Neurotherapy for Ataxia

Ataxia is a rare neurological condition or clinical sign which is characterised by reduced movement control and incoordination. This often occurs due to damage to the cerebellum (also known as our ‘small brain’) or it’s connections. The cerebellum sits at the back of our head, just above and behind where the spinal cord connects to our brain. Ataxia can also be caused by damage to the spinal cord and nerves. Damage may be a result of an injury or illness, or it may be hereditary causing degeneration of the spinal cord or cerebellum. It is possible that there is no known cause for ataxia at all, and this is known as idiopathic ataxia.

 

Understanding Physiotherapy assessment in ataxia

Symptoms of ataxia can vary depending on the type of ataxia the patient has and/or the area of damage from an injury or illness. Ataxia can affect someone more centrally around their trunk and head/neck, and/or more peripherally into a single limb. This means that physiotherapy assessments can look very different from one patient to the next, depending on how they present and the level of function they have. The general principles of the physiotherapy assessment stay the same however, and the therapist will always want to look at what active movement the patient has and how ‘efficient’ and ‘selective’ these movements are, the alignment of their trunk and limbs, and how movement impacts their ‘postural stability’.

Patients with ataxia often don’t have an issue with movement, but rather an issue with controlling their movement, and very often these patients have more difficulty staying still. Patients often struggle to achieve ‘selective’ movement on a basis of a stable foundation, which is essential in all movement control. For example, if we have instability at our trunk, then our upper limbs are likely to become ‘fixing limbs’ as a way of gaining some stability, and this means that we cannot access the most efficient movement patterns as easily.

 

Physiotherapy treatment approaches for ataxia

The cerebellum thrives off novelty and newness of movement/skills, and responds well to ‘hands-on’ therapy as a way of giving the patient sensory cues and influencing their movement patterns. This information is vitally important for us to consider in our treatment approaches. Physiotherapy intervention can involve:

Improving alignment through reducing areas of stiffness or soft tissue/muscle shortening, and using hands-on approach to give sensory feedback about where they should be in space, and provide stability if required. This will maximise their opportunity to access the desired activity and strengthen their weaker muscle groups in this way. Changing a person’s alignment and then activating them in their new alignment is a really effective way of treating cerebellar problems.

Balance and coordination work, again ensuring that the patient is in the best position and alignment to effectively challenge their balance, without causing a big balance displacement and therefore utilising ‘fixing’ strategies.

Functional training is a nice way of incorporating the role of stability for movement, and also using movement as a postural demand to create stability at more proximal joints and more centrally at the patient’s trunk/core muscle groups.

General advice and ‘homework’ for patients to complete outside of sessions, which will encourage the patient to utilise their new alignment and movement between sessions and maximise the carry over of this work.

 

Conclusion

Physiotherapy is an effective way of treating and/or better managing symptoms of patients with ataxia. From initial assessment through to treatment sessions, the focus is on improving the persons ability to gain stability, in an optimal alignment, to achieve more selective movement patterns and allow them to complete functional tasks more easily. Regular, hands-on sessions with a skilled physiotherapist is vitally important and can make a huge difference in day to day life.