Hi Aussyy

It sounds like you have got some good ideas for treating this patient. I think you have to go off the presenting impairments as everyone is different. From an evidence point of view there isn’t much out about cerebellar management let alone a mixture of brainstem+ cerebellar signs which seems what your patient has. Have you looked at this systematic review? This might give you some ideas:

Effectiveness of physiotherapy for adults with cer... [Clin Rehabil. 2009] - PubMed result

My comments would be:

If ataxia is a big component then this really is a huge dexterity issue. Applying task-oriented training is the way to go. Utilise your motor learning principles as much as you can - particularly task specificity, repetitious practice, and intrinsic learning.

These patients are often motor learning disabled so they need to really get the practice in to compensate for this problem

These patients often have some ability to balance statically but if all goes to seed when they start walking. Obviously your patient does has difficulty with static standing so good idea to work on it. However building up her static standing may have not real transference to balance in walking.

I would therefore not delay walking practice if you possibly can set up safe walking. Body weight support treadmill training may get around this if you have access to the equipment. This may be an ideal way for your patient to build up skill of walking while her balance is still so atrocious. If you don’t have access then may be she might manage walking with an Arjo frame or even a gutter frame. For any of these techniques you may need more than one pair of hands to start off with.


Best of luck!