Features of gait most responsive to tap test in normal pressure hydrocephalus

Lisa D. Ravdin, Heather L. Katzen, Anna E. Jackson, Diamanto Tsakanikas, Stephanie Assuras, Norman R. Relkin

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Objective: To identify components of gait associated with a positive tap test (TT) in patients with idiopathic normal pressure hydrocephalus (iNPH). Patients and methods: Thirty-three patients with iNPH underwent clinical evaluation pre- and post-TT and were classified as responders (Rs) or non-responders (NRs). Elements of gait were assessed with a formal standardized Gait Scale and compared between groups. Results: Analysis of pre/post-TT group differences revealed an interaction for Total Gait Score and Walking Score, with improvements in responders only. Total Gait Scores improved by 29% in the Rs and 4.85% in the NRs. Rs showed significant post-TT improvements on a timed 10 m walk, turning, and balance. Tandem walking, turning, truck balance and start stop hesitation showed trends toward improvement. Conclusions: The classic features of gait often used in determining diagnosis of NPH (wide based stride, reduced foot-floor clearance, and small steps) were not helpful in identifying responders to the TT. Walking speed, steps for turning, and tendency towards falling were most likely to improve post-TT. These straightforward measures can readily be adapted into clinical practice to assist in determination of shunt candidacy.

Original languageEnglish (US)
Pages (from-to)455-461
Number of pages7
JournalClinical Neurology and Neurosurgery
Issue number5
StatePublished - May 2008
Externally publishedYes


  • Candidacy for shunt
  • Gait assessment
  • Gait disorders
  • Idiopathic normal pressure hydrocephalus
  • Neurologic
  • Tap test

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology


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