title: Functional recovery and rehabilitation of postural impairment and gait ataxia in patients with acute cerebellar stroke.
abstract: Studies about recovery from cerebellar stroke are rare. The present study assessed motor deficits in the acute phase after isolated cerebellar stroke focusing on postural impairment and gait ataxia and outlines the role of lesion site on motor outcome, the course of recovery and the effect of treadmill training. 23 patients with acute and isolated cerebellar infarction participated. Deficits were quantified by ataxia scores and dynamic posturography in the acute phase and in a follow up after 2 weeks and 3 months. MRI data were obtained to correlate lesion site with motor performance. Half of the patients that gave informed consent and walked independently underwent a 2-week treadmill training with increasing velocity. In the acute phase patients showed a mild to severe ataxia with a worse performance in patients with infarction of the superior in comparison to the posterior inferior cerebellar artery. However, after 3 months differences between vascular territories were no longer significant. MRI data showed that patients with larger infarct volumes had a significantly more severe ataxia. In patients with ataxia of stance, gait and lower limbs lesions were more common in cerebellar lobules IV to VI. After 3 months a mild ataxia in lower limbs and gait, especially in gait speed persisted. Because postural impairment had fully recovered, remaining gait ataxia was likely related to incoordination of lower limbs. Treadmill training did not show significant effects. Future studies are needed to investigate whether intensive coordinative training is of benefit in patients with cerebellar stroke.
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Bultmann
authors.forename: Daniela
authors.initials: D
authors.lastname: Pierscianek
authors.forename: Elke R
authors.initials: ER
authors.lastname: Gizewski
authors.forename: Beate
authors.initials: B
authors.lastname: Schoch
authors.forename: Nicole
authors.initials: N
authors.lastname: Fritsche
authors.forename: Dagmar
authors.initials: D
authors.lastname: Timmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Maschke
authors.forename: Markus
authors.initials: M
authors.lastname: Frings
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020526:Brain Stem Infarctions / Q000150:complications / Q000473:pathology / Q000534:rehabilitation*; D002524:Cerebellar Ataxia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D002531:Cerebellum / Q000098:blood supply / Q000473:pathology; D005081:Exercise Therapy; D005260:Female; D020234:Gait Ataxia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology; D020127:Recovery of Function; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Ataxia; Brain imaging; Cerebellar infarction; Treadmill training; Voxel based lesion symptom mapping