A Home Balance Exercise Program Improves Walking in People With Cerebellar Ataxia

Background. Physical therapy intervention is the primary treatment for gait ataxia and imbalance in individuals with cerebellar damage. Our aim was to determine if a home balance exercise program is feasible for improving locomotor and balance abilities in these individuals. Methods. A total of 14 patients with cerebellar ataxia participated in a 6-week individualized home-based balance exercise program and attended 5 testing sessions (2 pretraining, 1 midtraining, 1 posttraining, and 1 one-month follow-up visit). Pretraining, posttraining, and follow-up testing included a neurological assessment, clinical gait and balance tests, and laboratory assessments of balance and walking. Participants kept logs of the frequency and level of balance challenge during their training. Results. Walking speed improved across visits, as did stride length, percentage double-limb support time, Timed Up and Go (TUG), and Dynamic Gait Index. Post hoc comparisons in these measures revealed that significant rehabilitative improvements occurred over the 6-week training period, and all but TUG gains were retained 1 month later. There were no changes across the other measures for the group. Regression analysis indicated that improvements in walking speed were affected by the level of balance challenge but not by age, ataxia severity, proprioception, or duration of exercise. Conclusions. Improvement in locomotor performance in people with cerebellar ataxia was observable after a 6-week home balance exercise program. The exercise program must be designed to provide a significant challenge to the person’s balance.

[1]  Jaynie F. Yang,et al.  Walking tasks encountered by urban-dwelling adults and persons with incomplete spinal cord injuries. , 2007, Journal of rehabilitation medicine.

[2]  A. Bastian.  Moving, sensing and learning with cerebellar damage , 2011, Current Opinion in Neurobiology.

[3]  S. M. Morton,et al.  Relative contributions of balance and voluntary leg-coordination deficits to cerebellar gait ataxia. , 2003, Journal of neurophysiology.

[4]  M. Giese,et al.  Intensive Coordinative Training Improves Motor Performance in Degenerative Cerebellar Disease Editorial, Page Xxx , 2022 .

[5]  Challenge of Neurorehabilitation for Cerebellar Degenerative Diseases , 2012, The Cerebellum.

[6]  P. Serrano-Aguilar,et al.  Effectiveness and safety of treatments for degenerative ataxias: A systematic review , 2009, Movement disorders : official journal of the Movement Disorder Society.

[7]  M. Stokes,et al.  Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses , 1998, Clinical rehabilitation.

[8]  Marjorie H. Woollacott,et al.  Motor Control: Theory and Practical Applications , 1995 .

[9]  D. Stetts,et al.  Continued recovery in an adult with cerebellar ataxia , 2013, Physiotherapy theory and practice.

[10]  R. Balliet,et al.  Retraining of functional gait through the reduction of upper extremity weight-bearing in chronic cerebellar ataxia. , 1987, International rehabilitation medicine.

[11]  E. Martínez-Góngora,et al.  [Effects of a physical training program on quantitative neurological indices in mild stage type 2 spinocerebelar ataxia patients]. , 2004, Revista de neurologia.

[12]  D. Stetts,et al.  Use of trunk stabilization and locomotor training in an adult with cerebellar ataxia: A single system design , 2010, Physiotherapy theory and practice.

[13]  S. Studenski,et al.  Functional reach: a new clinical measure of balance. , 1990, Journal of gerontology.

[14]  S. M. Morton,et al.  Cerebellar Contributions to Locomotor Adaptations during Splitbelt Treadmill Walking , 2006, The Journal of Neuroscience.

[15]  Amy J Bastian,et al.  Role of the cerebellum in the control and adaptation of gait in health and disease. , 2004, Progress in brain research.

[16]  S. Studenski,et al.  Meaningful Change and Responsiveness in Common Physical Performance Measures in Older Adults , 2006, Journal of the American Geriatrics Society.

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

[18]  Winfried Ilg,et al.  No increased risk of obstructive sleep apnea in Parkinson's disease , 2010, Movement disorders : official journal of the Movement Disorder Society.

[19]  C. Wright,et al.  Self-management approaches for people with chronic conditions: a review. , 2002, Patient education and counseling.

[20]  M. Hallett,et al.  International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome , 1997, Journal of the Neurological Sciences.

[21]  Martin A. Giese,et al.  Video game–based coordinative training improves ataxia in children with degenerative ataxia , 2012, Neurology.

[22]  Noriaki Hattori,et al.  Cerebellar Ataxia Rehabilitation Trial in Degenerative Cerebellar Diseases , 2012, Neurorehabilitation and neural repair.

[23]  M Karakaya,et al.  Investigation and comparison of the effects of rehabilitation on balance and coordination problems in patients with posterior fossa and cerebellopontine angle tumours. , 2000, Journal of neurosurgical sciences.

[24]  L. E. Powell,et al.  The Activities-specific Balance Confidence (ABC) Scale. , 1995, The journals of gerontology. Series A, Biological sciences and medical sciences.

[25]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

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

[27]  S. M. Morton,et al.  Longitudinal tracking of gait and balance impairments in cerebellar disease , 2010, Movement disorders : official journal of the Movement Disorder Society.