Rehabilitation of Balance in Two Patients With Cerebellar Dysfunction

Abstract

The treatment of two patients with cerebellar dysfunction is described. One patient was a 36-year-old woman with a 7-month history of dizziness and unsteadiness following surgical resection of a recurrent pilocystic astrocytoma located in the cerebellar vermis. The other patient was a 48-year-old man with cerebrotendinous xanthomatosis (CTX) and diffuse cerebellar atrophy, and a 10-year history of progressive gait and balance difficulties. Each patient was treated with a 6-week course of physical therapy that emphasized the practice of activities that challenged stability. The patient with the cerebellar tumor resection also performed eye-head coordination exercises. Each patient had weekly therapy and performed selected balance retraining exercises on a daily basis at home. Measurements taken before and after treatment for each patient included self-perception of symptoms, clinical balance tests, and stability during selected standing and gait activities; for the patient with the cerebellar tumor resection, vestibular function tests and posturography were also performed. Both patients reported improvements in symptoms and demonstrated similar improvements on several kinematic indicators of stability during gait. The patient with the cerebellar tumor resection improved on posturography following treatment, whereas the patient with CTX improved on clinical balance tests. This case report describes two individualized treatment programs and documents functional improvements in two patients with different etiologies, durations, and clinical presentations of cerebellar dysfunction. The outcomes suggest that patients with cerebellar lesions, acute or chronic, may be able to learn to improve their postural stability.

Effect of oculo-motor and gaze stability exercises on postural stability and dynamic visual acuity in healthy young adults

“…There are many reported benefits of gaze stability exercises for patients with vestibular dysfunction [12][13][14][15][16][17]. Strupp et al [17] reported significant reduction of body sway caused by improved VSR compensation in patients with vestibular dysfunction as a result of specific vestibular rehabilitation exercises.…”

“…Decreased postural stability and visual acuity can be induced by active neck rotation and/or head tilt in patients with vestibular dysfunction as well as in healthy people [4][5][6][7][8][9][10][11]. The effects of vestibular rehabilitation gaze stability exercises in patients with vestibular dysfunction is well established and includes improved postural stability and dynamic visual acuity (DVA), however there are no reports that gaze stability exercises are beneficial for healthy populations [12][13][14][15][16][17].…”

High curvature and jerk analyses of arm ataxia

“…Healthy subjects were free of musculoskeletal disorders, visual impairment (or were corrected for visual impairment), and vestibular or central nervous system disorders. The CB patients were diagnosed by a neurologist using MRI or CT scans to demonstrate cerebellar de®ciency, and they showed symptoms of locomotor and balance impairment upon clinical examination (Gill-Body et al 1997). Apart from their CB dysfunction, the patients were healthy (no signi®cant co-morbidity) and were able to rise from a chair and walk unassisted.…”

The neurological outcomes of cerebellar injury in premature infants

“…Therefore, cerebellar injury alone might not predict a patient's motor development, which might be affected by supratentorial lesions, including those in the white matter and basal ganglia [9]. Rehabilitation of balance is important for patients with cerebellar lesions, as it improves their postural stability [20]. Long-term rehabilitation beginning from infancy or early childhood might have improved the ability of our patients to walk.…”