Hydrocephalus Rehabilitation


Hydrocephalus is a disease characterized by the accumulation of excessive amount of cerebrospinal fluid (CSF) in the enlarged cerebral ventricles and subarachnoid space.

CSF is a fluid mainly produced in the brain in a structure called the choroid plexus. The rest of the CSF is made by the cerebral tissue.

CSF first passes to the system of cavities in the brain (ventricle) and then to the system under the cerebral membrane (subarachnoid space) and meets the nutritional and fluid needs of the nerve cells in all these regions.

What is Hydrocephalus in Children?

Hydrocephalus means excessive water accumulation in the brain. It is a condition that draws attention with the excessive growth of the head in children. Cerebrospinal fluid (CSF) protects the brain and spinal cord against concussions. In addition, CSF acts as a protective shield against harmful substances in the blood through a mechanism called the blood barrier.

CSF is a fluid that is continuously made and absorbed and removed from the brain and spinal cord. After completing its circulation, it is absorbed into the circulation through the veins. Therefore, any obstacle or abnormality that may occur during production and discharge will cause hydrocephalus. Hydrocephalus occurs as a result of an imbalance between CSF production and absorption in the skull.

What Causes Hydrocephalus in Children?

Hydrocephalus in children is always associated with increased intracranial pressure syndrome (KIBAS).

  • Increase in CSF production in the choroid plexus,
  • Inadequate absorption of CSF,
  • Intracranial pressure will increase due to the increased amount of CSF as a result of congestion, congenital stenosis, etc. that may occur anywhere along the path of the CSF.

The most common cause of Hydrocephalus in children is a disorder in the CSF circulation. As a result, large amounts of CSF accumulate in the cerebral spaces. Less commonly, it occurs as a result of absorption failure. Unless KIBAS increases too much, CSF production amounts will continue to remain within physiological limits.

Enlargement occurs in the brain cavities above the obstruction. As a result, brain tissue damage occurs. If hydrocephalus in infancy develops before the cranial sutures are closed, there will be a significant increase in the circumference of the head. Therefore, intracranial pressure does not increase much and brain tissue damage is relatively less.

If hydrocephalus occurs after the sutures are closed or acutely, a severe KIBAS will occur and the damage to the brain tissue will increase.

  • Hydrocephalus is seen between 0-2 years of age as a result of congenital (most frequently occurring in this way, it may occur only in the form of congenital hydrocephalus or accompany with other syndromes) and as a result of intra-brain hemorrhage.
  • In children and adults, it is seen as a result of brain infections, brain hemorrhage, head trauma and brain tumors.

What are the Symptoms of Hydrocephalus in Children?

Although it varies according to age and person, in the first two months;

  • Head growing more than normal,
  • Thinning of the scalp
  • Clarification of the veins in the head,
  • Vomiting
  • Eyes crossing down,
  • Symptoms such as suffering a seizure are at the forefront.

In addition to these symptoms, different complaints such as nausea, vomiting, visual disturbances, sensory movement disorders will occur in later months and ages.

Vital signs (such as breathing, swallowing, etc.) may be adversely affected as a result of the brain stem being affected. Changes such as slow heart rate, systemic hypertension, respiratory disorders may occur.

How Is Hydrocephalus Diagnosed in Children?

Hydrocephalus can be detected by prenatal ultrasound examination during pregnancy. Serial head circumference measurements should be made after delivery, and ultrasound examination should be prioritized before anterior fontanel closure. Although the lateral ventricles can be seen successfully with ultrasound, the posterior fossa cannot be seen. After the anterior fontanel is closed, imaging methods such as CT or MRI should replace ultrasound in diagnosis.

How Should Hydrocephalus Be Treated in Children?

Hydrocephalus in children cannot be treated with medication. Surgical treatment methods for the underlying cause are preferred. Therefore, the CSF will need to be transferred from the brain to another area in the body by placing a shunt (canal). This operation is performed with a thin catheter. However, since the BOS is produced continuously, the shunt system must be in continuous working condition and open. The shunt can become infected with clogging microbes.

How Should Rehabilitation Be in Children with Hydrocephalus?

  • It is necessary to increase the strength of the muscles in the affected area, and to apply personal therapy.
  • Studies aimed at increasing balance and coordination should be implemented, and walking training should be done by increasing balance with robotic rehabilitation in today’s technology.
  • Ergotherapy is a method that allows the person to adapt to daily life. At the same time, the sensory integration training is given to help the person gain their functions.