{"id":28039,"date":"2017-07-04T00:00:00","date_gmt":"2017-07-04T04:00:00","guid":{"rendered":"https:\/\/www.hydroassoc.org\/pt-tips-for-nph-patients\/"},"modified":"2024-10-11T14:27:26","modified_gmt":"2024-10-11T18:27:26","slug":"pt-tips-for-nph-patients","status":"publish","type":"post","link":"https:\/\/www.hydroassoc.org\/pt-tips-for-nph-patients\/","title":{"rendered":"Physical Therapy Tips for NPH Patients"},"content":{"rendered":"

By<\/span> Tr<\/span>ish<\/span> Bogucki<\/span>\"\"<\/span>, <\/span>Guest <\/span>Blogger<\/span><\/h4>\r\nBy the time I was diagnosed with normal pressure hydrocephalus (NPH)<\/a> and had shunt surgery<\/a>, I had lost my ability to walk unaided, so I was very eager to begin Physical Therapy (PT). \u00a0I was thrilled when my neurosurgeon cleared me for driving a few weeks after surgery and gave me a prescription for physical therapy; my first drive was to their office.\r\n\r\nMy neurosurgeon told me that PT for NPH patients should focus primarily on improving balance and gait.\u00a0 Some amount of strength exercises may be good as well, but NPH patients should insist on at least equal time spent on gait and balance.\r\n\r\n
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Tip #1:\u00a0 Talk to your physical therapist about incorporating balance exercises if your PT routine does not include them.<\/h4>\r\nMy therapist did an initial evaluation and created an exercise program for me that included a variety of balance and strength exercises as well as walking on a special treadmill to improve my gait.\u00a0 The cameras on the AlterG treadmill showed me how irregular my gait was and over time it helped me reprogram my walking.\u00a0 As my gait improved I spent less time on the strength exercises and much more time on balance.\r\n\r\n
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Tip #2: Set short term and long term goals for your physical therapy<\/h4>\r\nMy first goal was independent walking \u2013 no cane and no one to hang onto.\u00a0 My long-term goal was to get back to the Advanced Step Class at the gym that I loved so much before NPH sidelined me.\u00a0 I wasn\u2019t sure I\u2019d ever reach that goal since my walking was so poor, but I still went to the gym several times a week and used the elliptical and bike to warm up before therapy.\u00a0 I occasionally watched the Step Class and told myself over and over that I would be back.\r\n\r\n
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Tip #3: Learn to love your PT sessions and spend as long as you need to get through all your exercises<\/h4>\r\nI came to regard PT as going to the gym with friends who picked up all my equipment for me. \u00a0I usually spent around two hours at each session three times a week \u2013 30 to 40 minutes on the AlterG followed by a series of balance and strength exercises The AlterG is a magical combination of a regular treadmill with an air chamber that relieves your feet and legs of up to 75% of your weight.\u00a0 You put on special shorts with a zippered flange across the top so you can be zippered into the chamber which is then inflated with air.\u00a0\u00a0 The AlterG was the single most important component of my physical therapy \u2013 it allowed me to walk without fear of falling and gradually my gait lengthened and strengthened.\u00a0 There are cameras on each side and in the front so you get instant feedback on a video screen on your walking and you can make adjustments immediately.\u00a0 It took me a long time to see permanent and significant improvement, but I was encouraged by the small improvements I saw temporarily after each session.\r\n\r\n
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Tip #4: Be proactive to prevent boredom – don\u2019t let your PT sessions become cookie cutter<\/h4>\r\nAsk your therapist to remind you how an exercise should be done and try to find things to laugh at.\u00a0 I dubbed one of my exercises \u201cWalk the Dog\u201d where I played the part of the dog.\u00a0 In this exercise I was tethered to a weight on a pulley and had to work hard to walk away from the pulley while dragging the weight and then not fly backwards when I returned to starting position.\u00a0 This routine took up a lot of space in the middle of the main room, and patients and their aides were naturally amused to see this rather large \u201cdog\u201d pulling on her harness, so occasionally I would \u201cWoof!\u201d just to get a smile.\r\n\r\nMy therapist created another exercise that had me jogging around cones while an aide tossed a squishy ball at me from various angles.\u00a0 It challenged my balance greatly but the squishy ball couldn\u2019t do any damage if I missed it (and I missed a lot at first).\u00a0 I still use this exercise a year later to further strengthen my balance and reflexes.\r\n\r\n
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Tip #5:\u00a0 As your walking improves, focus attention at PT on the activities that you have the most trouble with<\/h4>\r\nAfter some months of therapy<\/a>, I finally started seeing lasting improvement in my gait but noticed that I still had issues on sloping surfaces, including navigating slanted flooring in the corridors at work and any grassy terrain.\u00a0 I asked my neurosurgeon about it and he said that the brain can have trouble with slopes especially downhill.\u00a0 He suggested we find a way to work on that with the AlterG.\r\n\r\nThe Alter G does not have a decline setting but it does incline and it can run in reverse.\u00a0 So my therapist, an aide, and I got together and figured out that I could face backward and they would run the treadmill in reverse on an incline.\u00a0 Of course, I had to put the shorts on backward too but we were not worried about fashion.\u00a0 And the best part of all this creativity?\u00a0 I saw improvement after just one session of practicing my downhill walking!\r\n\r\n
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Tip #6: Prepare for life after PT<\/h4>\r\nOnce you have achieved your short-term goals and you\u2019re not seeing improvements after every session it may be time to talk with your therapist about ending therapy. Of course, some insurance plans are not as generous as mine was so you may not have the luxury of choosing when to end therapy.\r\n\r\nI asked my therapist when I should end therapy, and he asked me if I was able to do all my exercises comfortably and he wanted approval from the prescribing doctor.\u00a0 I also tried going back to Step Class and found to my great delight that I could manage most of it, so I had achieved both my short- and long-term goals.\r\n\r\n
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Tip #7: Don\u2019t stop cold turkey<\/h4>\r\nOnce we agreed it might be time to end therapy, my therapist put me on a reduced schedule: two times a week (instead of 3) for two weeks then once a week for two weeks, and all was well, so I was done!\u00a0 It was bittersweet really \u2013 after a year and five months of therapy three times a week PT had become a big part of my life.\u00a0 My therapist gave me exercises to do on my own and then set me free.\u00a0 I immediately increased my trips to the gym and hired a personal trainer to keep me challenged.\r\n\r\n
\r\n\r\nPost Script:<\/strong>\u00a0 A few months before my therapy ended there was a video shoot at my therapy center on the benefits of using the AlterG and I was invited to participate.\u00a0 Normally I avoid cameras, but this was different: the AlterG and the PT center had done me so much good that I wanted to spread the word.\u00a0 The video clip is now posted on the AlterG section of my therapy center\u2019s website; if you\u2019re interested you can see it in the box labeled Neurological AlterG on this page: https:\/\/spineandsportsmed.com\/services\/alterg-gravity-treadmill\/<\/a>\r\n\r\nThere are other good stories on the AlterG site for you to enjoy; one is a case study on the use of the AlterG in treating NPH.\u00a0 You can find that one here: https:\/\/www.alterg.com\/case-study\/normal-pressure-hydrocephalus<\/a>.\r\n\r\nAnd you can find my heart-felt thank you to the Alter G team for their terrific technology here: https:\/\/www.alterg.com\/treadmill-training-rehab\/rehabilitation\/patient-spotlight-trishs-triumph\/<\/a>\r\n\r\n
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Additional Blogs by Trish Bogucki:<\/h4>\r\nThriving with NPH \u2013 Trish Bogucki\u2019s Story<\/a>\r\n\r\nHow I decided to have shunt surgery<\/a>\r\n\r\nBalance Therapy Tips for NPH Patients<\/a>\r\n\r\nExercise Tips for NPH patients<\/a>\r\n\r\nCognitive Therapy for NPH Patients<\/a>\r\n\r\nInterview with Olivia Bell, Cognitive Therapist \u2013 Part 1<\/a>\r\n\r\nInterview with Olivia Bell, Cognitive Therapist \u2013 Part 2<\/a>\r\n\r\n
\r\n\r\nDisclaimer:\r\nThis page is designed to provide helpful information on the subjects discussed. It is not intended as a substitute for treatment advice from a medical professional. For diagnosis or treatment of any medical condition, consult your doctor.<\/em>\r\n\r\n\r\n
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