Ataxia in arm - need advice

[littlerachet]

My partner has Ataxia in his arm, due maybe to the TBI but possibly to increased tone and weakened muscle, particularly trunk muscles. Now we just need a plan for a few exercises we can try everyday to help with the shaking. Shaking is only in one arm, though he has balance issues when standing in frame.
He is restricted in what positions he can get into. Lying is fine, prone is difficult. He can sit on the edge of bed with help for limited time. He stands in electric frame for about 30 mins. We cannot do 4 point kneeling, he is not there yet. Currently, most physio is done in lying and some sitting, to work mainly on core.
We just need a few specific exercises that the care team can carry out that may help. We have resistance bands we could use and he goes to the gym each week, so there may be specific exercises he could do there.
Any help in layman terms will be VERY appreciated.

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[Dr Damien]

Dear littleratchet

Sorry to hear about your partner's condition. Its been a while since you put up this post, I was scheming through this forum and came across your thread and thought id just check to see whats happening with you.

It is going to be difficult to suggest anything meaningful for you and your partner to carry out. Cases like this, one needs to be physically there as everything to be suggested will mainly be along the lines of a problem solving approach. By problem solving, I mean devising ways to help him adjust to his current life in other to improve the quality of his daily living.

Before I give any advice, I would like to know the following:

What happened? Car accident? fall?...what did the doctors say? what explanation did they give and did they suggest there was the possibility of his movements getting better?

Ataxia means lack of coordination, suggesting perhaps a cerebellar problem...does he shake at rest or just mainly during trying to move his arm?

Any loss of sensation (can he feel you touch him everywhere in his arm lightly and deeply seperately?), does he know where the elbow, shoulder, wrist and fingers (particularly each one) when you ask him to touch any of these parts respectively with his eyes closed? Can he tell shapes of objects when placed in his arms with his eyes closed?

does he get into situations when his muscles just tighten up and his limbs seem hard to move?
is he left handed or right handed?
what is he having problems to manage with his hands?
can he use both his hands together for activities....?
What are you hoping that he should be able to do with his hands that would make his quality of life better...?

Intention Tremors (shaking from trying to move a part) are not something that physiotherapy can address...the quality of the movement and the task can be improved but this shaking will likely always be there...

So in my own opinion I think task specific training is necessary...
Repetitive use of the arm for a task such as reaching for a comb...attempting to pick matches and place them in a box etc are exercises that can be practiced over and over again...(it is better to use a task that he is likely to do in his daily life e.g comb his hair)

There are several exercises that help to improve coordination however it is best to put them in a functional task for your partner to be able to practice easily...

It sounds like he still has issues with his trunk control? this will greatly affect the ability to control his upper and lower limbs...because the stable base from where they can function is not optimal and his supporting muscles will appear weaker than they might be

These suggestions are speculations
remember that I do not know what movement he has got...at the very least he needs to keep his arm moving as best as he could...

You say he is working with a physio, bring some of your concerns to the physio and plan a functional goal that the physio can help you achieve...I am not sure if its reasonable to suggest any specific exercises to your partner without seeing what he can do with his arm

I would also suggest that you work with an neuro-occupational therapist with a special interest in upperlimb disorders, occupational therapists are fantastic at looking at functional tasks that a patient can be involved in to help improve his rehab...

Goodluck...