期刊
NEUROLOGY
卷 73, 期 22, 页码 1823-1830出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3181c33adf
关键词
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资金
- Hertie Institute for Clinical Brain Research
- Volkswagenstiftung
- Hermann and Lilly Schilling Foundation
- Werner-Reichardt Center for Integrative Neuroscience
- Deutsche Forschungsgemeinschaft [SFB 555, GI305/ 2, SCHO754/3-1, SCHO754/4-1]
- EU [Cobol FP6-NEST-2005-Path-IMP-043403, SEARISE FP7-ICT-215866, LSHM-CT-2004-503304]
- Volkswagen Foundation [I/76556-1, I/80711]
- HFSP [RGP54/2004]
- Santhera Pharmaceuticals
- German Research Council [01GM0644, 01GM0603]
- E-RARE [01GM0807, 01GM0820]
Objectives: The cerebellum is known to play a strong functional role in both motor control and motor learning. Hence, the benefit of physiotherapeutic training remains controversial for patients with cerebellar degeneration. In this study, we examined the effectiveness of a 4-week intensive coordinative training for 16 patients with progressive ataxia due to cerebellar degeneration (n = 10) or degeneration of afferent pathways (n = 6). Methods: Effects were assessed by clinical ataxia rating scales, individual goal attainment scores, and quantitative movement analysis. Four assessments were performed: 8 weeks before, immediately before, directly after, and 8 weeks after training. To control for variability in disease progression, we used an intraindividual control design, where performance changes with and without training were compared. Results: Significant improvements in motor performance and reduction of ataxia symptoms were observed in clinical scores after training and were sustained at follow-up assessment. Patients with predominant cerebellar ataxia revealed more distinct improvement than patients with afferent ataxia in several aspects of gait like velocity, lateral sway, and intralimb coordination. Consistently, in patients with cerebellar but without afferent ataxia, the regulation of balance in static and dynamic balance tasks improved significantly. Conclusion: In patients with cerebellar ataxia, coordinative training improves motor performance and reduces ataxia symptoms, enabling them to achieve personally meaningful goals in everyday life. Training effects were more distinct for patients whose afferent pathways were not affected. For both groups, continuous training seems crucial for stabilizing improvements and should become standard of care. Level of evidence: This study provides Class III evidence that coordinative training improves motor performance and reduces ataxia symptoms in patients with progressive cerebellar ataxia. Neurology (R) 2009; 73: 1823-1830
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