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Castiglia SF, Trabassi D, Conte C, Gioiosa V, Sebastianelli G, Abagnale C, Ranavolo A, Di Lorenzo C, Coppola G, Casali C, Serrao M. Local Dynamic Stability of Trunk During Gait is Responsive to Rehabilitation in Subjects with Primary Degenerative Cerebellar Ataxia. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1478-1489. [PMID: 38279000 PMCID: PMC11269439 DOI: 10.1007/s12311-024-01663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
This study aimed to assess the responsiveness to the rehabilitation of three trunk acceleration-derived gait indexes, namely the harmonic ratio (HR), the short-term longest Lyapunov's exponent (sLLE), and the step-to-step coefficient of variation (CV), in a sample of subjects with primary degenerative cerebellar ataxia (swCA), and investigate the correlations between their improvements (∆), clinical characteristics, and spatio-temporal and kinematic gait features. The trunk acceleration patterns in the antero-posterior (AP), medio-lateral (ML), and vertical (V) directions during gait of 21 swCA were recorded using a magneto-inertial measurement unit placed at the lower back before (T0) and after (T1) a period of inpatient rehabilitation. For comparison, a sample of 21 age- and gait speed-matched healthy subjects (HSmatched) was also included. At T1, sLLE in the AP (sLLEAP) and ML (sLLEML) directions significantly improved with moderate to large effect sizes, as well as SARA scores, stride length, and pelvic rotation. sLLEML and pelvic rotation also approached the HSmatched values at T1, suggesting a normalization of the parameter. HRs and CV did not significantly modify after rehabilitation. ∆sLLEML correlated with ∆ of the gait subscore of the SARA scale (SARAGAIT) and ∆stride length and ∆sLLEAP correlated with ∆pelvic rotation and ∆SARAGAIT. The minimal clinically important differences for sLLEML and sLLEAP were ≥ 36.16% and ≥ 28.19%, respectively, as the minimal score reflects a clinical improvement in SARA scores. When using inertial measurement units, sLLEAP and sLLEML can be considered responsive outcome measures for assessing the effectiveness of rehabilitation on trunk stability during walking in swCA.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy.
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.
| | - Dante Trabassi
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Carmela Conte
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Valeria Gioiosa
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Gabriele Sebastianelli
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Chiara Abagnale
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Alberto Ranavolo
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
- Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
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Grobe‐Einsler M, Bork F, Faikus A, Hurlemann R, Kaut O. Effects of cerebellar repetitive transcranial magnetic stimulation plus physiotherapy in spinocerebellar ataxias - A randomized clinical trial. CNS Neurosci Ther 2024; 30:e14797. [PMID: 38887169 PMCID: PMC11183922 DOI: 10.1111/cns.14797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND In absence of drug therapy options, standard treatment for spinocerebellar ataxia consists of symptomatic physiotherapy and speech therapy. New therapeutic options are urgently needed. Transcranial magnetic stimulation is a promising therapeutic option, but applicability is limited by lengthy duration of stimulation protocols. METHODS In this randomized sham controlled clinical trial, patients were assigned to verum (n = 15) or sham (n = 18) cerebellar transcranial magnetic stimulation. To yield best possible treatment effects, both intervention groups received intensified physiotherapy for the duration of the study. RESULTS Ataxia severity was reduced by 1.6 points on the Scale for assessment and Rating of Ataxia among patients in the verum group (p < 0.001). Clinical improvement was significantly larger in the verum group, compared to the sham group (p < 0.01). The treatment effect was mainly carried by improved appendicular coordination. Patients in the verum group also significantly improved in the 8 Meter Walk Test (p < 0.05) and PATA rate (p < 0.01). CONCLUSIONS Cerebellar rTMS ameliorates ataxia severity in patient with spinocerebellar ataxia. Condensing treatment duration to only 5 days without reduction of treatment effects facilitates applicability and therefore broadens availability to larger patient populations.
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Affiliation(s)
- Marcus Grobe‐Einsler
- Department of NeurologyUniversity Hospital BonnBonnGermany
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
| | | | - Aline Faikus
- Department of NeurologyUniversity Hospital BonnBonnGermany
| | - René Hurlemann
- Department of Psychiatry, School of Medicine and Health SciencesUniversity of OldenburgOldenburgGermany
| | - Oliver Kaut
- SRH Gesundheitszentrum Bad Wimpfen GmbHBad WimpfenGermany
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Bremova-Ertl T, Hofmann J, Stucki J, Vossenkaul A, Gautschi M. Inborn Errors of Metabolism with Ataxia: Current and Future Treatment Options. Cells 2023; 12:2314. [PMID: 37759536 PMCID: PMC10527548 DOI: 10.3390/cells12182314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
A number of hereditary ataxias are caused by inborn errors of metabolism (IEM), most of which are highly heterogeneous in their clinical presentation. Prompt diagnosis is important because disease-specific therapies may be available. In this review, we offer a comprehensive overview of metabolic ataxias summarized by disease, highlighting novel clinical trials and emerging therapies with a particular emphasis on first-in-human gene therapies. We present disease-specific treatments if they exist and review the current evidence for symptomatic treatments of these highly heterogeneous diseases (where cerebellar ataxia is part of their phenotype) that aim to improve the disease burden and enhance quality of life. In general, a multimodal and holistic approach to the treatment of cerebellar ataxia, irrespective of etiology, is necessary to offer the best medical care. Physical therapy and speech and occupational therapy are obligatory. Genetic counseling is essential for making informed decisions about family planning.
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Affiliation(s)
- Tatiana Bremova-Ertl
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, 3010 Bern, Switzerland; (J.H.); (J.S.)
- Center for Rare Diseases, University Hospital Bern (Inselspital) and University of Bern, 3010 Bern, Switzerland
| | - Jan Hofmann
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, 3010 Bern, Switzerland; (J.H.); (J.S.)
| | - Janine Stucki
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, 3010 Bern, Switzerland; (J.H.); (J.S.)
| | - Anja Vossenkaul
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (A.V.); (M.G.)
| | - Matthias Gautschi
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (A.V.); (M.G.)
- Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Bogaert A, Romanò F, Cabaraux P, Feys P, Moumdjian L. Assessment and tailored physical rehabilitation approaches in persons with cerebellar impairments targeting mobility and walking according to the International Classification of Functioning: a systematic review of case-reports and case-series. Disabil Rehabil 2023:1-23. [PMID: 37639546 DOI: 10.1080/09638288.2023.2248886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Cerebellar impairment (CI) manifests from different etiologies resulting in a heterogenic clinical presentation affecting walking and mobility. Case-reports were reviewed to provide an analytical clinical picture of persons with CI (PwCI) to differentiate cerebellar and non-cerebellar impairments and to identify interventions and assessments used to quantify impact on walking and mobility according to the International Classification of Functioning, Disability and Health (ICF). MATERIALS AND METHODS Literature was searched in PubMed, Web Of Science and Scopus. Case-reports conducting physical rehabilitation and reporting at least one outcome measure of ataxia, gait pattern, walking or mobility were included. RESULTS 28 articles with a total of 38 different patients were included. Etiologies were clustered to: spinocerebellar degenerations, traumatic brain injuries, cerebellar tumors, stroke and miscellaneous. The interventions applied were activity-based, including gait and balance training. Participation based activities such as tai chi, climbing and dance-based therapy had positive outcomes on mobility. Outcomes on body function such as ataxia and gait pattern were only reported in 22% of the patients. CONCLUSIONS A comprehensive test battery to encompass the key features of a PwCI on different levels of the ICF is needed to manage heterogeneity. Measures on body function level should be included in interventions.
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Affiliation(s)
- Anne Bogaert
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Francesco Romanò
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre Cabaraux
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- UMSC Hasselt, Pelt, Belgium
| | - Lousin Moumdjian
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- UMSC Hasselt, Pelt, Belgium
- IPEM Institute of Psychoacoustics and Electronic Music, Faculty of Arts and Philosophy, Ghent University, Ghent, Belgium
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Gerlach K. Improvement of Spinocerebellar Ataxia 3 Symptoms Treated with Eurythmy Therapy: A Case Vignette. Complement Med Res 2023; 30:460-465. [PMID: 37517401 DOI: 10.1159/000532120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
A 58-year-old male with genetically confirmed spinocerebellar ataxia 3 was treated with 10 sessions of eurythmy therapy. He was rated 9 on the "Scale for Assessment and Rating of Ataxia" before therapy started. Among movement and mental symptoms, he complained about sleep disturbances, insensitivity in the feet, and spasms in the legs. The patient was asked to build strong inner images as a basis for the eurythmy therapy movement exercises. After 10 sessions, he reported improvement in sleep disturbances, insensitivity in the feet, and spasms in the legs. He improved to 7.5 points on the "Scale for Assessment and Rating of Ataxia". In the 3 months, before starting and during eurythmy therapy, the patient did not alter the only medication taken (Bryophyllum 50% powder) and did not undergo any other therapy. Ein 58-jähriger Mann mit genetisch bestätigter spinozerebellärer Ataxie 3 wurde mit 10 Sitzungen Heileurythmie behandelt. Vor Beginn der Therapie wurde er auf der “Scale for Assessment and Rating of Ataxia” mit 9 bewertet. Neben Bewegungs- und psychischen Symptomen klagte er über Schlafstörungen, Unempfindlichkeit in den Füßen und Spasmen in den Beinen. Der Patient wurde aufgefordert, starke innere Bilder als Grundlage für die heileurythmischen Bewegungsübungen aufzubauen. Nach 10 Sitzungen berichtete er über eine Verbesserung der Schlafstörungen, der Unempfindlichkeit in den Füßen und der Spasmen in den Beinen. Er verbesserte sich auf 7.5 Punkte auf der “Scale for Assessment and Rating of Ataxia”. Während der drei Monate vor Beginn und während der Eurythmie Therapie änderte der Patient seine Medikation nicht (Bryophyllum 50% Pulver) und unterzog sich keiner weiteren Therapie.
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Affiliation(s)
- Katharina Gerlach
- Institute for Eurythmy Therapy, Alanus University of Arts and Social Sciences, Alfter, Germany
- RIArT - Research Institute for Creative Arts Therapies, Alfter, Germany
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Chien HF, Zonta MB, Chen J, Diaferia G, Viana CF, Teive HAG, Pedroso JL, Barsottini OGP. Rehabilitation in patients with cerebellar ataxias. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:306-315. [DOI: 10.1590/0004-282x-anp-2021-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/13/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Cerebellar ataxias comprise a heterogeneous group of diseases characterized by motor and non-motor symptoms, which can be acquired, degenerative, or have a genetic cause, such as spinocerebellar ataxias (SCA). Usually, the genetic and neurodegenerative forms of cerebellar ataxias present a progressive and inevitable worsening of the clinical picture so that rehabilitation treatment is fundamental. Rehabilitation treatment includes physical therapy, respiratory therapy, speech, voice and swallowing therapy, occupational therapy, and new technologies, such as the use of exergames. The current treatment of patients with cerebellar ataxias, especially neurodegenerative forms, genetic or not, should include these different forms of rehabilitation, with the main objective of improving the quality of life of patients.
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