Can pre-screening vestibulocerebellar involvement followed by targeted training improve the outcomes of balance in cerebellar ataxia?

Efficacy of dual-task training on stability and function in children with ataxia after medulloblastoma resection: A randomized controlled trial

BACKGROUND/OBJECTIVE

In children, medulloblastoma (MB) is the most prevalent posterior fossa tumor. The first line of treatment is maximal safe resection. Therefore, symptoms of ataxia are commonly seen. Training the brain on balance and cognitive tasks makes balance more automatic than without cognitive tasks. The goal was to assess the effectiveness of dual-task practice on balance after MB excision in children with ataxia.

METHODS

Thirty children with ataxia after MB resection at Children Cancer Hospital Egypt were randomized into two equal groups. Exercises for mobility, balance, and gait training were given to both groups. The research group underwent a specific dual-task program (balance and cognitive). The program ran 3 days per week for 8 weeks. Children were evaluated before and after the treatment regimen using the Scale of Assessment and Rating of Ataxia (SARA), the HUMAC Balance System, Pediatric Balance Scale, and Functional Independent Measurement. All children's legal guardians signed an ethical agreement.

RESULTS

A notable improvement in balance was found in the dual group in Pediatric Balance Scale (PBS) (p = .028) and stability test (p = .0001) in favor of the study group. No discernible difference was observed in the Functional Independent Measurement score among the two groups (p = .158), although there was a statistically significant increase in both groups after treatment.

CONCLUSION

Dual-task program is more effective than traditional physical therapy alone in improving balance in children with ataxia after MB resection.

Injury of the vestibulocerebellar tract in a patient with intracerebral hemorrhage: A case report

OBJECTIVE

The vestibulocerebellar tract (VCT) is an important pathway of the central vestibular system, and plays a role in posture reflexes as well as perception of the head and body motion in spatial direction. We report on a patient with intracerebral hemorrhage (ICH), who showed injury of the VCT, which was demonstrated by diffusion tensor imaging (DTI).

CASE DESCRIPTION

This study recruited an 81-year-old male patient presented with quadriparesis due to ICH on both cerebellar hemispheres and 5 control subjects. A patient had the dizziness that was occurred when he moved and the motor weakness in lower limb. The primary and secondary VCTs of a patient with total 25 score of Scale of the Assessment and Rating of Ataxia were reconstructed using DTI.

RESULTS

The results of DTI parameters of primary VCT showed that the tract volumes of primary VCT in both hemispheres of a patient showed significant decrease compared to those of control subjects. All of DTI parameters of ipsilateral secondary VCT in left hemisphere of a patient were within the reference range. Additionally, the ipsilateral secondary VCT in right hemisphere and the contralateral secondary VCTs in both hemispheres of a patient were not reconstructed.

CONCLUSION

We suggest that a patient's ataxia appears to be related to injury of the VCT. Therefore, we believe that the current study would be helpful in evaluating and clinical managing patients with ataxia following cerebellar injury.

Effects of therapeutic exercise on disease severity, balance, and functional Independence among individuals with cerebellar ataxia: A systematic review with meta-analysis

BACKGROUND

Balance impairments are common in cerebellar ataxia. Exercises are beneficial in this population.

OBJECTIVE

Explore the benefits of therapeutic exercises on disease severity, balance and functional independence in cerebellar ataxia.

METHODS

Databases were searched from inception until July 2021. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale and the Newcastle-Ottawa Scale (NOS); and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool.

RESULTS

Twenty-six studies were included and eight studies of low to high PEDro methodological quality were meta-analyzed. 'Low' to 'moderate' GRADE quality evidence supports the use of therapeutic exercises to reduce disease severity, assessed using the Scale for the Assessment and Rating of Ataxia [weighted mean difference (WMD): -3.3; 95% confidence interval (95%CI): -3.7, -2.8; p < .01]; and improve balance, assessed using the Berg Balance Scale (WMD: 2.6; 95%CI: 1.1, 4.2; p < .01). The effect of therapeutic exercises on functional independence was insignificant (WMD: 1.6; 95%CI: -1.5, 4.6; p = .31).

CONCLUSION

Low to moderate evidence from studies of low to high methodological quality provides some support for therapeutic exercises for reducing disease severity among non-hereditary degenerative cerebellar ataxia and improving balance among acquired cerebellar ataxia. Exercises did not benefit functional independence. Additional studies of large sample size and high methodological quality are necessary to substantiate these findings.

Anatomical Location of the Vestibulocerebellar Tract in the Healthy Human Brain: A Diffusion Tensor Imaging Study

The vestibulocerebellar tract (VCT) is regarded as an important pathway of the central vestibular system. We identified the anatomical characteristics of the primary and secondary VCTs in a normal human brain using diffusion tensor imaging (DTI) tractography. Thirty-one healthy adults were recruited. A 1.5 T scanner was used for DTI tractography. A seed region of interest (ROI) was placed on the superior and medial vestibular nuclei at the pons level and a target ROI was placed on the uvula–nodulus of the cerebellum for reconstructing the primary VCT. In the secondary VCTs, the seed ROI was placed on the inferior and medial vestibular nuclei at the medulla oblongata level, and target ROIs were placed on the bilateral uvula–nodulus of the cerebellum. The primary VCT originated from the superior and medial vestibular nuclei at the pons level and terminated at the ipsilateral uvula–nodulus of the cerebellum. The component of the secondary VCTs originated from the inferior and medial vestibular nuclei at the level of the medulla oblongata and terminated at the bilateral uvula–nodulus of the cerebellum. Among them, 70.97% in the contralateral secondary VCT crossed at the vermis of the cerebellum. In addition, the fractional anisotropies (FAs) and mean diffusivity (MD) values of the primary VCT were significantly higher and lower, respectively, compared to those of the secondary VCTs (p < 0.05). The contralateral secondary VCT was significantly higher and lower in the MD and tract volume, respectively (p < 0.05), compared to the ipsilateral VCT. Therefore, we believe that the results will be useful for future studies of the vestibular projection pathway in the human brain injury aspect of central vestibular syndrome.

Does integrated cognitive and balance (dual-task) training improve balance and reduce falls risk in individuals with cerebellar ataxia?

Frequent falls in people with cerebellar ataxia (CA) is a significant problem Therefore, an intervention that could improve balance and reduce the number of falls is of paramount importance from the patients' perspective. Combining cognitive training with physical training to improve balance is a new approach for reducing the risk of falls in patient populations who are at risk for falls. To determine if adding structured cognitive demands to conventional balance and coordination training we designed the Cognitive-coupled Intensive Balance Training (CIBT) program. We found that the more intensive and focused CIBT intervention reduced dual-task cost, improved balance, and reduced the number of falls in a sample of individuals with CA. We hypothesize that (1) CIBT will improve balance and reduce falls; and (2) CIBT will be a cost-effective treatment option for improving balance and reduce falls. To test these hypotheses, we propose conducting a randomized controlled trial (RCT) with economic evaluation . This paper reports the findings of our study testing the feasibility of the CIBT program, rationale for testing our hypothesis and an overview of our future study design to test the effectiveness and cost-effectiveness of the CIBT program.