Longitudinal tracking of gait and balance impairments in cerebellar disease

Abstract

Cerebellar damage typically results in ataxia and can be caused by stroke, tumor or one of many forms of degenerative disease. Since few pharmacological options are available, most treatments rely heavily on rehabilitation therapy. Little data exist on methods for tracking the progression of ataxia, which is critical for assessing the efficacy of current and newly developing treatments. Here, we tracked the severity of ataxia, with a particular emphasis on gait and balance dysfunction, in a group of individuals with cerebellar damage using the International Cooperative Ataxia Rating Scale (ICARS) and several instrumented laboratory measures of gait and balance impairments over one year. We found that the ICARS was able to distinguish between subjects with static lesions and those with degenerative disorders, was sensitive to increases in ataxia severity occurring over one year, and correlated well with specific instrumented measures of gait in persons with cerebellar degeneration. These results suggest the ICARS is a valuable tool for clinicians and investigators to document and track long-term changes in gait and balance performance in individuals with cerebellar degenerative disorders.

Gait and balance in adults with Friedreich's ataxia

“…Gait velocity of subjects with FA was significantly slower than controls, and 6 out of 8 FA subjects walked below speeds required for community ambulation, considered faster than 0.80 m/s [22]. These results are consistent with studies reported for individuals with a variety of cerebellar ataxias [5][6][7]. Self-selected walking speed is considered a valid, reliable, sensitive and specific measure, which correlates with functional abilities, balance confidence and falls risk [22].…”

“…Studies have shown that people with cerebellar ataxia experience a gait pattern characterized by unsteadiness, reduced stride length, decreased gait velocity and increased gait variability [5,6]. The cerebellar ataxic gait pattern has been widely studied, however, the majority of these studies include subjects across age groups and with a variety of different cerebellar disorders [5][6][7][8].…”

“…The cerebellar ataxic gait pattern has been widely studied, however, the majority of these studies include subjects across age groups and with a variety of different cerebellar disorders [5][6][7][8]. Less well understood is the gait pattern of individuals with FA.…”

Physical Therapy for Cerebellar Ataxia

“…Clinical scales are often used for investigating the effect of physical therapy. In cerebellar ataxia, the most often used specific scales for the severity of cerebellar ataxia in previous studies were the scale for the assessment and rating of ataxia (SARA) [5, 10, 16, 56-59] and international cooperative ataxia rating scale (ICARS) [55,57,[60][61][62][63][64]. These scales include the measurement of not only incoordination movement of the upper and lower extremities but also balance in sitting, standing, and gait [10, 56,62].…”

Outcome measures for the assessment of balance and posture control in cerebellar ataxia

“…18 The ICARS is frequently used in pharmacological studies, 20 and has 19 items in total to assess posture and gait disturbances, kinetic function, speech disorders, and oculomotor disorders. 21,22 This test takes over 30 minutes to complete, and thus a shorter version was developed, the BARS. The BARS has five items (gait, knee-tibia test, finger-to-nose test, dysarthria, and oculomotor abnormalities) resulting in a maximum score of 30 and all the items are a part of the modified international cooperative ataxia rating scale.…”