Physiotherapy in Cerebellar disorders

[Manohar]

Hello,

Can any one suggest to me physical therapies for a individual with Cerebellar lesions. I am looking for proven exercises which will help in coordination, ataxia, speech problems, motor learning and so on. Inaddition to your expert advise, could you please suggest books, websites, journals from which i could i can get this information

Thanks in advance,

Manu

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[sdkashif]

For detail about the cerebellar lesions resulting in problems of Speech, incoordination, ataxia and motor learning, have a look over

Physical Rehabilitation, Assessment and Treatment, 4th Edition, by Susan. B. O'Sullivan & Thomas J.Schmitz

Kindly also have a look over the following detail.

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.

[Manohar]

thanks, i will take a look at that book.

Cheers,

Manu

[jebapt]

can u plz suggest specific exercises to control cerebellar symptoms such as tremor, dysmetria and postural instability, and gait

[Gawaine]

for postural instability, gait, and to help decrease ataxia a little bit, i've had fair to good success with anything that helps them find their midline... if you're fortunate enough to have a balancemaster machine or something that gives electronic visual biofeedback as to where their center of gravity is, use that!!
if not, start them in a concave corner. have them stand against the walls so they can experience the feedback that helps them find their center. then progress them to standing against a convex corner... they should be paying attention to their midline and what the wall "Tells them"... you should then progressively have them bring their center of gravity a bit away from the corner point so they can learn to maintain this center of gravity without the feedback..
for gait, start with small, controlled steps... do whatever they can do without ataxia and then progress that toward normal... one good feedback device is to take a LONG theraband (about 5-6 feet), wrap the middle of that long theraband around their foot-- pull it upward (with a bit of pull into eversion if necessary), cross it over then wrap it behind the knee, then wrap it back around to the anterior side of the thigh, then tie both ends off to a belt around their waist... try it on yourself to get the idea... it gives good proprioceptive feedback and it assists with the proper motion of portions of the gait cycle... ankle weights, i feel, are generally less effective but can have some advantages with certain patients... consider ankle weights for stair training...

beyond that, general gait and balance training should also be incorporated into the patient's routine...

i don't know how "proven" this stuff is....... but it's what has worked for me in real situations...


patrick, MPT


ps- let me know if you don't "get" the theraband wrap thing...... i could search for or just draw up/photograph an example...

[jebapt]

Thanxs for ur suggestions.. If possible can you post any videos, illustrations, pictured diagrams for these exercises...

[Neh]

Hi Gawaine..
i tried gettin dat theraband wrap thing but was unable to get it practically ..cud u plz help me wid sum drawing stuff..so dat visually it becomes simpleer to understand..
thanku!!