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Bonanno M, De Pasquale P, De Marchis C, Lombardo Facciale A, Paladina G, Fonti B, Quartarone A, Calabrò RS. Might patients with cerebellar ataxia benefit from the Computer Assisted Rehabilitation ENvironment (CAREN)? A pilot study focusing on gait and balance. Front Bioeng Biotechnol 2024; 12:1385280. [PMID: 39011156 PMCID: PMC11247328 DOI: 10.3389/fbioe.2024.1385280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction: Ataxia is a neurological symptom that causes decreased balance, loss of coordination, and gait alterations. Innovative rehabilitation devices like virtual reality (VR) systems can provide task-oriented, repetitive and intensive training with multisensorial feedback, thus promoting neuroplastic processes. Among these VR technologies, the Computer Assisted Rehabilitation ENvironment (CAREN) associates a split belt treadmill on a 6-degrees of freedom platform with a 180° VR screen and a Vicon motion capture system to monitor patients' movements during training sessions. Methods: Eight patients affected by cerebellar ataxia were enrolled and received 20 sessions of CAREN training in addition to standard rehabilitation treatment. Each patient was evaluated at the beginning and at the end of the study with 3D gait analysis and clinical scales to assess balance, gait function and risk of falls. Results: We found improvements in kinematic, kinetic, and electromyographic parameters (as per pre-post- CAREN training), as well as in clinical outcomes, such as balance and risk of falls in ataxic patients. In addition, we found that trunk rotation improved, after CAREN intervention, approximating to the normative values. Discussion: Our results suggested that CAREN might be useful to improve specific biomechanical parameters of gait in ataxic patients.
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Affiliation(s)
| | | | | | | | | | - Bartolo Fonti
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
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Liu X, Zhang L, Xu HL, Liu XH, Sikandar A, Li MC, Xia XY, Huang ZQ, Chen NP, Tu YQ, Hu JP, Gan SR, Chen QL, Chen XY, Wang SZ. Effect of Regional Brain Activity Following Repeat Transcranial Magnetic Stimulation in SCA3: A Secondary Analysis of a Randomized Clinical Trial. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01689-8. [PMID: 38558026 DOI: 10.1007/s12311-024-01689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS), a noninvasive neuroregulatory technique used to treat neurodegenerative diseases, holds promise for spinocerebellar ataxia type 3 (SCA3) treatment, although its efficacy and mechanisms remain unclear. This study aims to observe the short-term impact of cerebellar rTMS on motor function in SCA3 patients and utilize resting-state functional magnetic resonance imaging (RS-fMRI) to assess potential therapeutic mechanisms. Twenty-two SCA3 patients were randomly assigned to receive actual rTMS (AC group, n = 11, three men and eight women; age 32-55 years) or sham rTMS (SH group, n = 11, three men and eight women; age 26-58 years). Both groups underwent cerebellar rTMS or sham rTMS daily for 15 days. The primary outcome measured was the ICARS scores and parameters for regional brain activity. Compared to baseline, ICARS scores decreased more significantly in the AC group than in the SH group after the 15-day intervention. Imaging indicators revealed increased Amplitude of Low Frequency Fluctuation (ALFF) values in the posterior cerebellar lobe and cerebellar tonsil following AC stimulation. This study suggests that rTMS enhances motor functions in SCA3 patients by modulating the excitability of specific brain regions and associated pathways, reinforcing the potential clinical utility of rTMS in SCA3 treatment. The Chinese Clinical Trial Registry identifier is ChiCTR1800020133.
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Affiliation(s)
- Xia Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Lin Zhang
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Hao-Lin Xu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Xia-Hua Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Arif Sikandar
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Meng-Cheng Li
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Xiao-Yue Xia
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Zi-Qiang Huang
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Na-Ping Chen
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Yu-Qing Tu
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Jian-Ping Hu
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Shi-Rui Gan
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
| | - Qun-Lin Chen
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| | - Xin-Yuan Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
| | - Shi-Zhong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
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Jain M, Harjpal P, Yadav V, Kovela RK, Vardhan V. Early Rehabilitation for Cerebellar Complications Following Left Atrial Myxoma Excision: A Stitch in Time Saves Nine. Cureus 2022; 14:e28773. [PMID: 36225469 PMCID: PMC9531849 DOI: 10.7759/cureus.28773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022] Open
Abstract
The most known of all primary cardiac tumors is myxoma, which is most usually detected in the left atrium. As there are no physical signs or symptoms, a diagnosis is rarely made purely based on clinical evidence. Our study aims to investigate the case of post-operative left atrial myxoma with cerebellar signs. A 50-year-old woman complained of dizziness and syncope, which caused her to collapse on the floor early in the morning. Myxoma in the left atrium and mitral valve regurgitation was discovered after prompt medical assistance. She was recommended for surgery to excise the left atrial myxoma and mitral valve repair. Post the surgery, she developed breathing difficulties and cerebellar signs for which she was referred for physiotherapy. She underwent two weeks of tailor-made inpatient rehabilitation. This case study intends to emphasize the importance of early diagnosis, treatment, and, most importantly, rehabilitation to return the patient to her functional state. A structured exercise regimen assists the patient while also reducing post-surgery problems. Timely monitoring and treatment are projected to improve outcomes in patients treated with a multidisciplinary approach.
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Wu X, Dong N, Liu Z, Tang T, Liu M. Case report: A novel APTX p.Ser168GlufsTer19 mutation in a Chinese family with ataxia with oculomotor apraxia type 1. Front Neurol 2022; 13:873826. [PMID: 36119692 PMCID: PMC9479491 DOI: 10.3389/fneur.2022.873826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Ataxia with oculomotor apraxia type 1 (AOA1) is a rare genetic disorder and is inherited in an autosomal recessive manner. It is mainly characterized by childhood-onset progressive cerebellar ataxia, with dysarthria and gait disturbance being the two most common and typical manifestations. Axonal sensorimotor peripheral neuropathy, dystonia, chorea, and cognitive impairment are common associated symptoms, as are hypoalbuminemia and hypercholesterolemia. Oculomotor apraxia (OMA)has been reported to be a feature often, although not exclusively, associated with AOA1. The Aprataxin gene, APTX, is ubiquitously expressed, and numerous APTX mutations are associated with different clinical phenotypes have been found. In the present study, we enrolled a 14-year-old boy who developed ataxia with staggering gait from the age of 4 years. Early-onset cerebellar ataxia, peripheral axonal neuropathy, cognitive impairment and hypoalbuminemia, hypercholesterolemia were presented in this patient, except for OMA. We applied ataxia-related genes filtering strategies and whole-exome sequencing (WES) to discover the genetic factors in a Chinese family. Sanger sequencing was used in the co segregation analysis in the family members. A compound heterozygous mutation in APTX gene (c.739C>T and c.501dupG) was identified. This is the first description of a genetically confirmed patient of AOA1 in a Chinese family in addition to a novel mutation of c.501dupG in APTX.
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Affiliation(s)
- Xuan Wu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Nan Dong
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhensheng Liu
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Tieyu Tang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Meirong Liu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
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