: 27547180.].

No Effect of Anodal Transcranial Direct Current Stimulation Over the Motor Cortex on Response-Related ERPs during a Conflict Task.

Anodal transcranial direct current stimulation (tDCS) over the motor cortex is considered a potential treatment for motor rehabilitation following stroke and other neurological pathologies. However, both the context under which this stimulation is effective and the underlying mechanisms remain to be determined. In this study, we examined the mechanisms by which anodal tDCS may affect motor performance by recording event-related potentials (ERPs) during a cued go/nogo task after anodal tDCS over dominant primary motor cortex (M1) in young adults (Experiment 1) and both dominant and non-dominant M1 in older adults (Experiment 2). In both experiments, anodal tDCS had no effect on either response time (RT) or response-related ERPs, including the cue-locked contingent negative variation (CNV) and both target-locked and response-locked lateralized readiness potentials (LRP). Bayesian model selection analyses showed that, for all measures, the null effects model was stronger than a model including anodal tDCS vs. sham. We conclude that anodal tDCS has no effect on RT or response-related ERPs during a cued go/nogo task in either young or older adults.

Community-dwelling stroke survivors: function is not the whole story with quality of life.

OBJECTIVE: To compare function and quality of life in community-dwelling stroke survivors at 1, 3, and 5 years after stroke. DESIGN: A community-based, cross-sectional study of 3 retrospective cohorts. SETTING: Community-dwelling stroke survivors in Australia. PARTICIPANTS: The 3 cohorts comprised 30 participants each at 1, 3, and 5 years poststroke discharge from a tertiary referral hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Stroke severity, comorbidity, medications used, and demographic information were recorded. Poststroke function was assessed using the Modified Rankin Scale, Mini-Mental State Examination, Stroke Impact Scale, and Multidimensional Scale of Perceived Social Support. RESULTS: This cross-sectional study provides insights into trends in stroke survivors over time. A high proportion of stroke survivors use community services, even those who are independent with activities of daily living. Although there was little attrition in medication use over time except for warfarin, this was from a baseline of suboptimal compliance and adherence with stroke preventive therapies. Stroke survivors report high levels of perceived social support; however, emotional well-being was low overall. The data suggest that those who are independent at 1 year tend to remain independent, although this was an extrapolation from serial cross-sections and needs to be explored in a longitudinal study. CONCLUSIONS: Stroke survivors' function does not change significantly over time. A high proportion of survivors require community services. The development of needs-related effective long-term service delivery models is required.