Association of posturography with clinical measures in balance rehabilitation of ataxic patients.

The assessment of balance includes posturography measures and clinical balance tests in individuals with ataxia. Although both advantages and disadvantages of these assessments have been stated, no relationship between them in individuals with ataxia has been shown in the literature. The aim of this cross-sectional study was to investigate the relationships between commonly used clinical balance tests and posturography measures in ataxic individuals. The study included a total of 42 patients (mean age: 33.90 ± 8.75 years) with different diagnoses causing ataxia. The sensory organization test (SOT), limits of stability (LOS), unilateral stance and rhythmic weight shift (RWS) tests in computerized dynamic posturography and the clinical balance tests of Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS) and timed up and go (TUG) test were used to assess balance. The Spearman correlation test was used to evaluate the relationships between the clinical balance tests and posturography variables. Moderate and strong correlations were found between the ICARS, BBS and TUG scores and Unilateral Stance sway velocity, directional control parameter of RWS and LOS (P < 0.01-0.05). The ICARS and BBS scores were correlated with the SOT-Composite Equilibrium Score (P < 0.01-0.05). The results of this study suggest the use of both posturography and clinical balance tests in the rehabilitation of ataxic individuals with mild-moderate balance impairment, because posturography variables determine the underlying cause of imbalance and clinical tests evaluate balance in functional activities.

Predictive Validity of the Scale for the Assessment and Rating of Ataxia for Medium-Term Functional Status in Acute Ataxic Stroke.

OBJECTIVES: This study examines the prognostic validity of the Scale for the Assessment and Rating of Ataxia for patients with acute stroke. MATERIALS AND METHODS: We enrolled 120 patients with posterior circulation stroke having ischemic or hemorrhagic lesions with ataxia who had physical therapy. We recorded the clinical stroke features and obtained the scale for the assessment and rating of ataxia and National Institutes of Health Stroke Scale scores 7 days after admission and at discharge. Predictive factors for a 3-month modified Rankin Scale score of <3 were investigated. RESULTS: During hospitalization, the Scale for the Assessment and Rating of Ataxia score decreased from 7.5 (interquartile range, 4.5-12.5) to 4.0 (interquartile range, 1.5-8.0) points, whereas the National Institutes of Health Stroke Scale score changed from 1 (interquartile range, 0-3) to 1 (interquartile range, 0-2) point. A significant correlation between functional outcome and the Scale for the Assessment and Rating of Ataxia scores 7 days after onset was observed. The cutoff value for the assessment and rating of ataxia for predicting favorable outcome (modified Rankin scale, 0-2) at 3 months post-onset was 14 points (0-40) at 7 days after onset. CONCLUSIONS: The Scale for the Assessment and Rating of Ataxia scores showed good responsiveness to neurological changes in patients with acute ataxic stroke, could predict functional outcomes 3 months after onset on day 7, and could be a useful and reliable marker for patients with ataxic stroke.

The Use of New Mobile and Gaming Technologies for the Assessment and Rehabilitation of People with Ataxia: a Systematic Review and Meta-analysis.

There are no currently available disease-modifying pharmacological treatments for most of the chronic hereditary ataxias; thus, effective rehabilitative strategies are crucial to help improve symptoms and therefore the quality of life. We propose to gather all available evidence on the use of video games, exergames, and apps for tablet and smartphone for the rehabilitation, diagnosis, and assessment of people with ataxias. Relevant literature published up to June 8, 2020, was retrieved searching the databases PubMed, ISI Web of Science, and the Cochrane Database. Data were extracted using a standardized form, and their methodological quality was assessed using RoB and QUADAS-2. Six studies of 434 retrieved articles met the predefined inclusion/exclusion criteria. Two of them were diagnostic, while 4 were experimental studies. Studies included participants ranging from 9 to 28 in trials and 70 to 248 in diagnostic studies. Although we found a small number of trials and of low methodological quality, all of them reported an improvement of motor outcomes and quality of life as measured by specific scales, including the SARA, BBS, DHI, and SF-36 scores. The main reason for such low quality in trials was that most of them were small and uncontrolled, thus non-randomized and unblinded. As video games, exergames, serious games, and apps were proven to be safe, feasible, and at least as effective as traditional rehabilitation, further and more high-quality studies should be carried out on the use of these promising technologies in people with different types of ataxia.

Investigating the Clinical Significance and Research Discrepancies of Balance Training in Degenerative Cerebellar Disease: A Systematic Review.

OBJECTIVE: The aims of this study were to understand the clinical significance of balance training in degenerative cerebellar disease and to analyze inconsistencies among published data. DESIGN: Five databases were searched from inception to October 8, 2019. Cochrane guidelines informed review methods, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The Australian National Health and Medical Research Council Evidence Hierarchy, PEDro scale, and Joanna Briggs Institute Critical Appraisal Tools were used to evaluate methodological quality. Outcome measures examined included ataxia severity, gait speed, and balance. RESULTS: Fourteen articles were identified that met inclusion criteria. The quality of evidence was moderate to high, with recent articles being of higher quality. Nine of 12 articles showed statistical improvements in ataxia severity (reduction ranging from 1.4 to 2.8 in the Scale for the Assessment and Rating of Ataxia points), three of eight showed statistical improvements in gait speed (average increase of 0.1 m/sec), and six of nine showed improvements in balance measures (average increase of 1.75 in Berg Balance Scale and 1.5 in Dynamic Gait Index). CONCLUSION: Most studies showed statistical and clinically significant ataxia severity improvements in subjects who performed balance training. The amount of balance challenge and frequency of training were important factors in determining the extent of training benefit. Gait speed may also improve if walking exercises are included in the balance training, but more studies need to be conducted. Balance measures statistically improved with training, but these improvements did not meet criteria for clinical significance. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe the cause(s) of discrepancies in the literature regarding the benefits of balance training in degenerative cerebellar disease; (2) Determine if benefits from balance training are clinically meaningful for individuals with cerebellar degeneration; and (3) Understand the best practices gleaned from the current literature regarding balance training for these diseases. LEVEL: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Effectiveness of bimanual coordination tasks performance in improving coordination skills and cognitive functions in elderly.

BACKGROUND: The purpose of the study was to determine the impact of the performance of bimanual coordination tasks with specific characteristics on the changes in quality of coordination, musculoskeletal load of the upper limbs and cognitive functions. METHODS AND FINDINGS: A group of 26 people aged 60-67 years performed 6 sessions of bimanual coordination training. Each session included set of tasks that varied depending on the shape in which the cursor moved, the coordination mode (in-phase, anti-phase, complex) and the tracking mode (imposed or freely chosen speed). Performance was assessed by: Error, Variability and Execution. The load of upper limb muscles was expressed with the value of the normalized EMG amplitude. Cognitive functions were evaluated using the Vienna Test System. The Variability and Error values obtained during the sixth training session decreased by more than 50% of the initial values. Tasks with freely chosen speed showed changes from 15% to 34% for Error and from 45% to 50% for Variability. For tasks with imposed speed and coordination mode anti-phase or complex it was between 51% and 58% for Error and between 58% and 68% for Variability. Statistically significant differences between load during the sixth training session compared to the first session occurred in three out of four muscles and were between 9% to 39%. There were statistically significant differences in motor time and no differences in variables describing attention and working memory. CONCLUSIONS: Coordination mode is meaningful for improving coordination skills; tasks in the anti-phase and complex are recommended. Tracking mode also plays a role, tasks with an imposed cursor movement speed have greater potential to improve coordination skills than tasks with freely chosen. Improved control skills resulted in the reduction of upper limb musculoskeletal load. It can be assumed that an increase in coordination skills with the use of appropriate training can help to reduce musculoskeletal load.

Methotrexate-induced Acute Myelopathy in a Teenager With High-risk Acute Lymphoblastic Leukemia.

Acute lymphoblastic leukemia (ALL) is one of the most frequent malignancies in childhood whose long-term survival has increased up to 80% thanks to modern therapy enhancements. Nevertheless, methotrexate (MTX) remains a mainstay of ALL therapy, but also represents one of the major causes of neurotoxicity in patients with ALL. MTX-induced toxicity occurs in about 9% of patients treated for ALL. It usually affects deep white matter region leading to leukoencephalopathy, which has varying clinical manifestations ranging from acute neurologic disturbances to seizures or chronic permanent encephalopathy. Here we describe a 13-year-old girl affected with ALL who developed lower limbs hypesthesia and static ataxia due to transverse myelopathy after intrathec administration of MTX therapy. A high-dose corticotherapy combined to vitamin supplementation and rehabilitation was tested. Neurological evolution was characterized by slow and partial recovery.

Effect of object substitution, spontaneous compensation and repetitive training on reaching movements in a patient with optic ataxia.

We report the case of M.B. who demonstrated severe optic ataxia with the right hand following stroke in the left hemisphere. The clinical picture may shed light on both the pathological characteristics of reaching and grasping actions, and potential rehabilitation strategies for optic ataxia. First, M.B. demonstrated a dissociation between severely impaired reaching and relatively spared grasping and tool use skills and knowledge, which confirms that grasping may be more intermingled with non-motoric cognitive mechanisms than reaching. Besides, M.B.'s reaching performance was sensitive to movement repetition. We observed a substitution effect: Reaching time decreased if M.B. repeatedly reached toward the same object but increased when object identity changed. This may imply that not only object localization but also object identity, is integrated into movement programming in reach-to-grasp tasks. Second, studying M.B.'s spontaneous compensation strategies ascertained that the mere repetition of reaching movements had a positive effect, to the point M.B. almost recovered to normal level after an intensive one-day repetitive training session. This case study seems to provide one of the first examples of optic ataxia rehabilitation. Reaching skills can be trained by repetitive training even two years post-stroke and despite the presence of visuo-imitative apraxia.

The use of motor learning and neural plasticity in rehabilitation for ataxic hemiparesis: A case report.

Background and Purpose: Although the principles of neural plasticity for stroke rehabilitation are well established, specific intervention plans for patients with ataxia following a lacunar infarct are not well described. The purpose of this case report is to describe the intervention program for a patient with ataxic hemiparesis based on principles of motor learning and neural plasticity. Case Description: An 83-year-old, socially active male presented to the emergency department with right-sided upper extremity weakness and ataxia. The patient's acute hospital course included 4 days in a stoke unit, followed by 13 days in inpatient rehabilitation. Intervention: A 3-phase graded mobility and coordination plan was used during inpatient rehabilitation. Interventions included function-based training with repeated ambulation, coordination activities for the upper and lower extremities, and strengthening to help the patient achieve his goal of walking "without gait deviations." The concepts of motor learning and neural plasticity were utilized for timing and feedback on patient errors when implementing this novel program. Outcomes: The patient's level of assistance for mobility and activities of daily living improved from minimal assistance to modified independence without use of an assistive device. The Dynamic Gait Index score improved from 16/24 to 20/24 suggesting a decreased fall risk. Discussion: This case report describes a novel intervention strategy for a patient with ataxia following a lacunar stroke. The application of the principles of neural plasticity and motor learning was the foundation for a function-based plan of care.

Motor Improvement in Adolescents Affected by Ataxia Secondary to Acquired Brain Injury: A Pilot Study.

AIM: To assess changes in locomotion and balance in adolescents affected by ataxia secondary to acquired brain injury after a rehabilitation treatment with physiotherapy and the Gait Real-time Analysis Interactive Lab (GRAIL), an immersive virtual reality platform. METHODS: 11 ataxic adolescents (16(5) years old, 4.7(6.7) years from injury) underwent 20 45-minute sessions with GRAIL plus 20 45-minute sessions of physiotherapy in one month. Patients were assessed before and after rehabilitation with functional scales and three-dimensional multiple-step gait analysis. RESULTS: Results showed significant improvements in ataxia score assessed by the Scale for the Assessment and Rating of Ataxia, in dimension D and E of Gross Motor Function Measure, in walking endurance and in balance abilities. Moreover, the training fostered significant changes at hip, knee, and ankle joints, and the decrease of gait variability, toward healthy references. INTERPRETATION: In spite of the pilot nature of the study, data suggest that training with immersive virtual reality and physiotherapy is a promising approach for ataxic gait rehabilitation, even in chronic conditions.

Motor Function Improvement in Children with Ataxia Receiving Interval Rehabilitation, Including Vibration-Assisted Hometraining: A Retrospective Study.

BACKGROUND: Physiotherapy, including vibration-assisted therapy, has been proven to be effective for patients with ataxic cerebral palsy. Herewith, we studied the effect of a functional, goal-oriented interval rehabilitation program, including vibration-assisted home-training on the motor function of children with congenital ataxias. PATIENTS: 45 children (mean age 7.7 years, SD 4.70) with ataxia, having received a 6-month home-based side-alternating vibration-assisted therapy combined with intensive, goal-oriented, functional rehabilitation intervals, were included in the study, classified according to the progressive or non-progressive ataxia character. METHOD: Retrospective analysis of the prospectively collected data of the registry of the Cologne rehabilitation program "Auf die Beine". Motor abilities have been assessed prior to the intervention (M0), after 6 months of home-training (M6) as well as in a follow-up 6 months later (M12). We performed a gait analysis, a 1-minute walking test (1-MWT), and the Gross Motor Function Measure (GMFM-66). RESULTS: The GMFM-66 improvement (M6-M0 vs. M12-M6) was statistically significant with median improvement of 2.4 points (non-progressive) and 2.9 points (progressive) respectively, and clinically relevant. The 1-MWT improvement was statistically significant and clinically relevant for non-progressive ataxia. CONCLUSION: The intensive training, including vibration-assisted therapy significantly improved the motor function of children with ataxia. Six months later the skills were preserved in children with progressive ataxia and could be further developed in non-progressive forms.

Model for prompt and effective classification of motion recovery after stroke considering muscle strength and coordination factors.

BACKGROUND: Muscle synergies are now widely discussed as a method for evaluating the existence of redundant neural networks that can be activated to enhance stroke rehabilitation. However, this approach was initially conceived to study muscle coordination during learned motions in healthy individuals. After brain damage, there are several neural adaptations that contribute to the recovery of motor strength, with muscle coordination being one of them. In this study, a model is proposed that assesses motion based on surface electromyography (sEMG) according to two main factors closely related to the neural adaptations underlying motor recovery: (1) the correct coordination of the muscles involved in a particular motion and (2) the ability to tune the effective strength of each muscle through muscle fiber contractions. These two factors are hypothesized to be affected differently by brain damage. Therefore, their independent evaluation will play an important role in understanding the origin of stroke-related motor impairments. RESULTS: The model proposed was validated by analyzing sEMG data from 18 stroke patients with different paralysis levels and 30 healthy subjects. While the factors necessary to describe motion were stable across heathy subjects, there was an increasing disassociation for stroke patients with severe motor impairment. CONCLUSIONS: The clear dissociation between the coordination of muscles and the tuning of their strength demonstrates the importance of evaluating these factors in order to choose appropriate rehabilitation therapies. The model described in this research provides an efficient approach to promptly evaluate these factors through the use of two intuitive indexes.

Smart and Assistive Walker - ASBGo: Rehabilitation Robotics: A Smart-Walker to Assist Ataxic Patients.

Locomotion is an important human faculty that affects an individual's life, bringing not only physical and psychosocial implications but also heavy social-economic consequences. Thus, it becomes paramount to find means (augmentative/assistive devices) to empower the user's residual capacities and promote functional recovery.In this context, a smart walker (SW) is explored for further clinical evaluation of ataxic patients during walker-assisted and to serve as a functional compensation and assist-as-needed personalized/customized rehabilitation tool, autonomously adapting assistance to the users' needs, through innovative combination of real-time multimodal sensory information from SW built-in sensors. To meet the users' needs, its design was weighed, considering to whom it is intended.Thereby, this paper presents the system overview, focusing on design considerations, mechanical structure (frame and main components), electronic and mechatronic components, followed by its functionalities. Lastly, it presents results regarding the main functionalities, addressing clinical evidence.

Use of optokinetic chart stimulation to restore mobility and reduce ataxia in a patient with pseudo-Cushing ataxia.

A 61-year-old patient was admitted to hospital after a fall. She presented with bilateral muscle weakness and severe ataxia. She was unable to maintain sitting balance or place feet on the floor and was unable to tolerate hoist transfers due to the severity of her ataxia. Nursing and physiotherapy staff found it difficult to sit her out of bed. Her physiotherapy intervention changed to optokinetic chart stimulation (OKCS) and sensory interaction for balance. After treatment for 5 days, her intention tremor fully resolved. At discharge, she was mobile with a wheeled zimmer walking frame and supervision of one person. At follow-up after 8 months, she was independently mobile without any walking aid in and around her house. She was going out shopping with her son. For recovery from ataxia, it is recommended that further research on restorative intervention at the nervous system level be carried out.

A Comparative Study of Conventional Physiotherapy versus Robot-Assisted Gait Training Associated to Physiotherapy in Individuals with Ataxia after Stroke.

OBJECTIVES: To assess the influence of RAGT on balance, coordination, and functional independence in activities of daily living of chronic stroke survivors with ataxia at least one year of injury. METHODS: It was a randomized controlled trial. The patients were allocated to either therapist-assisted gait training (TAGT) or robotic-assisted gait training (RAGT). Both groups received 3 weekly sessions of physiotherapy with an estimated duration of 60 minutes each and prescribed home exercises. The following outcome measures were evaluated prior to and after the completion of the 5-month protocol treatment: BBS, TUG test, FIM, and SARA. For intragroup comparisons, the Wilcoxon test was used, and the Mann-Whitney test was used for between-group comparison. RESULTS: Nineteen stroke survivors with ataxia sequel after one year of injury were recruited. Both groups showed statistically significant improvement (P < 0.05) in balance, functional independencein, and general ataxia symptoms. There were no statistically significant differences (P < 0.05) for between-group comparisons both at baseline and after completion of the protocol. CONCLUSIONS: Chronic stroke patients with ataxia had significant improvements in balance and independence in activities of daily living after RAGT along with conventional therapy and home exercises. This trial was registered with trial registration number 39862414.6.0000.5505.

The use of Goal Attainment Scaling (GAS) in the rehabilitation of ataxic patients.

The aim of this study was to formulate an exercise program according to GAS, an approach that reflects the patients' point of view and expectations and investigate the effects of this program in ataxia rehabilitation. This study was designed as an assessor-blinded, single-group trial, and 24 patients with cerebellar ataxia were included. Treatment goals, postural control, disease severity, and daily living activities were assessed pre- and post-treatment using the Goal Attainment Scaling (GAS), the Sensory Organization Test (SOT), the International Cooperative Ataxia Rating Scale (ICARS), and the Barthel Index (BI), respectively. An exercise program was applied by taking patients' individual expectations and treatment goals into account. The participants enrolled in the physiotherapy program for 8 weeks, 3 days a week for 1 hour per day. The mean age of the patients was 34.00 ± 9.15 years. While the GAS, kinetic functions ICARS subscores, ICARS total scores, SOT-composite, and BI scores improved significantly after treatment (p < 0.05), other ICARS subscores did not change after treatment (p > 0.05). The results showed that putting the patient at the center of the evaluation and treatment process while formulating a treatment plan had a positive effect on treatment outcome. If the functions that patients consider important are known and the treatment process concentrates on these functions, a patient's participation in his/her individual treatment is supported by increasing his/her motivation and contribution to more successful rehabilitation practices.

Motor control exercises of the lumbar-pelvic region improve respiratory function in obese men. A pilot study.

PURPOSE: Obese subjects have decreased pulmonary function. The hypothesis of our study was that poor coordination of the lumbar-pelvic musculature secondary to obesity may hinder the synergic activation of the respiratory muscles. The aim of the paper was to evaluate whether specific motor control exercises of the lumbar-pelvic musculature were able to improve respiratory function. METHOD: Twenty obese male patients underwent a rehabilitation program including adapted physical activity and respiratory physiotherapy. Patients were randomly assigned to a Specific Motor Control Exercise Group (SG) and a Control Group (CG). SG followed a protocol according to the SMARTERehab concept aimed at improving posture, intra-abdominal pressure, rib cage mobility, and perception of correct muscle activation. CG performed an exercise training protocol to improve aerobic capacity and muscle strength. RESULT: After intervention, both groups showed similar changes in body weight, fat, and fat-free mass. Respiratory function indexes improved in SG due to improved proprioception and coordination of the deep lumbar-pelvic muscles. CONCLUSION: Our study provides preliminary evidence that breathing, postural control, and spinal stability are intertwined. Positive respiratory effects in obese men can be obtained by prescribing specific motor control exercises of the lumbar-pelvic muscles. Implications for rehabilitation Obese subjects present with decreased pulmonary function and postural changes. Poor coordination of the lumbar-pelvic muscles affects posture and the synergic activation of the respiratory muscles. Specific motor control exercises of the lumbar-pelvic musculature can improve respiratory function. Breathing and postural control are intertwined: positive respiratory effects can be obtained by enhancing motor control of the lumbar-pelvic muscles.

[Application of BARS scale in children with ataxia in a child rehabilitation center in Chiapas, Mexico]. / Aplicación de la escala BARS en niños con ataxia en un centro de rehabilitación infantil en Chiapas.

BACKGROUND: Ataxias are an heterogeneous group of diseases with different etiologies. Scales are used to understand better its natural history and evaluate properly drug efficacy in clinical trials. SARA and ICARS scales have been the most studied and validated so far. BARS scale is based on a modified form of the ICARS scale and is valid, reliable and sufficiently fast for clinical purposes. METHODS: Cross-sectional, descriptive and correlational study. Kruskall-Wallis test was used. We administered BARS to children from 4 to 18 years of age, with ataxic syndrome, without cognitive impairment, in active status, from February, 2007 to September, 2014, at the CRIT (Centro de Rehabilitación Infantil Teletón) from Chiapas, Mexico. RESULTS: 14 children were included. The main BARS score was 17.9/30; 4H syndrome with the worst score was 27.6/30; ataxia telangiectasia 15.6/30; ataxic cerebral palsy 12/30; and others 16.1/30. Kruskall-Wallis test did not show a significant statistically difference when comparing the etiology with BARS score (p = 0.068). CONCLUSIONS: BARS items were an easy way to assess ataxic clinic in children; worse condition was found in neurodegenerative ataxias and better results in ataxic cerebral palsy.

INTRODUCCIÓN: las ataxias son enfermedades con diferentes etiologías. Las escalas son usadas para entender mejor la historia natural de la enfermedad y evaluar la eficacia de los tratamientos en ensayos clínicos. Las escalas SARA e ICARS han sido las mejor validadas hasta el momento. La escala BARS se basa en una modificación de ICARS y es valida, confiable y suficientemente rápida para propósitos clínicos. Métodos: estudio transversal, descriptivo y correlacional, en el que se empleó la prueba de Kruskall-Wallis. Se aplicó la escala BARS a niños de 4 a 18 años, con ataxia sin deterioro cognitivo, en estado activo, de febrero 2007 a septiembre 2014 en el CRIT de Chiapas, México. RESULTADOS: se incluyeron 14 niños. El promedio de BARS fue 17.9/30; el síndrome de 4H con el peor promedio fue de 27.6/30; la ataxia telangiectasia 15.6/30; la parálisis cerebral atáxica 12/30, y otras etiologías 16.1/30. La prueba KruskalWallis no mostró diferencia significativa cuando se comparó la etiología con BARS (p = 0.068). CONCLUSIONES: los ítems de la escala BARS son una manera rápida de evaluar clínica de ataxia en niños; los peores puntajes fueron encontrados en enfermedades neurodegenerativas y los mejores en parálisis cerebral atáxica.

Rehabilitation for Individuals With Genetic Degenerative Ataxia: A Systematic Review.

BACKGROUND: Treatment of genetic degenerative ataxia is currently based on symptom management and maintenance of function. However, utilization of rehabilitation is limited due to a lack of evidence supporting its efficacy. OBJECTIVE: This systematic review evaluated rehabilitation interventions for individuals with genetic degenerative ataxia. In addition, long-term outcomes from rehabilitation and optimal duration and intensity of rehabilitation were examined. METHODS: A comprehensive search of 4 databases (MEDLINE, CINAHL, PEDro, and Cochrane) identified randomized, nonrandomized controlled, and cohort studies published from inception through to January 2016. The studies included at least one measure examining function, ataxia, balance, or gait. Methodological quality was assessed with the Australian National Health and Medical Research Council (NHMRC) Hierarchy of Evidence and the randomized controlled trials were rated according to the PEDro scale. RESULTS: Seventeen studies met eligibility criteria. Five randomized controlled trials were included; however, the majority were classified as level III-3 and IV studies. Of 292 participants included, 148 had autosomal dominant ataxia, and 85 had autosomal recessive ataxia. Rehabilitation interventions included coordination and balance training, multifaceted inpatient rehabilitation, a cycling regime, balance exercises with technology assisted biofeedback, respiratory muscle training, and treadmill training. Two studies examined adjuncts to rehabilitation. Fifteen of the 17 studies demonstrated a statistically significant improvement in at least 1 outcome measuring ataxia, function, gait, or balance. Less than half of the studies included assessment of long-term outcomes and follow-up time frames varied considerably. CONCLUSION: There is consistent evidence that rehabilitation improves function, mobility, ataxia, and balance in genetic degenerative ataxia.

Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study.

PURPOSE: To investigate the effects of different exercise protocols on ataxia in patients with multiple sclerosis (MS). METHOD: A total of 42 MS patients, 17 male and 25 female (Expanded Disability Status Scale (EDSS): 3-5), were enrolled in this randomized controlled study. The patients were divided into three groups: a balance training (BT) group, a lumbar stabilization (LS) group and a task-oriented training (TT) group. All groups received balance training; additionally, the LS group received lumbar stabilization exercises, and the TT group received task-oriented training. The Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), Functional Reach Test (FRT), 2-Minute Walk Test (2MWT), Sensory Organization Test (SOT), and measurement of Somatosensory Evoked Potentials (SSEPs) were performed before and at the end of the 18 training sessions. RESULTS: The BBS, ICARS, FRT, 2MWT, and composite balance score of the SOT were improved in all groups. The ICARS kinetic function sub-score and the left limb cortical onset amplitudes of SSEPs were increased significantly in both the TT and the LS groups. The ICARS total score, composite balance score, and 2MWT were different between groups (p < 0.05). According to multiple comparison analyses of the ICARS total score and the composite balance score, the LS, and the TT group were different from the BT group (p < 0.005), while the LS and the TT groups improved similarly (p > 0.005). The 2MWT results were better for the LS group than the BT group, while the BT and the TT groups improved similarly. CONCLUSION: Balance training alone is not sufficient for rehabilitation of ataxic MS patients. A combination of lumbar stabilization exercises or task-oriented training increases the success of balance rehabilitation. Implications for rehabilitation Multiple sclerosis is a chronic inflammatory and autoimmune disease of central nervous system and ataxia is one of the most challenging symptoms of this disease. Different exercise modalities are commonly employed to control ataxic symptoms in MS patients. Lumbar stabilization exercises or task-oriented training should be considered as complementary approach to improve balance and coordination in ataxic multiple sclerosis patients.