Case Study – Cerebellar Ataxia

November 18, 2017 | By | Reply READ MORE...

20 year old female, Ms. A is a known case of Cerebellar Atrophy since 7 yrs of age presenting with the following chief complaints:

  • Inability to walk independently since 10 years
  • Difficulty in maintaining balance while standing and doing daily activities
  • Difficulty in fine motor activities like writing, buttoning, tying laces.

History Of Present Illness:

  • Symptoms started at the age of seven when her teacher first noticed her making mistakes while copying down sentences from the board.
  • Mother slowly started noticing clumsiness and imbalance while walking in addition to gaze abnormalities which went on progressing.
  • Ms. A could walk independently only till the age of 10.
  • There was no history of seizures, bulbar or sphincter disturbance.
  • Family history of consanguineous marriage between 1st cousins is present.

Investigations:

  • Brain PET-CT scan
  • Hypoplastic cerebeller vermis with cystic dilatation of 4rth ventricle.
  • Moderate to severe hypometabolism in atrophic bilateral cerebellar cortex.

CEREBELLUM

Evaluation:

  • Ms A stands with support of walker and ankle foot orthosis (AFO) with a slight forward lean, wide base of support, both knees hyper-extended.
  • All higher functions except speech and vision were normal.
  • No cranial nerve abnormalities.
  • Superficial sensations were intact, lower limb joint proprioception affected.
  • Hypotonia in limbs and trunk, diminished superficial and deep reflexes.
  • Generalized reduced muscle strength (asthenia)
  • Nystagmus present bilaterally causing her to look from the sides than straight to fix gaze.
  • Static and dynamic balance affected.
  • Postural and intentional tremors seen.
  • Dysmetria (overshooting and undershooting target) present in bilateral upper and lower limbs.
  • Ataxic gait with reduced heel strike and push off.

Pre- treatment Activity Level:

  • Was independent in bed mobility and sitting.
  • Required AFO and walker support to get up from sitting, standing and moving around.
  • Modified independence in toilet transfers.
  • Completely independent in feeding, grooming, bathing.
  • Dependent on walker and one person supervision for outdoor activities.

Plan of care:

In case of Ms. A, our goal was to improve her functional level through restorative techniques. Whenever this was not possible, compensatory strategies were used to make her perform her daily activities as independently as possible within the present functional level.

Goals of treatment:

  • To improve balance and postural reactions
  • To improve postural stabilization
  • To improve general body strength
  • To improve fine motor control and gaze control
  • To improve her gait and coordination

Standing balance training-

  • Ms A needed assistance of a person/ walker to stand. Weight transfers onto the front, back and sides, narrowing the support surface were given.
  • Progression- standing with wall support- ball catch and throw.
  • She could not be progressed to tandem stance.

Strengthening exercises-

  • Open chain strengthening was done for all muscle groups with focus on eccentric control.
  • Sit to stand (involving many reps- to train function)
  • Wall squats
  • Kneel sit- kneel stand
  • Bridging on gym ball
  • Static cycle

To improve coordination-

  • Frenkel’s Exercises in various positions

Gait training-

  • With walker and AFO’s
  • Forward and sideways walking with ankle weights in the parallel bar reduced the ataxia.
  • Marching
  • Forward and side stepping in the parallel bar
  • Step up and down with hand support over a small stepper
  • Stair climbing and descending.

Gaze exercises-

  • 5 times a day were given.

Fine motor activity training was given and Ms A was advised to practice at home.

RESULTS:

  • At the end of 3 months, Ms A started showing improvements in gait, gaze control and coordination.
  • Her postural tremor had reduced, fine motor activities like buttoning, lacing, writing and painting her nails had improved significantly.
  • We modified her Ankle foot orthosis to supra malleolar orthosis.

In terms of activities-

Ms A could now do all her activities of daily living like transfers, toileting, grooming, dressing and bathing independently with walker support. She needed supervision in outdoor activities.

At PHYSIOREHAB, we diagnose a condition with detailed assessment by looking at the functional limitations and not just symptoms. We strive hard to give the best results to the patient.

Category: Case Studies

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