Balance Therapy Tips for NPH Patients

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By Trish Bogucki
Guest Blogger

A few months ago, I noticed that my balance was deteriorating so I mentioned it to my GP at my annual physical.  He immediately ordered a CT scan and more Physical Therapy.  The CT scan showed nothing was amiss with my shunt but the new round of PT made a big improvement in my life.  Below are some tips I’d like to share from this part of my NPH journey:

  1. Speak up and seek help

One of the classic symptoms of NPH is a loss of balance.  That was very much the case with me three years ago, and though my balance improved after shunt surgery and my initial round of Physical Therapy, it was never really strong again.  And it was not what I needed it to be to pursue one of my new hobbies – line dancing -which challenges both my memory and balance.  Line dancing involves a lot of turns, and I just couldn’t manage them.  I also noticed occasional loss of balance while taking a walk or doing routine chores around the house – especially anything that changed the level of my head or line of sight.  I mentioned all of this at my annual physical, and my GP prescribed more Physical Therapy and gave me a list of recommended therapy centers.

  1. Be as detailed as possible in describing your problems

When I was evaluated at the new PT place I stressed how much I wanted to focus on balance and not spend time on general strength exercises that I could do at the gym.  I was fortunate to find a very creative and accommodating physical therapist – Katie Finn of Excel Physical Therapy in Mahwah, NJ.  Katie asked me to give her as much detail as I could describing the circumstances where I had balance problems.  I was happy to spend some time coming up with a list of those, and I also included some of the therapies that helped in the past.  Based on this information Katie designed a program of balance exercises that worked on my problem areas.

  1. Try lots of things

Some of the exercises were relatively easy and comfortable – e.g. chin tucks while seated on an inflated ball – and some were very challenging – e.g. standing in tandem position on a foam pad with my eyes shut. A few didn’t seem to help much, so after some tries they were replaced.  I always greeted Katie’s announcement that she had something new for me with a mixture of joy and trepidation.  New moves frequently were difficult, but we both noticed that my brain seemed to adapt – most of the hardest exercises got easier after just a few sessions (but that tandem stand with eyes shut still needs more work!).

  1. Up the ante

One exercise that seemed like a keeper was a little too easy – standing toe taps on a cone – so we thought of a way to make it tougher – doing the taps while moving in a circle around the cone, changing direction once in a while. Another favorite exercise that I had learned at my earlier therapy was what I irreverently called Old Lady Dodge Ball – I jogged around cones while an aide tossed a ball at me.  Katie upped the ante on this one by having two people throwing a ball from different positions and angles as I jogged around the cones.  We dubbed this one Double Dodge Ball.  We even tried Triple Dodge Ball a few times but it was too much for my always-weak catching skills.

  1. Prepare for PT to end

After a month of appointments three times a week I started seeing significant improvement in all the problem situations I had identified but thought I needed a bit more work.  Katie and my doctor agreed, so my PT was extended for another month during which the improvements continued and became the norm.  I agreed that we could stop after the second month but wanted a list of the exercises so I could continue the work at home and at the gym.  I had been doing a few at home for in between sessions, but now I am doing 20-30 minutes of balance exercises 5 times a week.  And my goal of being able to do all the turns at line dancing has been achieved. I feel like I am finally back to normal and it feels great!


PS – I am so pleased with the fast results on this round of PT that I’d like to thank Katie Finn and all her colleagues at Excel Therapy for a very positive and effective therapy experience!

This 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.

11 Comments for : Balance Therapy Tips for NPH Patients
  1. Reply

    I am 87 years old and was an exercise freak and in great shape. A few months ago I was diagnosed with normal pressure hydrocephalus after an MRI. There is no blockage and the neurologist cannot find the cause. A spinal tap indicated that a shunt would not help. For a couple of years my balance has been declining. At first balance was very slightly affected. In the past year it has deteriorated at an amazing rate, to where I cannot stand without a walker and am in great danger of falling, Can you help?

    • Ann
    • June 23, 2020

    Is that list of exercises available. Balance is one main issue for me.

    • Sonya R Evans
    • April 17, 2020

    My NPH husband’s walking is really bad. He went out for a walk (with his cane –only about 1 mile at most for him) and he could hardly stagger back. He went immediately to the recliner and is asleep. I have researched all I know and get NO answers..

    • Sonya Evans
    • April 17, 2020

    I wish we could find SOMETHING to help my NPH husband’s balance. He can only walk a half mile with a cane and his wide-based walk has gotten worse every month. Balance therapy is now closed. If anyone knows ANYTHING to do, we would appreciate it. He gets so tired he sleeps a lot in the day. I am EXHAUSTED for trying to get help!

    • Mirra
    • February 25, 2020

    Thank you. What exercised did you do at the gym , what equipment if any did you use and at what progression-hand weights barre exercises,etc

    • Steven John Isaac
    • August 6, 2019

    Hi my father had a shunt fitted just under 2 years ago now, and although he has improved and can walk in a straight line with a frame, his balance is absolutely awful. I am not sure where we go next with this, as he is unable to walk without a frame and cannot go out of the house, for fear of falling.

    • Sandra Newsom
    • May 22, 2019

    Can you recommend a NPH P.T. in our area? Port Neches, Tx 77651

    • Jim
    • December 31, 2018

    I will certainly check into balance pt based on what you are telling me.

    • Mrs Mollie Krempel
    • July 16, 2018

    No one either st the UCLH or Southampton General has ever offered me any type of therapy for my poor balance and noise in my head like a pressure cooker going off all the time. No one at either of the above hospitals has spent time discussing the outcome and long term prognosis of anyone having a VP shunt. It is an extremely long, lonely road. Is possible recovery a reality or is the prognosis early death? No one has time to talk to me.

    • Reply

      I am sorry to hear that, Mollie. For me the VP shunt accompanied by various forms of therapy has led to tremendous improvement in my symptoms and quality of life. I hope you are able to find doctors willing to work with you. HA has a physician’s directory you could try.

    • Barbara
    • June 14, 2018

    I am in pt for balance but haven’t had results that dramatic I will show this information to my therapist thank you

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