27 hours ago Abstract. Objective: The use of external body weights, although controversial, is occasionally employed to improve balance or mobility in patients with ataxia or tremor. This case report describes the effect of torso-weighting to counteract directional balance loss in a woman with relapsing/remitting multiple sclerosis. >> Go To The Portal
Balance-based torso-weighting in a patient with ataxia and multiple sclerosis: a case report Abstract Objective: The use of external body weights, although controversial, is occasionally employed to improve balance or mobility in patients with ataxia or tremor.
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Ataxia was reported for subjects in this study as resulting from a variety causes: MS, cerebellar infarct, brainstem stroke, Freidreich’s ataxia, pontocerebellar degeneration, cerebellar degeneration, cerebellar atrophy due to alcoholism, and cerebellar dysfunction due to dilantin toxicity.
1 Although the clinical course of the disease varies dramatically, primary impairments can include ataxia, postural instability, balance deficits, sensory loss, weakness, incoordination, abnormal tone, fatigue, pain, and visual and cognitive dysfunction. 1–4 Many of these impairments affect gait and present challenges for clinicians to successfully address. Sixty-five percent of individuals with MS remain ambulatory for 20 years after diagnosis. 4 Therefore, interventions that effectively improve balance stability and mobility are important.
Sixty-five percent of individuals with MS remain ambulatory for 20 years after diagnosis . 4 Therefore, interventions that effectively improve balance stability and mobility are important. The use of external body weights, although controversial, is occasionally employed to improve balance or mobility in patients with ataxia or tremor.
One severely disabled subject was able to walk while weighted, but could not walk without the use of the weights. Morgan hypothesized there was an optimum amount (1-2 kg) and position (on the trunk and/or extremities) for the weight. He noted that too much weight resulted in increased subject unsteadiness.
Besides motor coordination and balance training, other goals in rehabilitation therapy in patients with ataxia include increased transfer and locomotion independence, muscle strengthening, increased physical resilience, “safe fall” strategy, learning to use mobility aids (e.g., a walker), monitoring posture while sitting and standing, preventing and minimizing deformities and pain in patients confined to a bed and/or wheelchair, and learning muscle relaxation exercises. This chapter provides a review of rehabilitation therapy in patients with ataxia.
Fragile X-associated tremor/ataxia syndrome (FXTAS) affects older adult carriers of the FMR1 premutation and can be associated with a broad array of clinical symptoms and presentations including tremor, ataxia, parkinsonism, executive function disturbance and dementia, psychiatric symptoms of anxiety, depression and disinhibition, peripheral neuropathy, autonomic dysfunction, hormonal dysfunction, and pain syndromes. Although controlled trials have not demonstrated efficacy for FXTAS symptoms, there is information available regarding symptomatic treatments. Treatment is generally supportive, directed at component symptoms that are most problematic, and makes use of evidence regarding effectiveness of medications and other interventions for treatment of disorders that have phenotypic overlap with FXTAS. This chapter summarizes available treatments and supports that can be helpful for persons with FXTAS.
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a progressive degenerative movement disorder characterized by kinetic tremor, cerebellar gait ataxia, parkinsonism, and cognitive decline. This disorder occurs in both males and females, frequently in families with children who have fragile X syndrome. The clinical features of this disorder, both classic and newly described, are summarized in this paper. In screening studies, fragile X mental retardation 1 (FMR1) gene premutation (55-200 CGG) expansions are most frequently seen in men with ataxia who have tested negative for spinocerebellar ataxias. Since the original description, the classic FXTAS phenotype has now been reported in females and in carriers of smaller (45-54 CGG) and larger (>200 CGG) expansions in FMR1. Premutation carriers may present with a Parkinson disease phenotype or hypotension, rather than with tremor and/or ataxia. Parkinsonism and gait ataxia may also be seen in individuals with gray zone (41-54 CGG) expansions. Studies regarding medication to treat the symptoms in FXTAS are few in number and suggest that medications targeted to specific symptoms, such as kinetic tremor or gait ataxia, may be most beneficial. Great progress has been made in regards to FXTAS research, likely given the readily available gene test and the screening of multiple family members, including parents and grandparents, of fragile X syndrome children. Expansion of genotypes and phenotypes in the disorder may suggest that a broader disease definition might be necessary in the future.
Movement disorders constitute a subspecialty of neurology focusing on a variety of conditions characterized by hypokinetic, hyperkinetic, or abnormally coordinated movements including, among others, tremor, dystonia, parkinsonism, myoclonus, chorea, ballismus, tics, restless limbs, and ataxia. The term "movement disorders" may be used to refer to either abnormal movements or syndromes that cause these abnormal movements. The classification of movement disorders is based on phenomenology, individual syndromes, or etiology. This article reviews terminology used to describe movement disorders, discusses individual movement disorders and their occurrence in patients with multiple sclerosis, and reviews treatment options.
Rehabilitation helps patients with MS maximize independence by helping to manage and minimize impairments. Deficits seen in ambulation should be addressed to improve energy efficiency and reduce falls. Compensation through appropriate prescription of assistive devices, bracing, and wheelchairs will help improve safety. Rehabilitation can make a significant impact on achieving and maintaining quality of life and independence.
... One rehabilitative intervention that has affected measures associated with fall reduction is balance-based torso-weighting (BBTW). 7 Unlike previous reports of the use of weights in rehabilitation in which larger, fixed amounts of weight (3.6-10% body weight) are placed at a standardized location at the waist or shoulders, 8,9 BBTW begins with assessment of an individual's unassisted balance during quiet and perturbed standing, and continues with trials of resisted rotation of the trunk at the shoulders and pelvis. Light weights are then strategically placed onto a garment worn on the torso until the person can resist perturbations with greater ease and produce more symmetrical responses during resisted rotation. ...
Therefore, allied health care is considered to be important in the management of these patients. The goal of this review is to evaluate scientific evidence for allied health care in cerebellar ataxia, to identify effective treatment strategies, and to give recommendations for clinical practice and further research. A systematic search for clinical trials concerning allied health care in cerebellar ataxias was conducted using the electronic databases of PubMed, Medline, Embase, Cinahl and Pedro, and references lists of articles, in the time period from 1980 up to and including December 2011 in English and Dutch. We identified 14 trials, of which the four best studies were formally of moderate methodological quality. There was a wide variation in disease entities and interventions. The combined data indicate that physical therapy may lead to an improvement of ataxia symptoms and daily life functions in patients with degenerative cerebellar ataxia (level 2), and in other diseases causing cerebellar ataxia (level 3). When added to physical therapy, occupational therapy might improve global functional status, and occupational therapy alone may diminish symptoms of depression (level 3). There are insufficient data for speech and language therapy. Despite the widespread use of allied health care interventions in cerebellar ataxia, there is a lack of good quality studies that have evaluated such interventions. We found some support for the implementation of physical therapy and occupational therapy, but more research is needed to develop recommendations for clinical practice.