Kadriye Armutlu, PT, Ph.D., Assoc. Prof. Hacettepe University Faculty of Health Sciences Department of Physical Therapy and Rehabilitation Neurological Rehabilitation Unit 06100 Samanpazari Ankara, Turkey karmutlu@hacettepe.edu.tr
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Ataxia is a movement disorder resulting from the incoordination of movements and inadequate postural control, presented in balance and walking disturbances. It has three subcategories, which are sensory, cerebellar and vestibular ataxia. Some researchers regard frontal ataxia as the 4th category. Mixed ataxia involves symptoms of at least two basic types of ataxia together. Different clinical symptoms, interference of different neurological structures and different diseases play role in the formation of each ataxia type. Since ataxia is resistant to medical treatments, physical treatment applications are of major importance. Physical therapy applications involve proprioceptive training, balance exercises, stabilization techniques regarding the extremity ataxia and vestibular exercises for accomplishing functional improvement and restoration of the ataxic patient. Compensatory applications employ supportive devices.
Human beings develop normal motor movements by the continuing neuro-developmental maturation following birth. Process of motor development is completed when normal postural mechanisms are localized, followed by the ability to maintain balance in different positions and finally by the formation of muscular coordination.
Normal postural tonus enables standing erect against gravity, adaptation to changes on support surface and proximal stabilization. Balance can be defined as postural adaptation to changes in gravitational center with the contribution of normal postural tonus. Muscular coordination on the other hand, is the functioning of all muscles active during the voluntary motor movement in appropriate rhythm, velocity and amplitude. A person may perform daily life activities through normal motor movement formed by the above mentioned three components.
Nervous system diseases and/or injuries usually affect postural control mechanisms. Patients who have diseases like stroke, head traumas, spinocerebellar ataxias, multiple sclerosis, Parkinson disease and sensory neuropathies frequently suffer from balance and coordination problems. In some of these diseases, balance problems are more dominant, whereas coordination problems related to extremities are more forefront in others. However, when studied closely, co-existance of both problems in many patients can be observed.
In the literature, there are many different statements concerning the definition, extension and terminology of ataxia. This variety of statements forms a confusing situation. For instance, when referring to balance dysfunction as a symptom only of vestibular diseases (Brown et al. 2006), or defining ataxia as a symptom developing from cerebellar influence (Martin 2009).
The goal of this article is to review the definition of ataxia, study its subtypes, measurement and assessment methods, and physiotherapy applications regarding its management.
The word 'ataxia' is derived from Greek meaning 'disorderly' (Bastian 1997). In the literature, most common definition of ataxia is "the in-coordination of movements" (Bastian 1997, Mariotti et al. 2005). However, this definition is to a large degree inadequate in denoting ataxia. In ataxia, both insufficient postural control and incoordination of multi-joint movements is observed (DeSouza 1990). Postural instability results from the inadequacy in postural control and leads to clinical balance dysfunctions. Therefore it is not possible to analyze ataxia in isolation from balance dysfunctions. Although incoordination is usually accompanied by balance dysfunction and gait problems; in some cases, balance dysfunction is observed without the existence of in-coordination of movements (e.g. muscle weaknesses). For example, if normal walking is considered to be the perfectly timed sequence of muscle activity that occurs in response to both internal and external forces, then it is easy to consider walking as a task requiring coordination as well as balance (Crutchfield et al. 1989).
Thus, in-coordination and balance dysfunction in movements without muscle weakness is a more precise definition of ataxia.
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Ataxia: Physical Therapy and Rehabilitation Applications for ...