Intensive coordinative training improves motor performance in degenerative cerebellar disease.
OBJECTIVE
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.


CONCLUSIONS
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.


METHODS
This study provides Class III evidence that coordinative training improves motor performance and reduces ataxia symptoms in patients with progressive cerebellar ataxia.
Ilg
W
W
Departments of Cognitive Neurology, Hertie Institute for Clinical Brain Research and Center of Neurology, Tübingen, Gernmany. winfried.ilg@uni-tuebingen.de
Synofzik
M
M
Brötz
D
D
Burkard
S
S
Giese
M A
MA
Schöls
L
L
D000328:Adult; D000368:Aged; D002526:Cerebellar Diseases / Q000150:complications* / Q000534:rehabilitation*; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D019636:Neurodegenerative Diseases / Q000150:complications* / Q000534:rehabilitation*; D011597:Psychomotor Performance / Q000502:physiology*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome