Ataxia is commonly known as “in-coordination of movements”. Insufficient postural control and in-coordination of multi-joint movements without muscle weakness are most observable features of ataxia. Coordination between various sensory and motor systems results in a normal gait pattern. The vestibular, visual and somatosensory systems interact in flexible manner for a particular posture depending on the environment and desired movements. The proprioceptive senses convey the information related to the body position and movements to the brain via the proprioceptors located in the joints, muscles, ligaments and tendons. These inputs, along with information from the visual system, are transmitted to the central nervous system. The central nervous system generates the motor output in accordance to the sensory input received.
The central vestibular system is responsible for coordination and integration of information about head and body movement. One particularly important function of the vestibular system is to keep eyes fixed in a particular direction with respect to the change in body position. The cerebellum also plays a major role in establishing balance and motor coordination. It receives information from the vestibular system regarding the balance and from the proprioceptive system regarding the body position in space. Based on this information, the cerebellum facilitates coordinated and balanced movement by making the appropriate adjustments.
Problems or damage in the proprioceptive system, visual system and vestibular system, the cerebellum and/or any problem in the interconnections of these systems, can lead to ataxia. Researchers classify ataxia into different types depending on the system or combination of systems affected, such as sensory ataxia, vestibular ataxia, cerebellar ataxia, frontal ataxia and mixed ataxia. However, cerebellar ataxia can be caused due dysfunctions in different connections of the cerebellum. They can be enlisted as vestibulo-cerebellar dysfunction, spino-cerebellar dysfunction, and cerebro-cerebellar dysfunction. The following symptoms are commonly observed in individuals with cerebellar ataxia: dysmetria, tremor, dyssynergia, dysdiadockokinesia, hypotonia, dysarthria, weakness and fatigue and nystagmus. There are certain clinical differences observed in individuals with ataxia based on the type of ataxia (Refer to table 1 in the article).
The primary goals of a physiotherapist in the rehabilitation of the individuals with ataxia are:
- To improve balance and postural reactions
- To improve and increase postural stability
- To improve and increase upper body functioning
- To improve quality of life (QOL) by developing independent and functional gait pattern
The physiotherapists are advised to follow certain basic principles during the training programs which are applicable to all individuals diagnosed with ataxia. However, the treatment plan for each individual depends on the needs of the client and symptoms demonstrated. There are various measurement methods and assessments designed to determine treatment programs suitable for the patient and his/her needs in order to attain the desired goal of the physiotherapy and rehabilitation program (Refer table 2 and table 3 in the article for details). A client centered physical therapy treatment approach is designed based on the findings from the scales and assessments used to determine type, and intensity of ataxia. The classification of treatment applications can be briefly described as follows:
- Approaches for improving proprioception
- Activities for improving balance
- Vestibular exercise
- Approaches to extremity ataxia
- Use of supportive aids
- Sports activities
Thus, evaluation of the patient, determination of appropriate treatment methods, along with performing the exercises regularly, are important criteria for successful treatment plan.