Integrative Approach Improves Fall Risk and Postural Stability in Spinocerebellar Ataxia-2 - A Case Report.

Spinocerebellar ataxias (SCAs) comprise a large heterogeneous group of autosomal dominant cerebellar ataxias. Despite availability of various conventional treatments, reducing disability and improving the quality of life is a challenge in this condition. In the present case report, based on the clinical symptoms and site of pathology, an Ayurveda-based diagnosis of kaphavruta vayana and kaphavruta udana was considered. Therapeutic measures such as rookshana (drying therapy), vatahara (measures to pacifying vata), balya (strengthening), and brimhana (nourishing) regimens were adopted along with oral medications and specific yoga practices. The objective of the treatment was to improve stability, posture, and balance. After 10 weeks of integrative treatment, a demonstrable improvement was observed in scale for assessment and rating of ataxia Scale for the Assessment and Rating of Ataxia (SARA), fall risk, and limit of stability (using computerized dynamic posturography). Hence, an integrated Ayurveda and Yoga-based lifestyle regimen may serve as a useful adjuvant in improving fall risk and limit of stability in patients with SCAs.

Shaky and unsteady: Dynamic posturography in essential tremor.

BACKGROUND: The spectrum of symptoms exhibited by patients with essential tremor (ET) extends far beyond the classical tremor. This study aims to explore and establish the presence of subtle balance abnormalities in ET using dynamic posturography (DP). METHODS: DP was performed on 18 patients with ET and 26 controls. Diagnosis of ET was based on the Consensus Statement of the Movement Disorder Society on Tremor. Dynamic stability which included the overall balance index, anterior-posterior index and mediolateral index, and limits of stability were measured. RESULTS: Patients with ET had significantly impaired balance indices. Impairment of dynamic stability revealed poor static balance control in all directions. Lower limits of stability scores indicated a smaller range of motion prior to which patients have to shift foot balance. No correlations were observed between age at evaluation, age at onset, duration of illness and the balance indices. CONCLUSIONS: Dynamic posturography reveals significant balance impairment in patients with ET which is unrelated to the age at onset, age at evaluation or duration of illness. This finding concurs with pre-existing reports and adds to the growing body evidence of cerebellar involvement in ET.

Quantitative Balance and Gait Measurement in Patients with Frontotemporal Dementia and Alzheimer Diseases: A Pilot Study.

INTRODUCTION: Alzhiemers disease and Frontotemporal dementia are common neurodegenerative dementias with a wide prevalence. Falls are a common cause of morbidity in these patients. Identifying subclinical involvement of these parameters might serve as a tool in differential analysis of these distinct parameters involved in these conditions and also help in planning preventive strategies to prevent falls. PATIENTS AND METHODS: Eight patients in age and gender matched patients in each group were compared with normal controls. Standardizes methods of gait and balance aseesment were done in all persons. RESULTS: Results revealed subclinical involvement of gait and balancesin all groups specially during divided attention. The parameters were significantly more affected in patients. Patients with AD and FTD had involement of over all ambulation index balance more affected in AD patients FTD patients showed step cycle, stride length abnormalities. DISCUSSION: There is balance and gait involvement in normal ageing as well as patients with AD and FTD. The pattern of involvement in AD correlates with WHERE pathway involvement and FTD with frontal subcortical circuits involvement. CONCLUSION: Identification the differential patterns of involvement in subclinical stage might help to differentiate normal ageing and the different types of cortical dementias. This could serve as an additional biomarker and also assist in initiating appropriate training methods to prevent future falls.