Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Commonly, ataxias are caused by cerebellar disorders of peripheral nerves. People with ataxias are likely to have most difficulty with gait, balance, speech, swallowing, and vision leading to a reduced quality of life. To date, there is no cure for the progressive disease, but some interventions may be helpful in managing the symptoms. This review aims to compile available data on rehabilitation interventions for managing cerebellar ataxia.
Methods
A total of 58 studies collected were published in Portuguese or English between 1990-2020. The review also included articles on the topics of new and emerging interventions.
Results by Category
Physical Therapy
Physical therapy is recommended for all stages of the disease. Coordination training improves motor performance and reduces ataxia symptoms. There is weak evidence for using virtual reality, biofeedback, and bodyweight support treadmill exercises for postural training, however high-intensity motor coordination training proved beneficial for those with degenerative ataxia for stability and motor coordination. Many studies at various levels of evidence conclude that rehab improves mobility, function, ataxia, and balance in adults and children, however, studies lack long-term follow-up and specific training strategies.
Outcome Measures and Clinical Scales
Scale for the Assessment and Rating of Ataxia is commonly used to quantify severity of ataxia with good construct validity. The Neurological Examination Score for Spinocerebellar Ataxias is also commonly used for measuring ataxia severity with good interrater reliability and consistency. The Berg Balance Scale and Timed Up and Go were determined to be the best outcome measures for the population.
Exergames and New Technologies
Incorporating virtual reality into therapy (exergames) can add a motivational aspect to rehab and target coordination, balance, and weight transfer. Some studies found that games such as the Wii can not only improve daily training, but also if used regularly can improve postural sway, balance, gait, and fall frequency.
Speech, Voice, Swallowing Therapy
Early detection and intervention for swallowing and speech impairments for degenerative ataxias is important due to the ultimate progression of the disease. Early intervention can improve swallowing and speech can enhance quality of life.
Occupational Therapy
OT can improve balance, and coordination of patients with degenerative ataxias, however, when combined OT and PT is more effective for long-term benefit. Though it is known that OT should be tailored to patients’ specific needs, specific aspects of treatment and interventions should continue to be studied.
Conclusion
Although there is no cure for cerebellar ataxias, various studies have proven that physical therapy, occupational therapy, speech therapy is essential for patient care and can aid with management of the disease. Some studies suggest they are best used in combination and when implemented early.
Reference
Chien, H.F., Zonta, M.B., Chen, J., Diaferia, G., Viana, C.F., Teive, H.A.G., Pedroso, J.L., &Barsottini, O.G.P. (2022). Rehabilitation in Patients with Cerebellar Ataxias. SciELO Brazil, 80(3), 306-315. https://doi.org/10.1590/0004-282X-ANP-2021-0065