A home balance exercise program improves walking in people with cerebellar ataxia

Abstract

Background: Physical therapy intervention is the primary treatment for gait ataxia and imbalance in individuals with cerebellar damage. Our aim was to determine if a home balance exercise program is feasible for improving locomotor and balance abilities in these individuals.

Methods: A total of 14 patients with cerebellar ataxia participated in a 6-week individualized home-based balance exercise program and attended 5 testing sessions (2 pretraining, 1 midtraining, 1 posttraining, and 1 one-month follow-up visit). Pretraining, posttraining, and follow-up testing included a neurological assessment, clinical gait and balance tests, and laboratory assessments of balance and walking. Participants kept logs of the frequency and level of balance challenge during their training.

Results: Walking speed improved across visits, as did stride length, percentage double-limb support time, Timed Up and Go (TUG), and Dynamic Gait Index. Post hoc comparisons in these measures revealed that significant rehabilitative improvements occurred over the 6-week training period, and all but TUG gains were retained 1 month later. There were no changes across the other measures for the group. Regression analysis indicated that improvements in walking speed were affected by the level of balance challenge but not by age, ataxia severity, proprioception, or duration of exercise.

Conclusions: Improvement in locomotor performance in people with cerebellar ataxia was observable after a 6-week home balance exercise program. The exercise program must be designed to provide a significant challenge to the person's balance.

Keywords: ataxia; exercise therapy; neurodegenerative diseases/rehabilitation; treatment outcome.

© The Author(s) 2014.

Figures

Figure 1. Study paradigm

All subjects performed a home-based exercise program for six weeks. Two sets of pre-training measurements were taken two weeks apart to assess repeatability of our measures. One mid-training visit was used to reevaluate the program progression. Subjects were retested after six weeks of training and again four weeks after the completion of training to assess retention.

Figure 2

Walking speed reliability across the two pre-training sessions was high (ICC = 0.9). The scatter plot shows walking speeds for both pre-training visits for all participants.

Figure 3. Results of training

Selected results from the comparison across pre-training, post-training, and follow-up visits. Clinical measures: timed up and go (A), dynamic gait index (B). Static balance measure: sway amplitude for eyes closed condition (average of all subjects except #9, 11, 12, 13, who were unable to perform the task) (C). Walking parameters: walking speed (D), stride length (E), double support time percent (F). Average values ± 1 standard error indicated for all measures; asterisks indicate post-hoc comparison for measures with significant differences (p<0.05).

Figure 4. Effect of degree of balance challenge

Scatter plot showing the correlation between change in walking speed and self-rated challenge of exercises. Regression equation: Δ WS = -0.06 + 0.004*challenge; R2=0.43; p=0.01.