Published online before print October 28, 2009, doi:10.1212/WNL.0b013e3181c33adf)
NEUROLOGY 2009;73:1823-1830
© 2009 American Academy of Neurology
Intensive coordinative training improves motor performance in degenerative cerebellar disease
W. Ilg, PhD,
M. Synofzik, MD,
D. Brötz,
S. Burkard,
M. A. Giese, PhD and
L. Schöls, MD
From the Departments of Cognitive Neurology (W.I., M.A.G.) and Neurodegeneration (M.S., L.S.), Hertie Institute for Clinical Brain Research and Center of Neurology, Tübingen; Institute of Medical Psychology and Behavioral Neurobiology (D.B.), MEG Center, University Tübingen; and Therapy Centre (S.B.), Center of Neurology, University Clinic Tübingen, Germany.
Address correspondence and reprint requests to Dr. Winfried Ilg, Section Computational Sensomotorics, Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, Frondsbergstrasse 23, 72070 Tübingen, Germany winfried.ilg{at}uni-tuebingen.de
Objectives: The cerebellum is known to play a strong functional role in both motor control and motor learning. Hence, the benefit of physiotherapeutic training remains controversial for patients with cerebellar degeneration. In this study, we examined the effectiveness of a 4-week intensive coordinative training for 16 patients with progressive ataxia due to cerebellar degeneration (n = 10) or degeneration of afferent pathways (n = 6).
Methods: Effects were assessed by clinical ataxia rating scales, individual goal attainment scores, and quantitative movement analysis. Four assessments were performed: 8 weeks before, immediately before, directly after, and 8 weeks after training. To control for variability in disease progression, we used an intraindividual control design, where performance changes with and without training were compared.
Results: Significant improvements in motor performance and reduction of ataxia symptoms were observed in clinical scores after training and were sustained at follow-up assessment. Patients with predominant cerebellar ataxia revealed more distinct improvement than patients with afferent ataxia in several aspects of gait like velocity, lateral sway, and intralimb coordination. Consistently, in patients with cerebellar but without afferent ataxia, the regulation of balance in static and dynamic balance tasks improved significantly.
Conclusion: In patients with cerebellar ataxia, coordinative training improves motor performance and reduces ataxia symptoms, enabling them to achieve personally meaningful goals in everyday life. Training effects were more distinct for patients whose afferent pathways were not affected. For both groups, continuous training seems crucial for stabilizing improvements and should become standard of care.
Level of evidence: This study provides Class III evidence that coordinative training improves motor performance and reduces ataxia symptoms in patients with progressive cerebellar ataxia.
Abbreviations: BBS = Berg balance score; GAS = goal attainment score; ICARS = international cooperative ataxia rating scale; SARA = scale for the assessment and rating of ataxia.
Editorial, page 1818
Supplemental data at www.neurology.org
e-Pub ahead of print on October 28, 2009, at www.neurology.org.
Supported by the Hertie Institute for Clinical Brain Research, the Volkswagenstiftung, the Hermann and Lilly Schilling Foundation, and the Werner-Reichardt Center for Integrative Neuroscience.
Disclosure: Author disclosures are provided at the end of the article.
Received February 26, 2009. Accepted in final form August 11, 2009.
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