Ataxia refers to the loss of control of voluntary movements of the body, including the limbs, face, or eyes. It is usually considered a symptom of an underlying diagnosis.

What is Ataxia?

Ataxia Overview
Ataxia refers to the loss of control of voluntary movements of the body,
including the limbs, face, or eyes. It is a rare disorder with many proposed
forms that are thought to affect common actions including walking, reaching,
speaking, and seeing. In some cases, ataxia can develop by itself; however, it
often manifests alongside another diagnosis. For purposes of this article, we
will discuss ataxia as a neurological symptom, its effects on upper and lower
extremity function, and supportive strategies to improve daily functioning while
living with ataxia.



What causes ataxia?
Ataxia often results from damage to a brain area called the cerebellum, a
structure that regulates coordination of movement and balance. It can affect one
side of the body (known as hemi-ataxia) or both, and can occur at any age
depending on its underlying cause. Ataxia can present quickly, following an
acute event, such as a stroke or brain injury, or slowly alongside a
neurodegenerative disorder. For some conditions, like cerebral palsy, ataxia may
be present from birth.

At this time, there is no cure for ataxia; however, prompt therapeutic
intervention can improve functional outcomes.



What does ataxia look like?
Ataxia symptoms can make an individual look as if they are clumsy. Ataxia
affecting the arms can cause difficulty holding and using objects as well as
decreased accuracy in reaching targets. Symptoms of ataxia affecting the core
and legs might present as impaired sitting or standing balance, unsteady
walking, and falling. Unlike apraxia
[https://www.neofect.com/us/blog/what-is-apraxia], another coordination
disorder, individuals with ataxia remain aware of the purpose of their actions
and associated tool use; however, their muscles do not respond in the correct
way to accomplish the desired task efficiently.

Therapeutic Treatments for Ataxia
There are many different options for treating ataxia with the help of an
occupational or physical therapist. Conventional OT and PT services aim to
improve independence and safety with daily living tasks. Occupational therapy
focuses on life skills from the basics, like eating, dressing, and grooming, to
bigger-picture tasks related to performing optimally at school or work. Physical
therapy addresses posture, balance, and walking so the individual can move
around with less assistance. Both OT and PT may incorporate strengthening and
cooridnation exercises as well as adaptive equipment or assistive device
recommendations into their treatment plans.



Constraint Induced Movement Therapy (CIMT)
CIMT
[https://blog.neofect.com/using-neofect-smartglove-to-maximize-constraint-induced-movement-therapy/] 
is a therapeutic intervention that can improve grasping, reaching, and in-hand
manipulation skills by constraining an individual’s less affected arm in a mitt,
cast, or sling, thereby forcing them to use their more affected side for the
majority of the time. A therapist will then lead the individual through
intensive training involving repetitive task performance to promote improved
functional use of the limb and increased motivation to use it when not
constrained.

Hippotherapy
Also known as equine assisted therapy, horseback riding under the direction of
an occupational or physical therapist is another treatment that is shown to
improve mobility and coordination for individuals with ataxia. This intervention
engages multiple body systems through incorporation of activities including
achieving and changing positions while on horseback. Hippotherapy promotes
improved core strength and posture that extends into better walking skills and
more accurate reaching to targets.

Gamified Therapy
Gamified therapies include digital products that can be used to address
functional impairments in a fun and stimulating environment. The Neofect Smart
Pegboard [https://www.neofect.com/us/smart-pegboard] is one example, targeting
dexterity, cognitive, and visual skills via multiple modes of gameplay. Users
are challenged to grasp, pinch, and release varied peg sizes and shapes while
paying attention to light and sound prompts during games like Simon Says, Memory
Placement, and Snake Trap.

Studies support that gamified rehab approaches can be more engaging than
traditional therapeutic techniques, promoting better compliance and improved
motor outcomes. Research specific to the Neofect Smart Pegboard supports that
regular gameplay can produce lasting improvements in arm and hand function for
daily tasks.



Ultimately, ataxia can be a challenging symptom to address due to the variety of
diagnoses that it may stem from. However, therapeutic interventions have shown
promise in reducing ataxia-related incoordination or providing means to
compensate for it. If you think you might be experiencing ataxia and are seeking
treatment options, please discuss your concerns with your medical team.

References

 1.  Columbia University Department of Neurology. (2015). Ataxia. Retrieved from 
     http://www.columbianeurology.org/neurology/staywell/document.php?id=35869
 2.  Ashizawa, T., & Xia, G. (2016). Ataxia. Continuum (Minneapolis, Minn.),
     22(4), 1208–1226. doi:10.1212/CON.0000000000000362
 3.  Brunberg JA; Expert Panel on Neurologic Imaging. Ataxia. AJNR Am J
     Neuroradiol. 2008 Aug;29(7):1420-1422.
 4.  Fernandez, H. (2019). Ataxia. Retrieved from 
     http://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Ataxia.htm
 5.  National Ataxia Foundation. (2019). What is Ataxia? Retrieved from 
     https://ataxia.org/what-is-ataxia/#ataxiaSymptoms
 6.  NORD National Organization for Rare Disorders. (2003). Apraxia. Retrieved
     from https://rarediseases.org/rare-diseases/apraxia/
 7.  Reiss, A. P., Wolf, S. L., Hammel, E. A., Mcleod, E. L., & Williams, E. A.
     (2012). Constraint-Induced Movement Therapy (CIMT): Current Perspectives
     and Future Directions. Stroke Research and Treatment, 1–8. doi:
     10.1155/2012/159391
 8.  Shurtleff, T. L., Standeven, J. W., & Engsberg, J. R. (2009). Changes in
     Dynamic Trunk/Head Stability and Functional Reach After Hippotherapy.
     Archives of Physical Medicine and Rehabilitation, 90(7), 1185–1195. doi:
     10.1016/j.apmr.2009.01.026
 9.  Hartley, H., Cassidy, E., Bunn, L., Kumar, R., Pizer, B., Lane, S., &
     Carter, B. (2019). Exercise and Physical Therapy Interventions for Children
     with Ataxia: A Systematic Review. The Cerebellum. doi:
     10.1007/s12311-019-01063-z
 10. Cho, M., Kim, D., & Yang, Y. (2015). Effects of visual perceptual
     intervention on visual-motor integration and activities of daily living
     performance of children with cerebral palsy. Journal of physical therapy
     science, 27(2), 411–413. https://doi.org/10.1589/jpts.27.411

For more information on Ataxia
National Ataxia Foundation - What is Ataxia [https://ataxia.org/what-is-ataxia/]
Mayo Clinic - Ataxia
[https://www.mayoclinic.org/diseases-conditions/ataxia/symptoms-causes/syc-20355652]
Johns Hopkins Medicine - Ataxia
[https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/ataxia/conditions/index.html]
WebMD - Ataxia: What Are the Types?
[https://www.webmd.com/brain/ataxia-types-brain-and-nervous-system#1]

Post-Stroke

Cerebral palsy is defined as non-progressive lesions or damages in the brain at or before birth, leading to impairments in movement and posture.

Movement and Strength of Children with Cerebral Palsy

Movement and Strength of Children with Cerebral Palsy
Cerebral palsy is defined as non-progressive lesions or damage in the brain at
or before birth, leading to impairments in movement and posture.

These impairments vary from person to person, but the majority of children with
cerebral palsy experience differences in muscle strength which can lead to many
functional challenges throughout their lives.





As discussed in the article above, strength training in children with cerebral
palsy has been shown to be beneficial particularly in improving their motor
activity. It can be confusing for caregivers to objectively determine what type
and frequency of strength training activity would be helpful. Evaluations such
as the Pediatric Functional Muscle Test can be useful for clinicians and
therapists for in-the-moment information, but provides limited information and
applications for continued training.

It is important to know the basic principles of strength training with children
with cerebral palsy before starting any program.



Strength training for children with cerebral palsy
 1. Repetition!
    Children with cerebral palsy often have difficulty activating certain muscle
    groups. In order to effectively strengthen these muscle groups, training
    should focus on repetition of postures or activities that encourage movement
    in these areas.
    
    
 2. Find the right tools!
    In order for a training program to be effective the child needs to be able
    to understand and engage in the instructed movements.
    
    
 3. Positioning!
    Engaging in the activity with good posture will enhance the effectiveness of
    the training
    
    
 4. Adaptation!
    Make sure the training activity is an appropriate amount of challenge for
    the child's abilities. Remove too-complex elements or add challenge to
    too-easy elements to ensure they stay motivated.
    
    
 5. Engagement!
    Training that is relevant to the child's interests will have better
    long-term effects. Ensure they have a say in their program, either catering
    a routine to include relevant personal touches or letting the child pick the
    day's activity are surefire strategies.
    
    





Goals of strength training for CP
Not only can strength training activities for children with cerebral palsy
strengthen muscle groups, these effects can translate into improved function in
daily life. Stronger and more coordinated muscles may lend to greater
independence in self-care skills and feelings of capability and self-confidence.

The benefits of strengthening for pediatric CP are clear. Look to your
rehabilitation team for additional tips to get started on an effective exercise
program.



Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of
strength-training programs for people with cerebral palsy. Arch Phys Med
Rehabil. 2002;83(8):1157-1164. doi:10.1053/apmr.2002.34286