The effectiveness of allied health care in patients with ataxia: a systematic review

Abstract

Many patients with cerebellar ataxia have serious disabilities in daily life, while pharmacological treatment options are absent. Therefore, allied health care is considered to be important in the management of these patients. The goal of this review is to evaluate scientific evidence for allied health care in cerebellar ataxia, to identify effective treatment strategies, and to give recommendations for clinical practice and further research. A systematic search for clinical trials concerning allied health care in cerebellar ataxias was conducted using the electronic databases of PubMed, Medline, Embase, Cinahl and Pedro, and references lists of articles, in the time period from 1980 up to and including December 2011 in English and Dutch. We identified 14 trials, of which the four best studies were formally of moderate methodological quality. There was a wide variation in disease entities and interventions. The combined data indicate that physical therapy may lead to an improvement of ataxia symptoms and daily life functions in patients with degenerative cerebellar ataxia (level 2), and in other diseases causing cerebellar ataxia (level 3). When added to physical therapy, occupational therapy might improve global functional status, and occupational therapy alone may diminish symptoms of depression (level 3). There are insufficient data for speech and language therapy. Despite the widespread use of allied health care interventions in cerebellar ataxia, there is a lack of good quality studies that have evaluated such interventions. We found some support for the implementation of physical therapy and occupational therapy, but more research is needed to develop recommendations for clinical practice.

Motor Training in Degenerative Spinocerebellar Disease: Ataxia-Specific Improvements by Intensive Physiotherapy and Exergames

“…Articles were included if they met all of the following criteria: (i) original report, but not, for example, conference abstracts or reviews; (ii) prospective clinical trial evaluating the effectiveness of physical therapy or of other motor training programs focusing on gait and stance (e.g., computer assisted training, treadmill training, or videogame based training); (iii) high-intensity training over an extended time period, defined as repeated continuous exercises without interruption for at least >45 minutes per training session with ≥3 training sessions and ≥3 hours per week for ≥2 weeks; (iv) control design (case-control or intraindividual control design), but not uncontrolled case or cohort studies; (v) recruitment of patients with spinocerebellar degeneration, but not with secondary cerebellar ataxias due to, for example, stroke, tumor, trauma, inflammatory, or autoimmune causes (for a systematic review on training studies in these patients; see [37]). Spinocerebellar degeneration had to be a core feature in these patients.…”

Quality of Life and the Degree of Disease Acceptance In Patients with Spinocerebellar Ataxia

“…Patients, apart from physical limitations, encountered limitations in social life, even in relations with those people who were the closest [16]. Unfortunately, there is a lack of good quality studies that have evaluated speech and language therapy [17].…”

Consensus Paper: Management of Degenerative Cerebellar Disorders

“…Another open question is to decide the best moment to introduce which kind of auxiliary device. Furthermore, there is lack of larger well-controlled studies showing that speech therapy and occupational therapy are indeed beneficial [139]. …”