Once again, we start off this week discussing in detail one of the most common neurological disorders: ataxia. In this post we will take a detailed look at what is a cerebellar ataxia, explaining the main causes responsible for this disorder and reviewing some of the possible treatments. As many of you already know, this disorder is responsible for a loss of muscle control or a lack of coordination of voluntary movements, like those required for walking or picking up objects, among others. Moreover, it is possible that problems while speaking, with eye movement or when swallowing food appear.
According to the Spanish Neurological Society (SEN), there are more than 13.000 people in Spain suffering from some type of cerebellar ataxia. In fact, every 25th of September we commemorate the International Ataxia Awareness Day. Furthermore, although this disorder encompasses more than 300 different types of neurological conditions that share the same main symptom -a reduction in the ability to coordinate movements- more than 8.000 people (60% of those affected by ataxia in Spain) suffer from a hereditary form of this disorder. In this case, Friedreich’s Ataxia is one of the most common ones.
What is an Ataxia?
Just as in other occasions, before going into detail about the main aspects related with this disorder, we need a clear definition. So, what is an ataxia?
Normally, an ataxia is defined as the inability to voluntarily control muscular movement or to coordinate movement. This disorder can affect all types of activities that require coordination in order to complete them successfully. As a result, it normally takes place when the associated injury affects the cerebellum. This is the part of the brain responsible for the coordination of muscular movements.
In general, there are many causes that can produce this disorder in a person. Among them are abuse of alcohol or certain medications, stroke, brain tumors, cerebral palsy, neurodegenerative diseases and Multiple Sclerosis. There is also the possibility that the main cause is hereditary, due to genetic abnormalities. For example, among the most common hereditary types are Friedreich’s Ataxia and Machado-Joseph Disease. Although as we mentioned before, an ataxia can take place if there is a family history, there are known cases where this disorder developed without any previous history.
As we saw in the previous section, an ataxia will take place when the cerebellum, the part of our brain responsible for muscular coordination, is injured. If this happens, one can say that a cerebellar ataxia has taken place. However, this is not a specific diagnosis but rather, a group of symptoms or even, of disorders. That is, the reasons that lead to an ataxia can be very different even if, at the end, the patient ends up suffering from an “ataxia”.
In general, the loss of the ability to coordinate muscle movement will have a direct effect on balance and in other motor functions. All of this, of course, will greatly affect the autonomy of those individuals affected by this disorder. Although in general the underlying causes that lead to this disorder will mainly result in the degeneration or atrophy of the affected cells in the cerebellum, sometimes the spinal cord can also be affected.
On the other hand, the prognosis and therefore, the treatment for those individuals affected by any type of ataxia will mostly depend on the underlying cause of the disorder.
Treatments for Ataxia
As was mentioned in the previous section, treatments for ataxia will vary and will depend on what caused the disorder. It is very important to clarify that there is no cure for hereditary ataxias. However, if the disorder was caused by an underlying condition, it is important to treat that condition as soon as possible. For example, an ataxia that is initiated by a metabolic disorder will normally be treated with medications and a special diet controlled by a specialist. On the other hand, physical rehabilitation can strengthen muscles and, on top of that, training coordination can obtain some improvements. In the same way, there are also devices (like technical aids) that can assist affected individuals when walking or when performing the activities of daily living, like for example, walking sticks, walkers or tripod canes.
On the other hand, other clinical areas, like occupational therapy or speech and language therapy, are also very useful to improve the autonomy of those individuals affected by an ataxia. Normally, these areas will focus on the use of the upper extremities, the swallowing function and on speech therapy, respectively. Finally, regular aerobic exercise will also be very beneficial for those individuals affected by this disorder.
Rehabilitation for Ataxias
In this section we will focus in the rehabilitation of ataxias. As shown in previous sections, physical rehabilitation is one of the possible treatments that can be useful to deal with this disorder. Physical rehabilitation sessions with a physical therapist will be very useful to strengthen patient’s muscles, to improve their balance and their coordination. In the same way, rehabilitation sessions with an occupational therapist, will be useful in preparing patients to perform the basic activities of daily living, like eating, bathing or getting dressed. These therapists are not only looking to recover lost motor function but also, to teach those compensatory techniques that can aid patients in attaining a greater level of autonomy.
In the same way, the physical rehabilitation exercises included in Rehametrics will enable clinicians to quantify those rehabilitation sessions completed by their patients. This information is extremely useful for all clinicians because it enables them to adjust patient treatment plans more efficiently, which could lead to better functional outcomes for their patients. Currently, Rehametrics has 34 exercises focused on the recovery of static and dynamic balance and 23 exercises whose main clinical objective is to improve coordination.