title: Individualized exergame training improves postural control in advanced degenerative spinocerebellar ataxia: A rater-blinded, intra-individually controlled trial.
abstract: Treatment options are rare in degenerative ataxias, especially in advanced, multisystemic disease. Exergame training might offer a novel treatment strategy, but its effectiveness has not been investigated in advanced stages.
  
  
  
  We examined the effectiveness of a 12-week home-based training with body-controlled videogames in 10 young subjects with advanced degenerative ataxia unable or barely able to stand. Training was structured in two 6-weeks phases, allowing to adapt the training according to individual training progress. Rater-blinded clinical assessment (Scale for the Assessment and Rating of Ataxia; SARA), individual goal-attainment scoring (GAS), and quantitative movement analysis were performed two weeks before training, immediately prior to training, and after training phases 1 and 2 (intra-individual control design). This study is registered with ClinicalTrials.gov, NCT02874911).
  
  
  
  After intervention, ataxia symptoms were reduced (SARA -2.5 points, p < 0.01), with benefits correlating to the amount of training (p = 0.04). Goal attainment during daily living was higher than expected (GAS: 0.45). Movement analysis revealed reduced body sway while sitting (p < 0.01), which correlated with improvements in SARA posture and gait (p = 0.005), indicating training-induced improvements in posture control mechanisms.
  
  
  
  This study provides first evidence that, even in advanced stages, subjects with degenerative ataxia may benefit from individualized training, with effects translating into daily living and improving underlying control mechanisms. The proposed training strategy can be performed at home, is motivating and facilitates patient self-empowerment.
authors.affiliation: Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany; Centre for Integrative Neuroscience (CIN), Tübingen, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schatton
authors.affiliation: Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany; German Research Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany.
authors.forename: Matthis
authors.initials: M
authors.lastname: Synofzik
authors.affiliation: Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany; Centre for Integrative Neuroscience (CIN), Tübingen, Germany; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany; German Research Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany.
authors.forename: Zofia
authors.initials: Z
authors.lastname: Fleszar
authors.affiliation: Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany; Centre for Integrative Neuroscience (CIN), Tübingen, Germany.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Giese
authors.affiliation: Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany; German Research Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany.
authors.forename: Ludger
authors.initials: L
authors.lastname: Schöls
authors.affiliation: Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany; Centre for Integrative Neuroscience (CIN), Tübingen, Germany. Electronic address: winfried.ilg@uni-tuebingen.de.
authors.forename: Winfried
authors.initials: W
authors.lastname: Ilg
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002648:Child; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D004856:Postural Balance / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology* / Q000534:rehabilitation*; D020754:Spinocerebellar Ataxias / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation*; D018709:Statistics, Nonparametric; D013997:Time Factors; D055815:Young Adult
keywords: Ataxia; Cerebellum; Exergames; Motor training; Neurorehabilitation; Postural control