arm ataxia from TBI - advice for non-expert

[Fyzzio]

Hi,
it is interesting that you use the expression ataxia (who diagnosed your partner?). Ataxia normally refers to a lack of co-ordination of muscle movements. Not commonly observed after a TBI, but possible, e.g after a cereballar event.
Your partner might suffer from unco-ordinated arm movements due to other symptoms, such as muscle weakness, combined with an increase in tone or spasticity.
It is really difficult to give specific advise over the distance, never having seen your partner move or feel the arm. So, I would recommend for you to consult a local, community-based Physiotherapist with experience in TBI or spinal injuries. She/he will be able to do an assessment and suggest therapeutic input and a home-based exercise programme. Sometimes, Botolinum Toxin-A injections, combined with intensive rehab programme (OT, PT, carer supported home programme)are also beneficial to give your partner a short window of opportunity to improve his arm functions to the max.

Hope this helps a little,
kind regards,
Fyzzio

[littlerachet]

Thanks Fyzzio, you make some good points.
My partner was in a specialist neuro rehabilitation unit and they diagosed ataxia, though weirdly that is his good side. He doesn't have spasticity in that side and not much high tone either. I have always been a bit dubious about this. He had a defuse brain injury from an RTA, so it is possible many parts of his brain were damaged.
He didn't have any shaking to begin with but it's there now from the moment he wakes up if he tries to move it. He's fine when the hand is still though.
Regarding getting a proper diagnosis - we don't have any physio support from the hospital and there is a physio as part of the community team who comes max once a week, though we haven't seen her for two weeks and honestly, getting her to look at the things we want to work on is difficult to say the least. It took her three months to organise a risk assessment to go to the gym and we still have no feedback. All the while I am thinking he just really needs to get into the gym and build himself back up.
If you have any suggestions it would be really really appreciated as at the moment we are struggling.

[Fyzzio]

Hi;
Yes, TBIs can present with all sorts of symptoms, since the injury is often diffuse and a nice "bang" to the head causes acceleration and deceleration damage. However, if the ataxia is a fairly recent problem (actually, how long after the accident was he diagnosed?) and is getting worse, this might need specialist, i.e. Neurologist assessment. It could be caused by a degenerative process - now this is going to make you really happy isn't it ...

TBI Rehab is a specialist area within Physio and not many of us have received additional training to provide the adequate treatment/ education. If your Physio support is unsatisfactory, would you be able to contact the Specialist Rehab Centre and ask for alternative support/ suggestions? Or are they able to review your partner and set up a plan for him?

Generally, ataxia is rather difficult to treat. I am unaware of what current research suggests. Here's my take:
Some patients do well with passive guidance for the desired movements; some work well when the joints are approximated (="pushed"), as in working against resistance or in a situation where e.g. the hand is fixed on a surface, rather then asking the patient to do a "free movement in space". The principle here is also to do task orientated and purposeful movements, i.e. aiming for a specific goal. In my experience, most ataxic patients lack trunk control = you need a firm trunk to be able to control arm movements. So that's worth looking at.

Hope you understand what I am talking about.
Good on you for caring so much,
best of luck,
Fyzzio