Effects of Task-Specific Obstacle Crossing Training on Functional Gait Capability in Patients with Cerebellar Ataxia: Feasibility Study

  • Park, Jin-Hoon (Department of Physical Education, College of Education, Korea University)
  • Received : 2015.04.09
  • Accepted : 2015.04.19
  • Published : 2015.04.25

Abstract

Purpose: The purpose of this study was to examine the effects of a task-specific obstacle crossing rehabilitation program on functional gait ability in patients with cerebellar ataxia. Overall, we sought to provide ataxia-specific locomotor rehabilitation guidelines for use in clinical practice based on quantitative evidence using relevant analysis of gait kinematics including valid clinical tests. Methods: Patients with cerebellar disease (n=13) participated in obstacle crossing training focusing on maintenance of dynamic balance and posture, stable transferring of body weight, and production of coordinated limb movements for 8 weeks, 2 times per week, 90 minutes per session. Throughout the training of body weight transfer, the instructions emphasized conscious perception and control of the center of body stability, trunk and limb alignment, and stepping kinematics during the practice of each walking phase. Results: According to the results, compared with pre-training data, foot clearance, pre-&post-obstacle distance, delay time, and total obstacle crossing time were increased after intervention. In addition, body COM measures indicated that body sway and movement variability, therefore posture stability during obstacle crossing, showed improvement after training. Based on these results, body sway was reduced and stepping pattern became more consistent during obstacle crossing gait after participation in patients with cerebellar ataxia. Conclusion: Findings of this study suggest that task-relevant obstacle crossing training may have a beneficial effect on recovery of functional gait ability in patients with cerebellar disease.

Keywords

References

  1. Earhart GM, Bastian AJ. Selection and coordination of human locomotor forms following cerebellar damage. J Neurophysiol. 2001;85(2):759-69. https://doi.org/10.1152/jn.2001.85.2.759
  2. Paulsen EK, Friedman LS, Myers LM, et al. Health-related quality of life in children with Friedreich ataxia. Pediatr Neurol. 2010;42(5):335-7. https://doi.org/10.1016/j.pediatrneurol.2010.01.002
  3. Hong SI, Bang DH, Shin WS. Effects of side walking training with elastic-band on gait and balance of stroke patients. J Kor Phys Ther. 2014; 26(5):372-8.
  4. Jeong HY, Choi JD. The Effects of vestibular sensory stimulation training on balance and gait in the patients with stroke. J Kor Phys Ther. 2014; 26(5):365-71.
  5. Shim HB, Cho HY, Choi WH. Effects of the trunk stabilization exercise on muscle activity in lumbar region and balance in the patients with hemiplegia. J Kor Phys Ther. 2014;26(1):33-40. https://doi.org/10.1589/jpts.26.33
  6. Kim JH. The effects of whole body vibration exercise on balance and lower extremity muscle activity in stroke patients. J Korean Soc Phys Ther. 2013;25(5):266-72.
  7. Ilg W, Bastian AJ, Boesch S, et al. Consensus paper: management of degenerative cerebellar disorders. Cerebellum. 2014;13:248-68. https://doi.org/10.1007/s12311-013-0531-6
  8. Miyai I, Ito M, Hattori N, et al. Cerebellar ataxia rehabilitation trial in degenerative cerebellar diseases. Neurorehabil Neural Repair. 2012;26: 515-22. https://doi.org/10.1177/1545968311425918
  9. Ilg W, Timmann D. Gait ataxia-specific cerebellar influences and their rehabilitation. Mov Disord. 2013;28:1566-75. https://doi.org/10.1002/mds.25558
  10. Plautz EJ, Milliken GW, Nudo RJ. Effects of repetitive motor training on movement representations in adult squirrel monkeys: Role of use versus learning. Neurobiol Learn Mem. 2000;74(1):27-55. https://doi.org/10.1006/nlme.1999.3934
  11. Bayona NA, Bitensky J, Salter K, et al. The role of task-specific training in rehabilitation therapies. Top Stroke Rehabil. 2005;12(3):58-65. https://doi.org/10.1310/BQM5-6YGB-MVJ5-WVCR
  12. Berard JR, Vallis LA. Characteristics of single and double obstacle avoidance strategies: A comparison between adults and children. Exp Brain Res. 2006;175(1):21-31. https://doi.org/10.1007/s00221-006-0529-0
  13. Bart PC, van de Warrenburg, Janneke AG, et al. Falls in degenerative cerebellar ataxias. Mov disord. 2005;20(4):497-508. https://doi.org/10.1002/mds.20375
  14. Trouillas P, Takayanagi T, Hallett M, et al. International cooperative ataxia rating scale for pharmacological assessment of the cerebellar syndrome. J Neurol Sci. 1997;145:205-11. https://doi.org/10.1016/S0022-510X(96)00231-6
  15. Berg KO, Wood-Dauphinee SL, Williams JI. The balance scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27:27-36.
  16. Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol. 1990;45(6):239-43. https://doi.org/10.1093/geronj/45.6.P239
  17. Lu TW, Chen HL, Chen SC. Comparisons of the lower limb kinematics between young and older adults when crossing obstacles of different heights. Gait Posture. 2006;23(4):471-9. https://doi.org/10.1016/j.gaitpost.2005.06.005
  18. Bastian AJ, Zackowski KM, Thach WT. Cerebellar ataxia: torque deficiency or torque mismatch between joints? J Neurophysiol. 2000;83(5): 3019-30. https://doi.org/10.1152/jn.2000.83.5.3019
  19. Said CM, Goldie PA, Patla AE, et al. Effect of stroke on step characteristics of obstacle crossing. J Neurophysiol. 2001;82(12):1712-9.
  20. Palliyath S, Hallett M, Thomas SL, et al. Gait in patients with cerebellar ataxia. Mov Disord. 1998;13(6):958-64. https://doi.org/10.1002/mds.870130616
  21. Krell J, Patla AE. The influence of multiple obstacles in the travel path on avoidance strategy. Gait Posture. 2002;16(1):15-9. https://doi.org/10.1016/S0966-6362(01)00194-1