Gait adaptability training improves obstacle avoidance and dynamic stability in patients with cerebellar degeneration.
Balance and gait problems in patients with cerebellar degeneration lead to reduced mobility, loss of independence, and frequent falls. It is currently unclear, however, whether balance and gait capacities can be improved by training in this group of patients. Therefore, the aim of this study was to examine the effects of gait adaptability training on obstacle avoidance and dynamic stability during adaptive gait. Ten patients with degenerative cerebellar ataxia received 10 protocolized gait adaptability training sessions of 1 h each during 5 weeks. Training was performed on a treadmill with visual stepping targets and obstacles projected on the belt's surface. As the primary outcome, we used an obstacle avoidance task while walking on a treadmill. We determined avoidance success rates, as well as dynamic stability during the avoidance manoeuvre. Clinical ratings included the scale for the assessment of ataxia (SARA), 10 m walking test, timed up-and-go test, berg balance scale, and the obstacle subtask of the emory functional ambulation profile (EFAP). Following the intervention, success rates on the obstacle avoidance task had significantly improved compared to pre-intervention. For successful avoidance, participants allowed themselves smaller stability margins in the sagittal plane in the (shortened) pre-crossing step. However, in the subsequent steps they returned to baseline stability values more effectively than before training. SARA scores and the EFAP obstacle subtask improved significantly as well. This pilot study provides preliminary evidence of a beneficial effect of gait adaptability training on obstacle avoidance capacity and dynamic stability in patients with cerebellar degeneration.
Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands; Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Ella M R
EM
Fonteyn
Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands; Rehabilitation Centre Groot Klimmendaal, Arnhem, The Netherlands.
Anita
A
Heeren
Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands.
Jasper-Jan C
JJ
Engels
Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands.
Jasper J Den
JJ
Boer
Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands. Electronic address: Bart.vandeWarrenburg@radboudumc.nl.
Bart P C
BP
van de Warrenburg
Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands; Sint Maartenskliniek Research, Nijmegen, The Netherlands.
Vivian
V
Weerdesteyn
D000222:Adaptation, Physiological; D003463:Cues; D005080:Exercise Test; D005081:Exercise Therapy; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D004856:Postural Balance / Q000502:physiology; D012678:Sensation Disorders / Q000503:physiopathology* / Q000534:rehabilitation*; D013132:Spinocerebellar Degenerations / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology
Ataxia; Obstacle avoidance; Physiotherapy; Treadmill; Visual cues