Hydrocephalus in Older Adults

In the middle of the brain, there are four holes better known as “ventricles”. Hydrocephalus is a condition where fluids, better known as cerebrospinal fluids, from the body build up in these ventricles. When the fluids build up beyond a certain point, the ventricles are stretched and pressure is put on the brain. The pressure on the brain that results from Hydrocephalus may cause permanent damage to areas of the brain.

Symptoms:

• Loss of bladder control
• Frequent urge to urinate
• Loss of thinking or reasoning skills
• Difficulty walking (often looks like a shuffling of the feet or a feeling of the feet being stuck)
• Poor coordination or balance
• Slower than normal movements
• Headaches

Seek a doctor if person has:

• Difficulty sucking or feeding
• Unexplained, recurrent vomiting
• An unwillingness to bend or move the neck or head
• Difficulty breathing
• Seizures

Causes:

• Too much cerebrospinal fluid is produced by the body
• The body doesn’t absorb enough cerebrospinal fluid
• If something is blocking the flow of the cerebrospinal fluid

Older adults who have Hydrocephalus may experience a decline in memory or other thinking skills. They also may have poorer recoveries and persistent symptoms after treatment of Hydrocephalus.

OT Intervention for Hydrocephalus:

An OT’s intervention approach for an older adult patient with Hydrocephalus depends on the patient’s symptoms, since patients exhibit different symptoms at varying degrees of severity depending on where damage occurs in the brain.

Some common complications and suggestions for intervention:

Balance or vestibular complications

• Assess whether or not he or she is a fall risk
  • Make environmental modifications, if so
  • Work slowly with improving his or her vestibular system through stimulation of the somatosensory system
• Teach compensatory techniques to help them adapt to their balance problems

• Using vision to help determine where the body is in space
• Possibly using a cane or walker to provide more points of contact with the surrounding environment

Mood Swings or Behavior Problems

• Be sympathetic and make sure to build rapport with them
• Be direct and make sure that they are aware of their behaviors
• Establish a routine and do your best to eliminate deviations from that routine.
• Build his or her confidence in themselves and the therapy you’re providing.
• Incorporate meaningful occupations or activities of interest into therapy sessions to maintain interest in therapy.

Trouble Initiating Walking or Other Voluntary Movements

• Encourage social participation with loved ones or with other people with similar diagnosis or symptoms
• Use a rocking motion to initiate movement
• Encourage dancing and listening to music with an accentuated initial beat to help restore rhythm within the patient
• Teach caregivers and loved ones about the efficacy of visual and auditory cues.
  • Compassion and patience are vital since anxiety may cause these symptoms to worsen.

Incontinence

• Attempt a bladder management program with pelvic floor exercises if patient is interested in becoming more independent in this area of his or her life.

Avoid inverted positions since this will increase intracranial pressure.

Resources:

Mayo Clinic http://www.mayoclinic.com/health/hydrocephalus/DS00393

Davidson, D. (1990). Occupational Therapy Intervention with an Adolescent with Brain Injury and Behavioral Disorders