Intensive coordinative training improves motor performance in degenerative cerebellar disease

Ilg, Winfried; Synofzik, Matthis; Brötz, Doris; Burkard, Susanne; Giese, Martin A.; Schöls, Lüdger

doi:10.1212/wnl.0b013e3181c33adf

Cited by 286 publications

(279 citation statements)

References 28 publications

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“…Although several postural parameters correlated with the severity of the disease, no significant changes in ataxia scores over time were observed. Both Ilg et al (2009) andMiyai et al (2012) identified earlier a significant improvement in clinical ataxia scores, most likely because their coordinative training included tasks that more closely resemble items assessed in the ataxia scales ICARS and SARA (Trouillas et al, 1997;Schmitz-Hübsch et al, 2006).…”

Section: Training-related Postural Changesmentioning

confidence: 99%

“…Yet, only recently, three well controlled group studies have demonstrated significant motor benefit following coordinative training. Ilg et al (2009Ilg et al ( , 2010 reported that after a 4 week intensive coordinative training cerebellar patients improved motor performance, reduced their ataxic symptoms, and sustained these benefits for up to one year. Similar gains persisting for 6 months following a 1 month rehabilitation program were also shown by Miyai et al (2012).…”

Section: Introductionmentioning

confidence: 99%

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Brain Changes Associated with Postural Training in Patients with Cerebellar Degeneration: A Voxel-Based Morphometry Study

Burciu¹,

Fritsche²,

Granert

et al. 2013

J. Neurosci.

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Recent research indicates that physiotherapy can improve motor performance of patients with cerebellar degeneration. Given the known contributions of the cerebellum to motor learning, it remains unclear whether such observable changes in performance are mediated by the cerebellum or cerebral brain areas involved in motor control and learning. The current study addressed this question by assessing the increase in gray matter volume due to sensorimotor training in cerebellar patients using voxel-based morphometry. Nineteen human subjects with pure cerebellar degeneration and matched healthy controls were trained for 2 weeks on a balance task. Postural and clinical assessments along with structural magnetic resonance imaging were performed pretraining and post-training. The main findings were as follows. First, training enhanced balance performance in cerebellar patients. Second, in contrast to controls patients revealed significantly more post-training gray matter volume in the dorsal premotor cortex. Third, training-related increase in gray matter volume was observed within the cerebellum and was more pronounced in controls than in patients. However, statistically cerebellar changes were at the trend level and thus require additional, independent confirmation. We conclude that sensorimotor training of patients with cerebellar neurodegeneration induces gray matter changes primarily within nonaffected neocortical regions of the cerebellar-cortical loop. Residual function of the cerebellum appears to be exploited suggesting either a recovery from degeneration or intact processes of cerebellar plasticity in the remaining healthy tissue.

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Section: Training-related Postural Changesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Brain Changes Associated with Postural Training in Patients with Cerebellar Degeneration: A Voxel-Based Morphometry Study

Burciu¹,

Fritsche²,

Granert

et al. 2013

J. Neurosci.

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“…Resultaram um total de 13 artigos, sendo 4 revisões da literatura 13,18,19,20 , 5 estudos de caso 9,15,21,22,23 e 4 ensaios clínicos 11,14,24,25 . Os tipos de estudo, procedimentos realizados e principais resultados apresentados naqueles que envolviam métodos de atendimento fisioterapêutico estão apresentados na Tabela 1.…”

Section: Resultsunclassified

“…A marcha pode ficar atáxica, com ampliação da base de sustentação, instabilidade, passos irregulares e mais lentos, lateropulsão e tremor na amplitude de movimento 11 .…”

Section: Introductionunclassified

Atendimento Fisioterapêutico para Indivíduos com Ataxia Espinocerebelar: Uma Revisão da Literatura

Artigas

Ayres

Noll

et al. 2013

RNC

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RESUMOA ataxia espinocerebelar (AEC) é uma patologia caracterizada pelo déficit na execução de movimentos coordenados com progressiva oscilação postural associada à dificuldade de manutenção do equilíbrio e diversas outras alterações motoras. A marcha pode ficar atáxica, com ampliação da base de sustentação, instabilidade, passos irregulares e mais lentos, lateropulsão e tremor na amplitude de movimento, sendo o tratamento fisioterapêutico uma importante alternativa para a melhora das disfunções decorrentes desta patologia. Objetivo. Realizar, com base na literatura científica, uma revisão sobre as estratégias fisioterapêuticas no tratamento da ataxia espinocerebelar. Método. Pesquisaram-se as bases de dados Medline e SciELO de 2001 a 2011, considerando os unitermos: ataxia espinocerebelar, Fisioterapia, tratamento, reabilitação e seus correlatos em inglês. Resultados. Foram encontrados 33 estudos que tivessem como tema principal a ataxia, sendo excluídos 20 artigos, pois estes não relatavam a abordagem fisioterapêutica para este tipo de patologia. Após análise, 13 referências foram utilizadas. Conclusões. Após a realização deste estudo, destaca--se a importância da Fisioterapia no tratamento dos portadores de AEC, em função dos benefícios promovidos, visto que nos estudos encontrados os indivíduos apresentaram melhora dos sintomas decorrentes desta patologia. Limitações metodológicas observadas sugerem a necessidade de maior rigor em futuras pesquisas.Unitermos. Ataxia, Fisioterapia, Reabilitação, Exercício.Citação. Artigas NR, Ayres JS, Noll J, Peralles SRN, Borges MK, Brito CIB. Atendimento Fisioterapêutico para Indivíduos com Ataxia Espinocerebelar: Uma Revisão da Literatura. ABSTRACTThe spinocerebellar ataxia (SCA) is a disorder characterized by deficits in the execution of coordinated movements with progressive postural sway associated with difficulty in maintaining balance and various other motor disorders. The gait may be ataxic, with broadening the base of support, instability, irregular steps and slow, lateropulsion and trembling in range of motion, so that physical therapy is an important alternative for the improvement of the disorders of this pathology. Objective. Make, based on scientific literature, a review of physical therapy strategies in the treatment of spinocerebellar ataxia. Method. The study researches the databases Medline and SciELO from 2001 to 2011, considering the following keywords: ataxia espinocerebelar, Fisioterapia, tratamento, reabilitação and its correlates in English. Results. We found 33 studies that had as its main theme ataxia, 20 articles were excluded because they did not report the physical therapy approach for this type of pathology. After review, 13 references were used. Conclusions. After this study, the importance of physical therapy in the treatment of patients with SCA becomes obvious, according to the benefits promoted, as all studies found an improvement of symptoms of this pathology. Methodological limitations observed suggest the need for greater rigor in futur...

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“…Six RCTs [2, [49][50][51][52][53][54] were included in these systematic reviews that were published before October 2016. In addition, another RCT [55] was found in PubMed, upon searching for all systematic reviews and RCT reports regarding physical therapy that were published from 1980 to 2016.…”

Section: Reviewmentioning

confidence: 99%

Physical Therapy for Cerebellar Ataxia

Matsugi¹

2017

Neurological Physical Therapy

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Ataxia, the incoordination and balance dysfunction in movements without muscle weakness, causes gait and postural disturbance in patients with stroke, multiple sclerosis, and degeneration in the cerebellum. The aim of this article was to provide a narrative review of the previous reports on physical therapy for mainly cerebellar ataxia offering various opinions. Some systematic reviews and randomized control trial studies, which were searched in the electronic databases using terms "ataxia" and "physical therapy," enable a strategy for physical therapy for cerebellar ataxia. Intensive physical therapy more than 1 hour per day for at least 4 weeks, focused on balance, gait, and strength training in hospital and home for patients with degenerative cerebellar ataxia can improve ataxia, gait ability, and activity of daily living. Furthermore, the weighting on the torso, using treadmill, noninvasive brain stimulation over the cerebellum for neuromodulation to facilitate motor learning, and neurophysiological assessment have a potential to improve the effect of physical therapy on cerebellar ataxia. Previous findings indicated that physical therapy is time restricted; therefore, its long-term effect and the effect of new optional neurophysiological methods should be studied.

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Intensive coordinative training improves motor performance in degenerative cerebellar disease

Abstract: This study provides Class III evidence that coordinative training improves motor performance and reduces ataxia symptoms in patients with progressive cerebellar ataxia.

Cited by 286 publications

References 28 publications

Brain Changes Associated with Postural Training in Patients with Cerebellar Degeneration: A Voxel-Based Morphometry Study

Brain Changes Associated with Postural Training in Patients with Cerebellar Degeneration: A Voxel-Based Morphometry Study

Atendimento Fisioterapêutico para Indivíduos com Ataxia Espinocerebelar: Uma Revisão da Literatura

Physical Therapy for Cerebellar Ataxia

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