Physical Therapy Tips for NPH Patients

By Trish Bogucki, Guest Blogger

By the time I was diagnosed with normal pressure hydrocephalus (NPH) and had shunt surgery, I had lost my ability to walk unaided, so I was very eager to begin Physical Therapy (PT).  I 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.

My neurosurgeon told me that PT for NPH patients should focus primarily on improving balance and gait.  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.

Tip #1:  Talk to your physical therapist about incorporating balance exercises if your PT routine does not include them.

My 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.  The cameras on the AlterG treadmill showed me how irregular my gait was and over time it helped me reprogram my walking.  As my gait improved I spent less time on the strength exercises and much more time on balance.

Tip #2: Set short term and long term goals for your physical therapy

My first goal was independent walking – no cane and no one to hang onto.  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.  I wasn’t sure I’d 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.  I occasionally watched the Step Class and told myself over and over that I would be back.

Tip #3: Learn to love your PT sessions and spend as long as you need to get through all your exercises

I came to regard PT as going to the gym with friends who picked up all my equipment for me.  I usually spent around two hours at each session three times a week – 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.  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.   The AlterG was the single most important component of my physical therapy – it allowed me to walk without fear of falling and gradually my gait lengthened and strengthened.  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.  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.

Tip #4: Be proactive to prevent boredom – don’t let your PT sessions become cookie cutter

Ask your therapist to remind you how an exercise should be done and try to find things to laugh at.  I dubbed one of my exercises “Walk the Dog” where I played the part of the dog.  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.  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 “dog” pulling on her harness, so occasionally I would “Woof!” just to get a smile.

My therapist created another exercise that had me jogging around cones while an aide tossed a squishy ball at me from various angles.  It challenged my balance greatly but the squishy ball couldn’t do any damage if I missed it (and I missed a lot at first).  I still use this exercise a year later to further strengthen my balance and reflexes.

Tip #5:  As your walking improves, focus attention at PT on the activities that you have the most trouble with

After some months of therapy, 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.  I asked my neurosurgeon about it and he said that the brain can have trouble with slopes especially downhill.  He suggested we find a way to work on that with the AlterG.

The Alter G does not have a decline setting but it does incline and it can run in reverse.  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.  Of course, I had to put the shorts on backward too but we were not worried about fashion.  And the best part of all this creativity?  I saw improvement after just one session of practicing my downhill walking!

Tip #6: Prepare for life after PT

Once you have achieved your short-term goals and you’re 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.

I 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.  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.

Tip #7: Don’t stop cold turkey

Once 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!  It was bittersweet really – after a year and five months of therapy three times a week PT had become a big part of my life.  My therapist gave me exercises to do on my own and then set me free.  I immediately increased my trips to the gym and hired a personal trainer to keep me challenged.

Post Script:  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.  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.  The video clip is now posted on the AlterG section of my therapy center’s website; if you’re interested you can see it in the box labeled Neurological AlterG on this page:

There 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.  You can find that one here:

And you can find my heart-felt thank you to the Alter G team for their terrific technology here:

Additional Blogs by Trish Bogucki:

Thriving with NPH – Trish Bogucki’s Story

How I decided to have shunt surgery

Balance Therapy Tips for NPH Patients

Exercise Tips for NPH patients

Cognitive Therapy for NPH Patients

Interview with Olivia Bell, Cognitive Therapist – Part 1

Interview with Olivia Bell, Cognitive Therapist – Part 2

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.