Ataxia refers to the loss of control of voluntary movements of the body, including the limbs, face, or eyes. (1) It is a rare disorder with many proposed forms that are thought to affect common actions including walking, reaching, speaking, and seeing. Ataxia is usually considered to be a symptom of an underlying diagnosis like stroke, cerebral palsy (CP), multiple sclerosis, or a brain tumor, rather than an independent occurrence. (2) For purposes of this article, we will discuss ataxia as a neurological symptom, its effects on upper and lower extremity function, and supportive strategies to improve daily living skills while living with ataxia.
What causes ataxia?
Ataxia often results from damage to a brain area called the cerebellum, a structure that regulates coordination of movement and balance. It can affect one side of the body (known as hemi-ataxia) or both, and can occur at any age depending on its underlying cause. Ataxia can present quickly, following an acute event like a stroke, or slowly over the course of years alongside a neurodegenerative disease. For individuals with CP, ataxia may be present from birth. At this time, there is no cure for ataxia; however, prompt therapeutic intervention can improve functional outcomes. (2, 3, 4)
What does ataxia look like?
Ataxia symptoms can make an individual look as if they are clumsy. Ataxia affecting the arms can cause difficulty holding and using objects as well as decreased accuracy in reaching targets. Symptoms of ataxia affecting the core and legs might present as impaired sitting or standing balance, unsteady walking, and falling. (5) Unlike apraxia, another coordination disorder, individuals with ataxia remain aware of the purpose of their actions and associated tool use; however, their muscles do not respond in the correct way to accomplish the desired task efficiently. (6)
Therapeutic Treatments for Ataxia
There are many different options for treating ataxia with the help of an occupational or physical therapist. Conventional OT and PT services aim to improve independence and safety with daily living tasks. Occupational therapy focuses on life skills from the basics, like eating, dressing, and grooming, to bigger-picture tasks related to performing optimally at school or work. Physical therapy addresses posture, balance, and walking so the individual can move around with less assistance. Both OT and PT may incorporate strengthening and cooridnation exercises as well as adaptive equipment or assistive device recommendations into their treatment plans.
Constraint Induced Movement Therapy (CIMT)
CIMT is a therapeutic intervention that can improve grasping, reaching, and in-hand manipulation skills by constraining an individual’s less affected arm in a mitt, cast, or sling, thereby forcing them to use their more affected side for the majority of the time. A therapist will then lead the individual through intensive training involving repetitive task performance to promote improved functional use of the limb and increased motivation to use it when not constrained. CIMT is commonly performed with children, but can be done with adults with ataxia as well. (7)
Also known as equine assisted therapy, horseback riding under the direction of an occupational or physical therapist is another treatment that is shown to improve mobility and coordination for individuals with ataxia. This intervention engages multiple body systems through incorporation of activities including achieving and changing positions while on horseback. Hippotherapy promotes improved core strength and posture that extends into better walking skills and more accurate reaching to targets. (8)
Virtual Reality (VR)
VR therapy is a newer approach to treating coordination disorders using a fun and stimulating video game environment. Systems including the Nintendo Wii, XBox Kinect, and NEOFECT Smart Glove and Smart Board incorporate motion-sensing technology to alter gameplay and provide feedback about the quality of movement during repetitive task training. Studies evaluating consistent use of these systems have shown that daily gameplay can produce lasting improvements in arm and finger function for daily tasks. (9)
Ultimately, ataxia can be a challenging symptom to address due to the variety of diagnoses that it may stem from. However, therapeutic interventions have shown promise in reducing ataxia-related incoordination or providing means to compensate for it. If you think you might be experiencing ataxia and are seeking treatment options, please discuss your concerns with your medical team.
The NEOFECT line of Smart Rehabilitation Solutions can assist with coordination difficulties stemming from stroke or other neurological diagnoses. Our neurorehabilitation products include support from occupational therapists to maximize functional gains. Please call (866) 534-4989 or email firstname.lastname@example.org for further inquiry.
- Columbia University Department of Neurology. (2015). Ataxia. Retrieved from http://www.columbianeurology.org/neurology/staywell/document.php?id=35869
- Ashizawa, T., & Xia, G. (2016). Ataxia. Continuum (Minneapolis, Minn.), 22(4), 1208–1226. doi:10.1212/CON.0000000000000362
- Brunberg JA; Expert Panel on Neurologic Imaging. Ataxia. AJNR Am J Neuroradiol. 2008 Aug;29(7):1420-1422.
- Fernandez, H. (2019). Ataxia. Retrieved from http://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Ataxia.htm
- National Ataxia Foundation. (2019). What is Ataxia? Retrieved from https://ataxia.org/what-is-ataxia/#ataxiaSymptoms
- NORD National Organization for Rare Disorders. (2003). Apraxia. Retrieved from https://rarediseases.org/rare-diseases/apraxia/
- Reiss, A. P., Wolf, S. L., Hammel, E. A., Mcleod, E. L., & Williams, E. A. (2012). Constraint-Induced Movement Therapy (CIMT): Current Perspectives and Future Directions. Stroke Research and Treatment, 1–8. doi: 10.1155/2012/159391
- Shurtleff, T. L., Standeven, J. W., & Engsberg, J. R. (2009). Changes in Dynamic Trunk/Head Stability and Functional Reach After Hippotherapy. Archives of Physical Medicine and Rehabilitation, 90(7), 1185–1195. doi: 10.1016/j.apmr.2009.01.026
- Hartley, H., Cassidy, E., Bunn, L., Kumar, R., Pizer, B., Lane, S., & Carter, B. (2019). Exercise and Physical Therapy Interventions for Children with Ataxia: A Systematic Review. The Cerebellum. doi: 10.1007/s12311-019-01063-z
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