The assessment and treatment of postural disorders in cerebellar ataxia: A systematic review

Abstract

Gait and balance disorders are often major causes of handicap in patients with cerebellar ataxia. Although it was thought that postural and balance disorders in cerebellar ataxia were not treatable, recent studies have demonstrated the beneficial effects of rehabilitation programs. This article is the first systematic review on the treatment of postural disorders in cerebellar ataxia. Nineteen articles were selected, of which three were randomized, controlled trials. Various aetiologies of cerebellar ataxia were studied: five studies assessed patients with multiple sclerosis, four assessed patients with degenerative ataxia, two assessed stroke patients and eight assessed patients with various aetiologies. Accurate assessment of postural disorders in cerebellar ataxia is very important in both clinical trials and clinical practice. The Scale for the Assessment and Rating of Ataxia (SARA) is a simple, validated measurement tool, for which 18 of the 40 points are related to postural disorders. This scale is useful for monitoring ataxic patients with postural disorders. There is now moderate level evidence that rehabilitation is efficient to improve postural capacities of patients with cerebellar ataxia - particularly in patients with degenerative ataxia or multiple sclerosis. Intensive rehabilitation programs with balance and coordination exercises are necessary. Although techniques such as virtual reality, biofeedback, treadmill exercises with supported bodyweight and torso weighting appear to be of value, their specific efficacy has to be further investigated. Drugs have only been studied in degenerative ataxia, and the level of evidence is low. There is now a need for large, randomized, controlled trials testing rehabilitation programs suited to postural and gait disorders of patients with cerebellar ataxia.

The “butterfly diagram”: A gait marker for neurological and cerebellar impairment in people with multiple sclerosis

“…Rehabilitation program options include virtual reality, biofeedback, treadmill exercises with supported bodyweight and torso weighting [33]. For example, in 26 outpatients with ataxic MS, neuromuscular rehabilitation provided significant improvements in balance and gait parameters, as well as in pendular movements and dysdiadochokinesia [34], therefore, early detection of ataxia in MS individuals may be helpful.…”

Three Faces of Fragile X

“…51 Available evidence related to interventions appropriate to FXD is, as yet, lacking. 52 Initial definitions and descriptions of FXD are primarily found in the genetic and psychiatric literature. More recently, the significance of the movement disorders typical for FXD has also been identified and described in movement disorder literature.…”

Use of optokinetic chart stimulation to restore mobility and reduce ataxia in a patient with pseudo-Cushing ataxia

“…Moderate level evidence demonstrates that rehabilitation improves postural control in patients with cerebellar ataxia 2. However, intensive balance and coordination exercises have to be carried out over a long period of time 2.…”

“…However, intensive balance and coordination exercises have to be carried out over a long period of time 2. Techniques such as biofeedback, virtual reality and treadmill exercises with supported bodyweight appear to be of value, although their specific efficacies need further investigation 2. Physiotherapy is the main treatment for ataxic gait, but there is limited high-quality evidence for the interventions used 3.…”