Date Presented 04/04/19
OT assessments can provide evidence that there is a functional change from pre- to post-external lumbar drain (ELD) in patients diagnosed with normal pressure hydrocephalus (NPH). This topic will advance the professional development of the field of OT by providing additional research on the topic of NPH and ELD trials.
Primary Author and Speaker: Kaylynn Michael
Faculty Advisor: Danielle McPeck
PURPOSE: The purpose of this research project was to examine the effectiveness of the external lumbar drain (ELD) trial on functional outcomes with patients suspected to have Normal Pressure Hydrocephalus (NPH) evidenced by occupational therapy assessments. The purpose of this research is to answer the question: In adults diagnosed with suspected Normal Pressure Hydrocephalus, what is the effectiveness of the lumbar drain trial on functional outcomes as evidenced by occupational therapy assessments? The reason I chose this topic is because I was approached by the medical team at Mercy Health St. Rita's Medical Center for my doctoral experience and with the NPH protocol being new at St. Rita's the team asked me to provide research on the topic of NPH and the involvement of occupational therapy.
DESIGN: In this small cohort pre-test/post-test retrospective design, a student examined adults diagnosed with suspected NPH and measured the effectiveness of the ELD on functional outcome using OT and Speech Therapy (ST) assessments during NPH Protocol (ELD trial). Eligibility Criteria: Suspected diagnosis of NPH, over 40 years of age, self-report of triad symptoms, ventricular enlargement (via MRI or CAT), and participated in ELD trial. Participants: Eight older adults diagnosed with suspected NPH recruited by convenience sampling from Mercy Health St. Rita’s Medical Center data base (EPIC). Seven patients participated in ELD trial, excluding one participant.
METHOD: A one-tailed, paired sample t test was used to analyze baseline and three days post-drain on variables that were considered parametric statistical (normally distributed). This included grip strength, Nine-Hole Peg Test, MMT, MOCA, Cog-Log, and O-Log. Wilcoxon signed-rank test was used for variables that were non-parametric statistical (non-normally distributed). This included FIM scores from sit to stand, stand to sit, standing balance, lower body dressing, and toileting. The significance level was set at alpha = 0.05. The researcher used Statistical Product and Solution Services (SPSS) (Version 23.0).
RESULTS: There was a positive trend in mean changes of pre-post ELD trial. The results showed that there was no significance in the paired sample t tests (p < .05) and showed significance in four out of five on the Wilcoxon signed ranks test (p < .05).
CONCLUSION: Occupational therapy assessments show that the ELD is effective on functional outcomes. However, there needs to be a larger sample size to determine further significance. The future direction is to continue collecting data and make this a longitudinal study. Another option is to have a doctoral student come in to expand the research in 10-12 months when there is a larger sample size. This proposal is important to occupational therapy practice because there is limited literature on the topic of NPH and the involvement of occupational therapy. This proposal can help with that gap in research and continue the growth of future research in occupational therapy.
References
Billek-Sawhney, B., & Jackson, N. A. (2012). Normal Pressure Hydrocephalus. Journal of Acute Care Physical Therapy, 3(2), 182-188. doi:10.1097/01592394-201303020-00002
Feick, D., Sickmond, J., Liu, L., Metellus, P., Williams, M., Rigamonti, D., & Hill-Briggs, F. (2008). Sensitivity and predictive value of occupational and physical therapy assessments in the functional evaluation of patients with suspected normal pressure hydrocephalus. Journal Of Rehabilitation Medicine, 40(9), 715-720. doi:10.2340/16501977-0241
Jackson, N. A., & Billek-Sawhney, B. (2012). Normal Pressure Hydrocephalus Physical Therapy Assessment Before and After Cerebrospinal Fluid Drainage. Journal Of Acute Care Physical Therapy (Acute Care Section - APTA, Inc.), 3(2), 189-192.
Petersen, J., Hellström, P., Wikkelsø, C., & Lundgren-Nilsson, A. (2014). Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus. Journal Of Neurosurgery, 121(4), 776-784. doi:10.3171/2014.6.JNS132003
