title: Ventriculoperitoneal shunt dysfunction during rehabilitation: prevalence and countermeasures.
abstract: OBJECTIVE
  We examined the prevalence of shunt dysfunction (e.g., overdraining or underdraining malfunctions) in patients with a ventriculoperitoneal shunt and elucidated effective countermeasures of a programmable valve shunt system in treatments for shunt dysfunction during rehabilitation therapy.
  
  
  METHODS
  Among 114 patients with a ventriculoperitoneal shunt for normal pressure hydrocephalus, underdraining appeared in eight patients during hospitalization for rehabilitation therapy, and seven patients experienced overdraining.
  
  
  RESULTS
  We could treat underdraining noninvasively for all six patients with a programmable valve shunt system by decreasing the opening pressure, whereas the other two patients with a fixed valve pressure system required surgical replacement of the valve unit. We could also treat overdraining noninvasively in two cases with programmable valve shunt system by increasing the opening pressure. In two cases with fixed valve pressure system, however, chronic subdural hematomas had to be surgically treated. Either dysfunction interfered with a better functional outcome in rehabilitation therapy. Barthel index after the countermeasures and continuous rehabilitation therapies was significantly larger than the index before the countermeasures in both overdraining and underdraining groups.
  
  
  CONCLUSIONS
  Shunt dysfunction appeared in approximately 13.2% of patients with a ventriculoperitoneal shunt during hospitalization for rehabilitation. The ventriculoperitoneal shunt using programmable valve shunt system was convenient and valuable for treating both overdraining and underdraining malfunctions in the rehabilitation ward.
authors.affiliation: Department of Internal Medicine, Kasugai Rehabilitation Hospital, Yamanashi, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Muramatsu
authors.forename: Kimiko
authors.initials: K
authors.lastname: Koike
authors.forename: Akira
authors.initials: A
authors.lastname: Teramoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013813:Therapy, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data