Rehabilitation of ataxias

Abstract

Cerebellar disorders (which include congenital, hereditary and acquired conditions) lead to several symptoms that may vary with the cause but typically include ataxia. The term ataxia (meaning “lack of order” in ancient Greek) refers to a lack of motor coordination, although growing evidence indicates that the cerebellum also contributes to regulation of certain non-motor features such as linguistic, cognitive and affective functions. Degenerative cerebellar ataxias, which have several different causes, are a significant group of disorders with an estimated prevalence ranging from 5.2 to 18.5 per 100,000 inhabitants [2, 33]. The typical cerebellar motor syndrome includes a wide range of features such as dysmetria, asynergia or dyssynergia, a- or dysdiadochokinesia, tremor, oculomotor abnormalities, speech disturbances, hypotonia and abnormalities of posture and gait (for a review see Bodranghien et al. [3]). Gait and balance disorders are crucial features of cerebellar ataxias, having a great influence on patients’ independence in daily life activities, quality of life and risk of falls [11, 28]. On these bases, and also considering the impact of these conditions in terms of economic costs and health-related quality of life [21], one of the main areas of neurorehabilitation intervention in patients with ataxia should be the treatment of gait and balance abnormalities. Over the last decade, evidence has emerged indicating that rehabilitation can improve postural and gait functions in cerebellar ataxia [15, 17, 18] and suggesting a potential role for neurorehabilitation in delaying the loss of independent walking.