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, 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 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 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
Mayo Clinic - Ataxia
Johns Hopkins Medicine - Ataxia
WebMD - Ataxia: What Are the Types?