Ataxia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There is no specific treatment for ataxia as such, altough there may be for the underlying cause. The disability of ataxia may be reduced by physical therapy, including exercises, along with leg braces or shoe splints. If foot alignment has been affected then a cane or walker is often used in the effort to prevent falls.

Medical Therapy

• Recovery tends to be better in individuals with a single focal injury (such as stroke or a benign tumour), compared to those who have a neurological degenerative condition.

• The movement disorders associated with ataxia can be managed by pharmacological treatments and through physical therapy and occupational therapy to reduce disability. Some drug treatments that have been used to control ataxia include: 5-hydroxytryptophan (5-HTP), idebenone, amantadine, physostigmine, L-carnitine or derivatives, trimethoprim–sulfamethoxazole, vigabatrin, phosphatidylcholine, acetazolamide, 4-aminopyridine, buspirone, or a combination of coenzyme Q10 and vitamin E.

• Physical therapy requires a focus on adapting activity and facilitating motor learning for retraining specific functional motor patterns. A recent systematic review suggested that physical therapy is effective, but there is only moderate evidence to support this conclusion. The most commonly used physical therapy interventions for cerebellar ataxia are vestibular habituation, proprioceptive neurofaciliation, Frenkel exercises, and balance training; however, therapy is often highly individualized and gait and coordination training are large components of therapy.

• Current research suggests that, if a person is able to walk with or without a mobility aid, physical therapy should include an exercise program addressing five components: static balance, dynamic balance, trunk-limb coordination, stairs, and contracture prevention. Once the physical therapist determines that the individual is able to safely perform parts of the program independently, it is important that the individual be prescribed and regularly engage in a supplementary home exercise program that incorporates these components to further improve long term outcomes. These outcomes include balance tasks, gait, and individual activities of daily living. While the improvements are attributed primarily to changes in the brain and not just the hip and/or ankle joints, it is still unknown whether the improvements are due to adaptations in the cerebellum or compensation by other areas of the brain.

• Decomposition, simplification, or slowing of multi-joint movement may also be an effective strategy that therapists may use to improve function in patients with ataxia. Training likely needs to be intense and focused (as indicated by one study performed with stroke patients experiencing limb ataxia who underwent intensive upper limb retraining). Their therapy consisted of constraint-induced movement therapy which resulted in improvements of their arm function. Treatment should likely include strategies to manage difficulties with everyday activities such as walking. Gait aids (such as a cane or walker) can be provided to decrease the risk of falls associated with impairment of balance or poor coordination. Severe ataxia may eventually lead to the need for a wheelchair. In order to obtain better results, possible coexisting motor deficits need to be addressed in addition to those induced by ataxia. For example, muscle weakness and decreased endurance could lead to increasing fatigue and worse movement patterns.
• There are several assessment tools available to therapists and health care professionals working with patients with ataxia. The International Cooperative Ataxia Rating Scale (ICARS) is one of the most widely used and has been proven to have very high reliability and validity. Other tools that assess motor function, balance and coordination are also highly valuable to help the therapist track the progress of their patient, as well as to quantify the patient's functionality. These tests include, but are not limited to:
  • The Berg Balance Scale
  • Tandem Walking (to test for Tandem gaitability)
  • Scale for the Assessment and Rating of Ataxia
  • Tapping tests - The person must quickly and repeatedly tap their arm or leg while the therapist monitors the amount of dysdiadochokinesia.
  • Finger-nose testing - This test has several variations including finger-to-therapist's finger, finger-to-finger, and alternate nose-to-finger.

References

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