Akiyoshi Matsugi

By Akiyoshi Matsugi

Ataxia, the incoordination and balance dysfunction in movements without muscle weakness, causes gait and postural disturbance in patients with stroke, multiple sclerosis, and degeneration in the cerebellum. The aim of this article was to provide a narrative review of the previous reports on physical therapy for mainly cerebellar ataxia offering various opinions. Some systematic reviews and randomized control trial studies, which were searched in the electronic databases using terms “ataxia” and “physical therapy,” enable a strategy for physical therapy for cerebellar ataxia. Intensive physical therapy more than 1 hour per day for at least 4 weeks, focused on balance, gait, and strength training in hospital and home for patients with degenerative cerebellar ataxia can improve ataxia, gait ability, and activity of daily living. Furthermore, the weighting on the torso, using treadmill, noninvasive brain stimulation over the cerebellum for neuromodulation to facilitate motor learning, and neurophysiological assessment have a potential to improve the effect of physical therapy on cerebellar ataxia. Previous findings indicated that physical therapy is time restricted; therefore, its long-term effect and the effect of new optional neurophysiological methods should be studied.

Part of the book: Neurological Physical Therapy

By Akiyoshi Matsugi, Kyota Bando, Yutaka Kikuchi, Yuki Kondo and Hideki Nakano

Rehabilitation is an important treatment for spinocerebellar ataxia (SCA). The lack of improvement in ataxia, deficit of motor learning, and unstable balance causes disability for activities of daily living and restricts participation in social activities, further resulting in a disturbance of the restoration of quality of life. This narrative review describes physical rehabilitation, including measurement of movement disorder, associated with ataxia and possible interventions. Several lines of evidence suggest that high-intensity individualized physical rehabilitation programs, especially for gait and balance training, improve motor function. Continuous exercise at home contributes to the maintenance of the gait and balance function. Moreover, videography and mechanical technology contribute to the evaluation of ataxia and motor learning ability, and assistive robotic systems may improve gait stability. Neuromodulation montages, such as repetitive transcranial magnetic stimulation and transcranial electrical stimulation, can enhance the effect of physical rehabilitation. Further research aimed at developing a more-effective physical rehabilitation for these patients is expected.

Part of the book: Spinocerebellar Ataxia