Hydrocephalus

Hydrocephalus

Hydrocephalus is a condition in which there is an abnormal build-up of cerebrospinal fluid (CSF) within the brain's ventricles. This can cause the ventricles to enlarge and, in some cases, increase pressure on the brain.

Cerebrospinal fluid is a clear fluid that surrounds and protects the brain and spinal cord. It helps cushion the brain, transport nutrients and remove waste products. CSF is continuously produced and normally flows through spaces within and around the brain before being absorbed into the bloodstream.

Hydrocephalus can occur when the normal flow or absorption of CSF is disrupted. This may happen because of a blockage, problems with absorption, bleeding, infection, differences in brain development or another underlying condition.

Hydrocephalus can affect people of all ages. The symptoms and impact can vary considerably depending on the person's age, the cause of the hydrocephalus and the areas of the brain affected.

At Positive Steps Physiotherapy, we support children, young people and adults with hydrocephalus to develop or maintain movement, mobility, strength, balance and independence.

What causes hydrocephalus?

Hydrocephalus can have many different causes. These can include:

• Differences in how the brain or its fluid pathways develop before birth

• Premature birth, particularly where there has been bleeding in or around the brain

• Bleeding within the brain

• Infections such as meningitis

• Head injuries

• Brain tumours or other conditions that obstruct the flow of CSF

• Conditions such as spina bifida that can be associated with hydrocephalus

In some people, the underlying cause of hydrocephalus is not known.

The cause and timing of hydrocephalus can influence the symptoms a person experiences and the treatment they require.

What are the different types of hydrocephalus?

Hydrocephalus can be classified in different ways depending on its cause and how the cerebrospinal fluid is affected.

Congenital hydrocephalus

Congenital hydrocephalus is present at birth. It may develop because of differences in the development of the brain or the pathways through which CSF flows.

It can occur alongside other conditions, including spina bifida.

Acquired hydrocephalus

Acquired hydrocephalus develops after birth.

Possible causes include bleeding in the brain, infections, head injuries, tumours and other conditions that affect the normal flow or absorption of CSF.

Communicating hydrocephalus

In communicating hydrocephalus, CSF can still flow through the ventricular system but is not absorbed normally. This can result in a gradual build-up of CSF.

Non-communicating or obstructive hydrocephalus

Non-communicating hydrocephalus occurs when a blockage prevents CSF from flowing normally through the ventricular system.

The location and cause of the blockage can influence the symptoms and treatment required.

Normal pressure hydrocephalus

Normal pressure hydrocephalus (NPH) is a type of hydrocephalus that usually affects older adults.

Despite an enlargement of the brain's ventricles, measurements of CSF pressure can be within the normal range when measured at particular times.

NPH can cause difficulties with walking and balance, changes in thinking and bladder problems. These symptoms can sometimes be mistaken for other conditions associated with ageing, so appropriate medical assessment is important.

Who can be affected by hydrocephalus?

Hydrocephalus can affect people of any age.

It can occur in babies and children as a result of differences in brain development, premature birth or conditions such as spina bifida.

In adults, hydrocephalus can develop following conditions such as bleeding, infection, head injury or a tumour. Normal pressure hydrocephalus is more commonly seen in older adults.

Because the causes of hydrocephalus vary between age groups, the symptoms and rehabilitation needs can also be very different.

How common is hydrocephalus?

Hydrocephalus can occur at any age, but the exact prevalence is difficult to determine because there are different causes and types of hydrocephalus.

Rather than relying on a single prevalence figure, which can vary depending on the population and definition used, it is more useful to understand that hydrocephalus can affect babies, children, young people and adults.

If a specific UK statistic is included on this page, we recommend dating the figure and reviewing it regularly as prevalence estimates can change.

What are the symptoms of hydrocephalus?

Symptoms can vary depending on a person's age, the underlying cause and how hydrocephalus is affecting the brain.

Symptoms in babies and young children may include:

• An unusually large or rapidly increasing head size

• A bulging or tense soft spot on the head

• Irritability

• Vomiting

• Excessive sleepiness

• Feeding difficulties

• Seizures

• Eye movement or visual difficulties

• Delayed development

• Difficulties with movement or coordination

Symptoms in older children and adults may include:

• Headaches

• Nausea or vomiting

• Changes in vision

• Balance difficulties

• Problems with coordination

• Walking difficulties

• Reduced mobility

• Changes in thinking or concentration

• Fatigue or drowsiness

• Bladder difficulties

People with normal pressure hydrocephalus may experience a combination of walking difficulties, changes in thinking and bladder problems.

Hydrocephalus can affect people differently, and not everyone will experience the same symptoms.

How is hydrocephalus diagnosed?

Hydrocephalus is diagnosed through a combination of a person's medical history, symptoms and neurological examination, alongside appropriate investigations.

Brain imaging is an important part of diagnosis. An MRI or CT scan may be used to look at the brain and identify enlarged ventricles or other changes that may explain the symptoms.

Additional tests may be required depending on the person's symptoms and suspected cause.

Diagnosis and treatment should be overseen by the appropriate medical team, which may include neurologists, neurosurgeons and other healthcare professionals.

How is hydrocephalus treated?

Hydrocephalus often requires medical treatment to manage the build-up of CSF.

Depending on the type and cause, treatment may include surgery to divert CSF away from the brain. This can include the insertion of a shunt or a procedure such as endoscopic third ventriculostomy (ETV) in appropriate cases.

The specific treatment depends on the individual's circumstances and should be determined by their medical team.

Physiotherapy does not treat the underlying build-up of CSF. Instead, it can play an important role in rehabilitation where hydrocephalus or its underlying cause has affected movement, strength, balance, coordination or functional independence.

Can physiotherapy help people with hydrocephalus?

Yes. Physiotherapy can support children and adults with hydrocephalus when the condition has affected their movement, physical function or independence.

The focus of physiotherapy depends on the person's age, abilities, symptoms, underlying condition and goals.

For children, physiotherapy may focus on supporting motor development and helping them develop skills such as rolling, sitting, crawling, standing and walking.

For adults, physiotherapy may focus on maintaining or improving strength, balance, walking, transfers, physical activity and independence.

Treatment is always individualised and should take account of the person's wider medical history and current medical management.

How can physiotherapy help with hydrocephalus?

Movement and motor development

For babies and children, physiotherapy can support the development of movement skills.

This may include practising:

• Rolling

• Sitting

• Reaching

• Crawling

• Pulling to stand

• Standing

• Walking

Activities can be incorporated into play to make movement practice meaningful and enjoyable.

Physiotherapy can also help parents and carers understand how to encourage movement and development during everyday activities.

Balance and coordination

Hydrocephalus and associated neurological conditions can affect balance and coordination.

Physiotherapy may use activities such as:

• Weight shifting

• Reaching outside the base of support

• Stepping in different directions

• Navigating obstacles

• Changing direction

• Standing on different surfaces

• Functional balance activities

Activities can be progressed according to the person's ability and goals.

Strength and muscle control

Reduced activity or neurological changes can affect muscle strength and control.

Physiotherapy can use strengthening exercises and functional activities such as:

• Sit-to-stands

• Step-ups

• Squats

• Reaching activities

• Supported standing

• Functional transfers

For children, strengthening can be incorporated into games and play. For adults, exercises can be linked to meaningful everyday activities.

Walking and gait rehabilitation

Walking difficulties may occur in people with hydrocephalus or associated neurological conditions.

Physiotherapy can assess walking and work on areas such as:

• Stepping

• Foot placement

• Walking speed

• Turning

• Changing direction

• Navigating obstacles

• Walking confidence

• Safe use of walking aids

Where appropriate, supported gait rehabilitation can be incorporated into treatment.

Postural control

Physiotherapy can work on control of the head, trunk and pelvis.

For children, this may support the development of sitting and standing skills.

For adults, postural exercises may help maintain an upright position during standing, walking and everyday activities.

Falls prevention

People experiencing balance or walking difficulties may have an increased risk of falls.

Physiotherapy can assess balance and mobility and develop an individualised programme to improve strength, balance and confidence.

We can also provide advice around safe mobility, transfers and strategies to reduce falls risk.

Transfers and functional mobility

Physiotherapy can help people practise everyday movements such as:

• Sitting to standing

• Standing to sitting

• Getting in and out of bed

• Moving between surfaces

• Getting in and out of a chair

• Navigating around the home

The aim is to make everyday movement as safe and independent as possible.

Education and support

Physiotherapy can provide education and practical advice to individuals, parents, carers and support networks.

This may include guidance around:

• Safe movement

• Transfers

• Exercise

• Mobility

• Positioning

• Falls prevention

• Encouraging physical activity

• Supporting movement during everyday routines

Where appropriate, we can also work alongside other professionals involved in the person's care.

Physiotherapy for children with hydrocephalus

Hydrocephalus can affect children's development and movement in different ways.

Physiotherapy can support children to develop movement skills and participate in activities appropriate for their age and abilities.

Sessions may involve play-based activities to encourage:

• Head and trunk control

• Reaching

• Rolling

• Sitting

• Crawling

• Standing

• Walking

• Balance

• Coordination

• Strength

• Confidence with movement

Goals are developed with the child and their family and can be adapted as the child develops.

Physiotherapy for adults with hydrocephalus

Adults with hydrocephalus may experience changes in walking, balance, strength, coordination or independence.

Physiotherapy can help assess these difficulties and develop a programme focused on maintaining or improving physical function.

Treatment may include gait rehabilitation, balance training, strengthening, functional transfers, falls prevention and physical activity.

For people with normal pressure hydrocephalus, walking and balance rehabilitation may be particularly relevant.

Specialist rehabilitation equipment at Positive Steps

Positive Steps has access to specialist rehabilitation equipment that may be incorporated into an individual's physiotherapy programme when appropriate.

Hydrotherapy

Water-based rehabilitation can provide a supportive environment for movement and exercise.

The buoyancy of water can reduce the load placed through the body and joints, allowing some movements to be practised in a different way.

Hydrotherapy may be particularly useful for practising functional movements such as walking, balance and strengthening, depending on the individual's needs.

BlazePods

BlazePods are interactive light-up targets that can be incorporated into rehabilitation activities.

They can be used to encourage:

• Reaching

• Stepping

• Balance

• Coordination

• Reaction

• Movement in different directions

They can make rehabilitation more interactive while still working towards specific functional goals.

EzyGain treadmill

The EzyGain treadmill provides supported gait rehabilitation and can be used to practise walking in a controlled environment.

It can be incorporated into an individual's programme to work on walking, balance, strength and confidence where appropriate.

Positive Steps is currently home to an EzyGain treadmill, providing access to this specialist gait rehabilitation equipment within our rehabilitation setting.

If the “only EzyGain treadmill in the UK” claim has been independently confirmed, this could instead be written as: “Positive Steps is currently home to the only EzyGain treadmill in the UK.” We recommend verifying this claim immediately before publication because it may change over time.

How can Positive Steps help?

At Positive Steps Physiotherapy, we work with each individual and their support network to understand their abilities, challenges and goals.

We recognise that hydrocephalus can affect people very differently. Our physiotherapy programmes are therefore personalised to the person's age, abilities, symptoms, medical history and the activities that are meaningful to them.

For children, this may mean supporting development, movement skills and participation through play.

For adults, this may mean maintaining strength, improving walking and balance, reducing falls risk or supporting independence with everyday activities.

Our aim is to find what can be done and work together towards meaningful goals.

Physiotherapy can help people with hydrocephalus develop or maintain movement, strength, balance and physical independence while supporting participation in everyday life.

If you or your child has hydrocephalus and would like to find out how physiotherapy at Positive Steps could help, please get in touch with our team.

Organisations and support

Shine

Shine provides information, support and services for people affected by spina bifida and hydrocephalus.

Harry's HAT

Harry's HAT provides information and support for families affected by hydrocephalus and related conditions.

The Brain Charity

The Brain Charity provides information and support for people affected by neurological conditions, including hydrocephalus.

If you have concerns about new or worsening symptoms associated with hydrocephalus, you should contact your GP or relevant medical team. If symptoms are sudden or severe, seek urgent medical attention.