Rehabilitation after diagnosis of hydrocephalus in severe acquired brain injury: the unmet need for evidence-based guidelines.

BACKGROUND

Hydrocephalus, defined as an abnormal accumulation of cerebrospinal fluid (CSF) within the brain’s ventricular system, often leads to neurological, motor, and cognitive impairments. While surgical procedures such as ventriculoperitoneal shunting or endoscopic third ventriculostomy effectively restore CSF dynamics, there are currently no specific clinical guidelines addressing rehabilitation strategies in the context of hydrocephalus.

OBJECTIVE

To identify and synthesize existing recommendations regarding post-acute rehabilitation in patients with hydrocephalus, focusing on evidence derived from broader clinical guidelines, and consensus statements.

METHODS

A structured literature review was conducted across international guideline repositories and databases (PubMed, Google Scholar). Inclusion criteria comprised guidelines and consensus statements addressing rehabilitation or functional recovery in hydrocephalus.

RESULTS

Five relevant documents were included. None specifically targeted rehabilitation in hydrocephalus, but three main themes emerged: (1) Neurological stabilization and early mobilization following prompt CSF management; (2) Physical and occupational rehabilitation, emphasizing individualized, goal-oriented training; and (3) Multidisciplinary care coordination, involving neurosurgeons, neurologists, physiatrists, and therapists.

CONCLUSIONS

Despite the recognized importance of rehabilitation, standardized, evidence-based protocols are lacking. Future research should define timing, intensity, and cognitive components of therapy to support neuroplasticity-driven, multidisciplinary rehabilitation and improve long-term functional outcomes in hydrocephalus.