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The Importance of Rehabilitation for Ataxia Treatment
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The Importance of Rehabilitation for Ataxia Treatment

Ataxia is a classical neurological sign comprising of a deficiency of the voluntary coordination of muscle movements, with a special symptom being gait abnormality – the patient cannot walk normally and usually walk with a shortened stride and a high step pattern and veering from one side to another. This is usually the most important part of the neurological examination.

 

Ataxia is not specific clinical manifestation to a singular neurological disease but shows dysfunction of some parts of the nervous system, mainly the Cerebellum (thus Cerebellar Ataxia) which coordinates movement. Cerebellar ataxia takes different forms depending on where the lesion is in the cerebellum ,but includes wide ranges of  symptoms such as asthenia(weakness), asynergy (Lack of coordination between muscles, organs and limbs) ,and displaying instability when walking and difficulties with eye movements.

 

Medical experts are yet to come up with a pharmacological cure for cerebellar ataxia due to its nature as a neurodegenerative disease and so for many years it was thought that postural and balance disorders in Cerebellar ataxia are untreatable. However, the results of several recent studies suggest that rehabilitation can relieve postural disorders in patients with cerebellar ataxia thus Ataxia rehabilitation therapy has been used as the primary ataxia treatment particularly in patients with degenerative ataxia or Multiple Sclerosis. Recent studies and tests have shown that rehabilitation in the form of Neurorehabilitation can greatly improve the condition of patients suffering with Cerebellar Ataxia. In a case study involving 14 patients with Cerebellar Ataxia (but without other neurological diseases e.g. Parkinson’s disease), ataxia rehabilitation program involving exercise was used in the form of a home based exercise program.

 

This Ataxia rehabilitation program, which aimed to restore normal movement prove difficult due to the fact that patients with cerebellar ataxia suffer deficiencies in motor learning, and so the treatment relies on a great deal of emphasis being on motor learning. In the case study, the patients undergo a long term motor training rehabilitation in which they begin with a six week intensive training that focused on restoring balance rather than leg coordination which is the case in cerebellar ataxia. The rehabilitation focused on static and dynamic balance actives instead of training to walk. Patients had to exercise balancing in sitting and standing positions to benefit those with early stage Ataxia to balance on 1 leg (Highly functional individuals) and mid to late stage ataxia patients standing with hand support (Severely affected individuals).

 

Static standing Balance was assessed by measuring posturing swaying whereby participants had to stand with arms crossed over their chest and feet shoulder-width apart. This was done firstly with their eyes open and then their eyes closed. The second assessment was done on their walking where participants had to walk on a 12 metre runway 6 times with each trial recorded to see the speed at which they can walk and to see if they would veer from side to side, and also to calculate their stride length on average .This was done daily over a six week duration

 

The results showed that on average ,the patients had improved in terms of strength of muscles to maintain balance, with a few reporting challenges in balance. There was an overall 60% improvement on balance of these individuals who participated in the Ataxia rehabilitation case study, with 40% balance challenge. The stride lengths of the whole group on average increased from 0.8m to 1.2 m and they had a considerably lower step .Of the participants who continued the ataxia rehabilitation exercises after the six weeks was over, none of them reported falling whilst doing the exercises .The group also recorded faster walking speed of 0.9m/s from 0.6m/s and they also recorded a faster transition in walking from the right foot to the left foot than recorded at the beginning of the study.

  

Laboratory tests for all these patients in Magnetic Resonance Imaging (MRI) of the cerebellum showed quite significant improvements in the areas affecting movements.

 

These results showed the great potential and importance of Physical rehabilitation in treatment of ataxia .We can deduce that the rehabilitation greatly improved the clinical wellbeing of the patients. The study also showed that the challenge level when balancing, rather than duration of exercise, produced greater results - thus showing the importance of one-on-one practise with a therapist.it is mostly advised however that patients when doing balancing exercises get assistance for safety.

 

Ataxia Rehabilitation was shown to greatly improve walking speeds, which is reflective of overall functional independence, greater control and good quality of life. With a better stride length and less support time required to obtain balance, patients can take longer steps and less time transitioning from one foot to the other.

 

The rehabilitation also improved eye movements and eyelid movements, as patients could close their eyes slower than they previously were able to do, and some patients do not need a walking stick to walk once they have completed the rehabilitation.

 

Most of these Exercises should be accredited to the Frenkel exercises, a set of exercises developed by Professor Heinrich Sebastian Frenkel to treat ataxia, in particular cerebellar ataxia.

 

Overall, it can be noted that Ataxia rehabilitation is very important in treatment of Ataxia. It improves locomotion. It aims to improve balance, which is the most vital to improving gait (walking). Patients suffering from Cerebellar Ataxia can use ataxia rehabilitation as treatment for a prolonged time to achieve greater results. However, besides the severity of the ataxia, factors like Age and other degenerative neurological diseases present could influence how well this treatment works. It remains of paramount importance that patients suffering from Cerebellar ataxia work towards remaining in good health by engaging in physical and mental exercise programs such as the Ataxia rehabilitation ,and in addition they should sleep well, eat well ,and  avoid injury from falling.

 

 

 

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