Physiotherapeutic rehabilitation strategies for individuals with spinocerebellar ataxia

Abstract

Introduction: Spinocerebellar ataxia (SCA) is caused by damage to the cerebellum and cerebellar pathways, besides affecting other brain regions, according to their subtypes. Thus, ataxic symptoms correspond to cerebellar lesions in addition to other non-ataxic neurological alterations, according to the affected brain regions. Ataxia is related to incoordination of gait and changes in body balance, favoring physical inactivity and impacting cardiovascular conditioning. On the other rand, the incidence of non-ataxic sings is not yet clearly described in the literature, although its knowledge may influence the prescription of rehabilitation exercises. A physical therapy approach to gait and balance training is the use of partial body weight support (BWS) associated with a treadmill. The BWS allows relieving a percentage of the body weight of individuals, facilitating safe walking. Another approach to gait, incoordination, and balance is axial or appendicular weight loading. Although widely used in clinical practice, there is no consensus about the optimal load, where to position it and its effects. Objective: In a sample of individuals with SCA, (i) To evaluate the effect of treadmill training associated with BWS on gait performance, balance, cardiopulmonary capacity, functionality and quality of life; (ii) Identify the presence and prevalence of non-ataxic signs; (iii) Evaluate the effect of addition of external loads on gait and balance. Methods: (i) participants were evaluated by a treadmill cardiopulmonary performance test and standardized assessment instruments. Eight subjects participated in the first stage of the study, focused on gait training and cardiovascular conditioning for 8 weeks. Of these, 5 individuals participated in a second stage in which the goal was balance training during gait (10 weeks). The sessions lasted 50 min. For studies (ii) and (iii), 25 subjects were assessed through a posturography exam, gait kinematic analysis and standardized assessment instruments. The last two measurements were performed under 10 conditions: without weight loading; adding 1, 2, 3 kg to each ankle; adding 2, 4, 6 kg over the shoulder girdle and adding 2, 4, 6 kg around the pelvic girdle. Results: Three articles resulted from this thesis: the first identified that treadmill gait training with BWS significantly increased exercise test duration and cardiopulmonary capacity in individuals with SCA. In addition, there was an improvement in postural demands during gait, balance and risk of falling. The second study identified that the most prevalent non-ataxic sings in individuals with SCA3 were: arreflexia, urinary dysfunction, hyperreflexia and spasticity, with a moderate significant correlation between non-ataxic signs and disease severity. The third study showed a decrease in anterior-posterior COP’s displacement when the loads are fixed around the ankles. In addition, there was also an increase in stride duration, a decrease in gait speed and in stride frequency with the loads around the ankle. Conclusion: Relieving or overloading the body weight of individuals with SCA seems to be beneficial and the choice of strategy should be made according to the treatment goals set.