ataxia

[rachelmcwilliams]

ideas predominantly for patients with cerebellar ataxia??

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[angela1]

Work in 4 point knealing or standing at parallel bars or walking with patients hands on your shoulders with her/his elbows straight.

[rachelmcwilliams]

thanks for that was good help

[davidjack]

HI,
start gait trainning with eyes open emphasising on foot placement.then slowly go for more complex activities as he keeps improving like with eyes closed/ standing balance on uneven surfaces/ ramp r stair climbing etc.
watch out, during exs session be by his side.

[sdkashif]

In ataxia the patient presents with incoordination, tremor, disturbances of posture, balance and gait. Physiotherapy is directed at promoting postural stability, accuracy of limb movements, and functional balance and gait.

Postural stability can be improved by focusing on static control ( holding) in a number of different weight bearing , antigravity postures ( e.g. prone on elbow, sitting, quadruped, kneeling, plantigrade and standing). Progression through a series of postures is used to gradually increase postural demand by varying the base of support and raising the centre of mass and increasing the number of body segments (degree of freedom) that must be controlled. Specific exercise techniques designed to promote stability include joint approximation applied through proximal joints ( through shoulders or hips) or head or spine, alternating isometrics (PNF), rhythmic stabilization (PNF). Patient with significant ataxia may not be able to hold steady and may benefit from the technique of slow reversal- hold (PNF), progressing through decrements of range. The desired end point is steady mid range holding.

Dynamic postural responses can be challeanged by incorporating controlled mobility activities (weight shifting, rocking, moving in and out of postures or movement transitions). The patient should practice important functional movement transitions, such supine to sit, sit to stand and scooting. Distal extremity movements can be superimposed on proximal stability to further challenge dynamic postural control. For example, resisited PNF Chop or lift patterns combined upper extremity movements with trunk movements ( flexion rotation or extension with rotation).

An important goal of therapy is to promote safe and functional balance. Static balance control can be improved by using force platform training. The patient with ataxia learns to reduce the postural sway (frequency and amplitude) and control centre of alignment position. The added biofeedback from visual and or auditory feedback display can improve control in some patients. Somatosensory, visual, and vestibular inputs can be varied, as appropriate, to assist in sensory compenssation in sensory sysytem less involved ( e.g. standing with eyes open to eyes closed, standing on flat surface top a foam surface). Prolonged latencies (onset of responces) should be expected. Dynamic balance control can be initiated using self initiated movements (e.g. reaching, truning, bending). A movable surface can also be used. For example, sitting activities on Swiss ball are an excellent way to promote balance control.

Control of dysmetric limb movements can be promoted by PNF extremity patterns using light resistance to moderate force output and reciprocal actions of muscles (e.g. slow reversals, slow reversal- hold). Frenkel's Exercises can be used to remediate the problems of dysmetria. The exercises are performed in supine, sitting and standing. Each activity is performed slowly with the patient using vision to guide correct the movement. The exercises require a high degree of mental concentration and effort. For those patients with prerequisite abilities they may helpful in regaining some control of ataxic movements through cognitive processes.

Ataxic movements have some times been helped by the application of light weights to provide additional proprioceptive loading and stablize movements. Velcro weight cuffs (wrist or ankle) or a weight belt or weight jacket can reduce dysmetric movements and tremors of the limbs and trunk. Th extra weights will also increase the energy expenditure, and must ,therefore, be used cautiously in order not to bring about increased fatigue. Weighted canes or walkers can be used to reduce ataxic upper limb movements during ambulation. For patient with significant tremor, this may mean the difference between assisted and independent ambulation. Elastic resistance bands can be used to provide resistance and reduce ataxic movements.

The pool is an important therapeutic medium to practice static and dynamic postural control in sitting and standing. Water provide graded resistance that slow down the patient ataxic movement, while the buoyancy aids in upright balance. Swimming and shallow water calisthenics have shown effective im improving strenght, decreasing muscular fatiguability and increasing endurance. In addition the use of moderate or cool water temperature may help moderate spasticity.

In general patients with ataxia do better in low stimulus environment that allows them to concentrate more fully on their movements. They benefit from augmented feedback ( verbal cuing of knowledge of results, knowledge of performance, biofeedback) and repitition to improve motor learning.

[pankajpt]

thanx a lot it is really helpful

[iawwad]

Hi Thanks for you all
I would like to suggest applying Tapping over the shoulders and pelvis to build up postural tone, and if child is able to walk, use Kay reverse walker.

[charlize29]

Hi sdkashif,

Thanks for all you input, I have tried doing PNF extremity patterns and with light weights and some of the treatment exercises you have mentioned, however there are certain positions that aren't applicable. My patient has a SEVERE cerebellar ataxia,a stroke case. Incoordination gets WORSE when he attempts to initate a movement. I also teach them visualization exercise for control purposes. Are there any other exercises for severe cases? thanks!!

regards,
Charlize29

[sdkashif]

Let me assure you that closed chain kinetic exercises and resisted exercises help a lot in resolving the ataxia and improving it.

[charlize29]

Hi sdkashif ,

I have been doing that too but maybe it's just a matter of time and patience. Anyway your help is deeply appreciated.

REgards,
Charlize29

[psychophysio]

I have had some success with putting weights on the pts feet while doing gait retraining. The increased resistance seems to help the pt to control their foot placement much better. You could do the smae with reaching tasks as well

[tiger99]

some PT in our country argue that PNF and application of light weight in treating cerebellar ataxia make ataxia worse. In your pracitce, are the two approaches effective for cerebellar ataxia?

[charlize29]

Hi tiger,

Application of weights is very helpful in treating ataxic patients, a high degree of concentration is necessary to achieve the desired task. Am getting good results with my patients.

Regards,
Charlize29

[tiger99]

Thank you!

[hijump]

man all of this is reallly helpful

[physiokhin]

HI,
start gait trainning with eyes open emphasising on foot placement.then slowly go for more complex activities as he keeps improving like with eyes closed/ standing balance on uneven surfaces/ ramp r stair climbing etc.
watch out, during exs session be by his side.

I found out the more emphasizing,the worse condition.may be because I don't have experience.please teach me u have good ways.

[hijump]

hi i got a patient 65 years old female she is suffering from cerebeller atrophy. she fell down few months back on her shoulder and now she has adhesive capsulitis. her abduction is just 90 degress with limitations in both rotations and if tried to move the arm she gets tremors.
how to mobilize her shoulder joint so that she wont face tremors and can be a bit more confedent to use the arm at home too for ADLs?

looking forward for feed back
tc