One‐year follow‐up of problem‐based task training for a child presenting cerebellar ataxia after brainstem glioma surgery: A single‐subject experimental study

Abstract

Background and purpose For the rehabilitation of patients with cerebellar ataxia, task training aids in achieving functional benefits. This study aimed to investigate the effects of problem‐based task training on balance and motor function in a child with cerebellar ataxia after brainstem glioma surgery. Methods This study used a single‐subject reversal design (A‐B) with a 1‐year follow‐up. A 5‐year old child with cerebellar ataxia due to a brain glioma completed problem‐based task training, including a 10‐step walk and return trial, walking while carrying an object, walking between parallel lines, and kicking a ball. Assessments were made using the Pediatric Balance Scale (PBS) and motor function tests (International Cooperative Ataxia Rating Scale (ICARS), Gross Motor Function Measure (GMFM), and Pediatric Evaluation of Disability Inventory (PEDI). Results During the intervention phase, the PBS score showed clinically and statistically significant improvement compared to the baseline score. The ICARS and GMFM scores improved by 10.53% and 3.56%, respectively, after the intervention. Furthermore, in the PEDI score, functional skills and caregiver assistance in the mobility domain increased by 7.58% and 5.02%, respectively, after the intervention. The improvements in all parameters were maintained or increased at further follow‐up phases. Conclusion These findings suggest that problem‐based task training has a positive effect on balance and motor function in a child with cerebellar ataxia after brainstem glioma surgery.

The Care and Management of Children and Young People with Ataxia Telangiectasia Provided by Nurses and Allied Health Professionals: a Scoping Review

“…Parents reported improvements in children’s mobility, sleep patterns, energy and activity levels, relaxation, and happiness 8 Elshafey et al (2022) Egypt [ 35 ] RCT CYP; n = 36 Cerebellar ataxic CP Physiotherapy Exercise and function Core stability exercise program alongside physical therapy program (physiotherapy 3 times weekly, intervention group received additional core stability training for 30 min) Statistically significant reduction reported in the severity of ataxia and improvement in balance, with stronger effects reportedfor IG. Core stability training improved strength and endurance of muscles, trunk control, corrective postural control mechanisms, and ability to use the vestibular, somatosensory, and visual systems to maintain balance and stability 9 Lee et al (2021) Republic of Korea [ 27 ] Single‐subject experimental study CYP; n = 1 Cerebellar ataxia Physiotherapy Exercise and function Problem-based task training consisting of four walking tasks- a 10‐step walk and return, walking while carrying an object, walking between parallel lines, and kicking a ball (10 min/task, 8 sessions each in baseline and intervention phase followed by 1-year follow-up. Total duration of intervention phase not reported) Repeated practice of functional tasks led to improvement in balance and physical performance thereby improving overall motor function in children with cerebellar ataxia 10 Yoo et al (2021) Republic of Korea [ 36 ] Case Report CYP; n = 2 Ataxic CP Physiotherapy Exercise and function Over-ground robot assisted gait training (Angel Legs M20) alongside conventional physical and occupational therapy (5 sessions/week for 1 month) Improvements reported in postural control, functional mobility, and balance in children with ataxic CP.…”

“…This was the most heavily represented theme in our search, with 37 sources of evidence reporting the impact of exercise and therapy on improving strength, coordination, and/or motor ability, and two sources of evidence reporting strategies to improve occupational performance. Although 12 studies examined the impact of physiotherapy, both the interventions and outcome measures varied considerably between studies [ 18 – 21 , 26 , 27 , 29 – 32 , 34 , 35 ]. Despite the wide range of outcome measures used, none of these studies with multiple participants focused on specifically evaluating age-dependent effects against treatment efficacy.…”

“…The study reported significant improvements in body structures and functions and positive improvements in the level of activity and participation following the therapy. Of the other ten studies reporting physiotherapy interventions, long-term multidimensional and individualized training programs generally led to improvements in strength, balance and stability, and/or functional parameters, which were often statistically and/or clinically significant although based on small sample sizes [ 19 – 21 , 27 , 29 – 32 , 34 , 35 ].…”

“…However, it is noteworthy that 6 months of intensive, goal-oriented functional rehabilitation intervals combined with vibration-assisted home training led to significantly improved motor function of children with ataxia [ 31 ]. Repeated practice of functional tasks led to improvement in balance and physical performance thereby improving overall motor function in children with cerebellar ataxia [ 27 ]. Reducing visual input during postural control [ 19 ], treadmill training in combination with transcranial direct current stimulation [ 32 ] or body weight support [ 21 ], standard physical therapy programs in combination with core stability program [ 35 ], and functional trunk training [ 34 ] were also identified as physiotherapy interventions that may be worthy of further study in the A-T population.…”

Effect of Exercise on the Ability of Children with Cerebellar Ataxia to Perform Activities of Daily Living

“…Besides, problem-based task training (10-step walk and return trial, walking while carrying an object, walking between parallel lines, and kicking a ball) was found to improve the balance, GMFM, ICARS, and PEDI score of children with cerebellar ataxia after brainstem glioma surgery [33] . Improvements in the SARA score, balance, GMFM, and Life Habits Questionnaire (LIFE-H) score, which is related to ADL, were also observed following balance and musclestrengthening exercises and video games (Wii Fit Balance Board and Wii games) in children with ataxia-telangiectasia, which is characterized by symptoms such as cerebellar ataxia [34,35] .…”