Use of trunk stabilization and locomotor training in an adult with cerebellar ataxia: A single system design

The purpose of this study is to describe the effects of trunk stabilization training and locomotor training (LT) using body-weight support on a treadmill (BWST) and overground walking on balance, gait, self-reported function, and trunk muscle performance in an adult with severe ataxia secondary to brain injury. There are no studies on the effectiveness of these combined interventions in persons with ataxia. The subject was a 23-year-old male who had a traumatic brain injury 13 months prior. An A-B-A withdrawal single-system design was used. Outcome measures were Berg Balance Test (BBT), timed unsupported stance, Functional Ambulation Category (FAC), 10-meter walk test (10-MWT), Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL), transverse abdominis (TrA) thickness, and isometric trunk endurance tests. Performance on the BBT, timed unsupported stance, FAC, 10-MWT, and OPTIMAL each improved after 10 weeks of intervention. In additions, TrA symmetry at rest improved as did right side-bridge endurance time. LT, using BWST and overground walking, and trunk stabilization training may be effective in improving balance, gait, function, and trunk performance in individuals with severe ataxia. Further research with additional subjects is indicated.

[1]  P. Hodges,et al.  Postural and respiratory activation of the trunk muscles changes with mode and speed of locomotion. , 2004, Gait & posture.

[2]  Deydre S Teyhen,et al.  Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus muscles. , 2009, Archives of physical medicine and rehabilitation.

[3]  J. Hidler,et al.  Altered Trunk Position Sense and Its Relation to Balance Functions in People Post-Stroke , 2008, Journal of neurologic physical therapy : JNPT.

[4]  H. Barbeau,et al.  Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. , 2003, Archives of physical medicine and rehabilitation.

[5]  David G. Behm,et al.  The Impact of Instability Resistance Training on Balance and Stability , 2005, Sports medicine.

[6]  John D. Childs,et al.  The use of ultrasound imaging of the abdominal drawing-in maneuver in subjects with low back pain. , 2005, The Journal of orthopaedic and sports physical therapy.

[7]  B. Knowlton,et al.  Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. , 2002, Archives of physical medicine and rehabilitation.

[8]  P. Hodges,et al.  Persistence of improvements in postural strategies following motor control training in people with recurrent low back pain. , 2008, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[9]  A. Häkkinen.  Guide to evidence-based physical therapy practice , 2009 .

[10]  J. L. Whittaker,et al.  Rehabilitative ultrasound imaging of the abdominal muscles. , 2007, The Journal of orthopaedic and sports physical therapy.

[11]  K. Refshauge,et al.  The reliability and validity of the Biering-Sorensen test in asymptomatic subjects and subjects reporting current or previous nonspecific low back pain. , 1999, Spine.

[12]  Stuart McGill,et al.  Previous history of LBP with work loss is related to lingering deficits in biomechanical, physiological, personal, psychosocial and motor control characteristics , 2003, Ergonomics.

[13]  M. Hinman,et al.  Reliability of the Berg Balance Scale and Balance Master Limits of Stability Tests for Individuals with Brain Injury , 2005, Journal of neurologic physical therapy : JNPT.

[14]  S. Gandevia,et al.  Measurement of muscle contraction with ultrasound imaging , 2003, Muscle & nerve.

[15]  B. Juul-Kristensen,et al.  Comparison of muscle sizes and moment arms of two rotator cuff muscles measured by ultrasonography and magnetic resonance imaging. , 2000, European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology.

[16]  P. Hodges,et al.  Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. , 1998, Journal of spinal disorders.

[17]  Stuart M. McGill,et al.  Low Back Disorders: Evidence-Based Prevention and Rehabilitation , 2002 .

[18]  Matthew R. Scherer,et al.  Gait rehabilitation with body weight-supported treadmill training for a blast injury survivor with traumatic brain injury , 2007, Brain injury.

[19]  P. Thompson,et al.  ACSM's Guidelines for Exercise Testing and Prescription , 1995 .

[20]  E. Protas,et al.  Performance-based gait tests for acute stroke patients. , 2002, American journal of physical medicine & rehabilitation.

[21]  D. Stetts,et al.  A Rehabilitative Ultrasound Imaging Investigation of Lateral Abdominal Muscle Thickness in Healthy Aging Adults , 2009, Journal of geriatric physical therapy.

[22]  Gregory E Hicks,et al.  Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. , 2005, Archives of physical medicine and rehabilitation.

[23]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[24]  S. Henry,et al.  The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects. , 2005, The Journal of orthopaedic and sports physical therapy.

[25]  K. Berg.  Measuring balance in the elderly: preliminary development of an instrument , 1989 .

[26]  W. Walker,et al.  Motor impairment after severe traumatic brain injury: A longitudinal multicenter study. , 2007, Journal of rehabilitation research and development.

[27]  P. Hodges,et al.  Inefficient Muscular Stabilization of the Lumbar Spine Associated With Low Back Pain: A Motor Control Evaluation of Transversus Abdominis , 1996, Spine.

[28]  S. Wood-Dauphinée,et al.  The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. , 1995, Scandinavian journal of rehabilitation medicine.

[29]  J. Cholewicki,et al.  Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. , 1996, Clinical biomechanics.

[30]  M. Ferreira,et al.  Changes in Recruitment of the Abdominal Muscles in People With Low Back Pain: Ultrasound Measurement of Muscle Activity , 2004, Spine.

[31]  K. M. Gill,et al.  Gait assessment for neurologically impaired patients. Standards for outcome assessment. , 1986, Physical therapy.

[32]  Sheyla Rossana Cavalcanti Furtado,et al.  Treadmill training for ataxic patients: a single-subject experimental design , 2008, Clinical rehabilitation.

[33]  Kathryn M Refshauge,et al.  Trunk muscle endurance tests: reliability, and gender differences in athletes. , 2007, Journal of science and medicine in sport.

[34]  K. M. Gill,et al.  Gait Assessment for Neurologically Impaired Patients , 1986 .

[35]  A. Bialocerkowski,et al.  Effectiveness of physiotherapy for adults with cerebellar dysfunction: a systematic review , 2009, Clinical rehabilitation.

[36]  P. Hodges,et al.  Contraction of the abdominal muscles associated with movement of the lower limb. , 1997, Physical therapy.

[37]  A. Behrman,et al.  Neuroplasticity After Spinal Cord Injury and Training: An Emerging Paradigm Shift in Rehabilitation and Walking Recovery , 2006, Physical Therapy.

[38]  Marc S. Goldstein,et al.  Development and testing of a self-report instrument to measure actions: outpatient physical therapy improvement in movement assessment log (OPTIMAL). , 2005, Physical therapy.

[39]  D. Jewell.  Guide To Evidence-Based Physical Therapy Practice , 2007 .

[40]  Julie A. Hides,et al.  Therapeutic exercise for lumbopelvic stabilization , 2004 .

[41]  J. Mcmeeken,et al.  The relationship between EMG and change in thickness of transversus abdominis. , 2004, Clinical biomechanics.

[42]  H. Barbeau.  Locomotor Training in Neurorehabilitation: Emerging Rehabilitation Concepts , 2003, Neurorehabilitation and neural repair.

[43]  Sandra B. Davis,et al.  Locomotor training progression and outcomes after incomplete spinal cord injury. , 2005, Physical therapy.

[44]  Anne Shumway-Cook,et al.  Locomotor Training Using Body-Weight Support on a Treadmill in Conjunction With Ongoing Physical Therapy in a Child With Severe Cerebellar Ataxia , 2008, Physical Therapy.

[45]  R. D. de Bie,et al.  Test–re-test reliability of walking speed, step length and step width measurement after traumatic brain injury: a pilot study , 2004, Brain injury.

[46]  Julie A. Hides,et al.  Low back disorders: evidence-based prevention and rehabilitation , 2004, British Journal of Sports Medicine.

[47]  K. Mcmahon,et al.  An MRI Investigation Into the Function of the Transversus Abdominis Muscle During “Drawing-In” of the Abdominal Wall , 2006, Spine.

[48]  A. Blau,et al.  Berg Balance Scale and Outcome Measures in Acquired Brain Injury , 2001, Neurorehabilitation and neural repair.

[49]  K. M. Gill,et al.  Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. , 1984, Physical therapy.

[50]  Subashan Perera,et al.  Improvements in Speed-Based Gait Classifications Are Meaningful , 2007, Stroke.

[51]  J. Cholewicki,et al.  Trunk Muscle Recruitment Patterns in Patients With Low Back Pain Enhance the Stability of the Lumbar Spine , 2003, Spine.

[52]  Emily Fox,et al.  Effects of Stroke Severity and Training Duration on Locomotor Recovery After Stroke: A Pilot Study , 2007, Neurorehabilitation and neural repair.

[53]  JoAnne K. Gronley,et al.  Classification of walking handicap in the stroke population. , 1995, Stroke.

[54]  J. Mehrholz,et al.  Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients: A Randomized Controlled Trial , 2002, Stroke.

[55]  J. H. van Dieen,et al.  Trunk muscle recruitment patterns in patients with low back pain enhance the stability , 2003 .

[56]  M. Stokes,et al.  Measurement of Quadriceps Cross–sectional Area by Ultrasonography: A Description of the Technique and its Applications in Physiotherapy , 1986 .

[57]  K. M. Gill,et al.  Clinical Gait Assessment in the Neurologically Impaired , 1984 .

[58]  J. Mehrholz,et al.  Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. , 2007, Archives of physical medicine and rehabilitation.