Motor Rehabilitation of Cerebellar Disorders

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Essentials of Cerebellum and Cerebellar Disorders
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Abstract

Disorders of the cerebellum affect motor functions in a variety of ways and can lead to significant and severe limitations in activities of daily living. Possibilities for medical interventions are still rare and limited to specific diseases and symptoms. Furthermore, motor rehabilitation for patients suffering from cerebellar damage—in particular by degenerative cerebellar disease—is challenging, since the cerebellum is known to play an important role in the execution as well as for adaptation and (re)-learning of movements.

This chapter briefly reviews the state-of-the-art on motor rehabilitation in cerebellar disease. Recent studies indicate that even in the case of degenerative cerebellar diseases intensive and continuous motor training can reduce ataxia symptoms and increase motor performance relevant to daily living.

In addition, current studies in the area of motor control and motor learning—in combination with modern imaging techniques—in cerebellar disease are described. These results offer promising perspectives for a deeper understanding of remaining motor learning capacities in cerebellar disease, and thus might help in the future to optimize motor rehabilitation for individual patients.

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References

  • Balliet R, Harbst KB, Kim D, Stewart RV (1987) Retraining of functional gait through the reduction of upper extremity weight-bearing in chronic cerebellar ataxia. Int Rehabil Med 8:148–153

    CAS  PubMed  Google Scholar 

  • Bastian AJ (1997) Mechanisms of ataxia. Phys Ther 77:672–675

    Article  CAS  PubMed  Google Scholar 

  • Bastian AJ (2006) Learning to predict the future: the cerebellum adapts feedforward movement control. Curr Opin Neurobiol 16:645–649

    Article  CAS  PubMed  Google Scholar 

  • Bastian AJ (2011) Moving, sensing and learning with cerebellar damage. Curr Opin Neurobiol 21:596–601

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bastian AJ, Martin TA, Keating JG, Thach WT (1996) Cerebellar ataxia: abnormal control of interaction torques across multiple joints. J Neurophysiol 76:492–509

    Article  CAS  PubMed  Google Scholar 

  • Bhanpuri NH, Okamura AM, Bastian AJ (2014) Predicting and correcting ataxia using a model of cerebellar function. Brain 137:1931

    Article  PubMed  PubMed Central  Google Scholar 

  • Bunn LM, Marsden JF, Giunti P, Day BL (2015) Training balance with opto-kinetic stimuli in the home: a randomized controlled feasibility study in people with pure cerebellar disease. Clin Rehabil 29(2):143–153

    Article  PubMed  Google Scholar 

  • Burciu RG, Fritsche N, Granert O, Schmitz L, Sponemann N, Konczak J, Theysohn N, Gerwig M, van Eimeren T, Timmann D (2013) Brain changes associated with postural training in patients with cerebellar degeneration: a voxel-based morphometry study. J Neurosci 33:4594–4604

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cakrt O, Vyhnalek M, Slaby K, Funda T, Vuillerme N, Kolar P, Jerabek J (2012) Balance rehabilitation therapy by tongue electrotactile biofeedback in patients with degenerative cerebellar disease. NeuroRehabilitation 31:429–434

    Article  PubMed  Google Scholar 

  • Cassidy E, Kilbridge C, Holland A (2009) Management of the Ataxias: towards best Clinical Practice—Physiotherapy Supplement. In: Ataxia UK

    Google Scholar 

  • Cernak K, Stevens V, Price R, Shumway-Cook A (2008) Locomotor training using body-weight support on a treadmill in conjunction with ongoing physical therapy in a child with severe cerebellar ataxia. Phys Ther 88:88–97

    Article  PubMed  Google Scholar 

  • Diener HC, Dichgans J (1996) Cerebellar and spinocerebellar gait disorders. In: Bronstein AM, Brandt T, Woollacott (eds) Clinical disorders of posture and gait, 1st edn. Arnold, London, pp 147–155

    Google Scholar 

  • Draganova R, Konietschke F, Steiner KM, Elangovan N, Gumus M, Goricke SM, Ernst TM, Deistung A, van Eimeren T, Konczak J, Timmann D (2021) Motor training-related brain reorganization in patients with cerebellar degeneration. Hum Brain Mapp 43:1611

    Article  PubMed  PubMed Central  Google Scholar 

  • Fleszar Z, Mellone S, Giese M, Tacconi C, Becker C, Schöls L, Synofzik M, Ilg W (2019) Real-time use of audio-biofeedback can improve postural sway in patients with degenerative ataxia. Ann Clin Transl Neurol 6:285–294

    Article  PubMed  Google Scholar 

  • Fonteyn EM, Heeren A, Engels JJ, Boer JJ, van de Warrenburg BP, Weerdesteyn V (2014) Gait adaptability training improves obstacle avoidance and dynamic stability in patients with cerebellar degeneration. Gait Posture 40:247–251

    Article  PubMed  Google Scholar 

  • Fryer JD, Yu P, Kang H, Mandel-Brehm C, Carter AN, Crespo-Barreto J, Gao Y, Flora A, Shaw C, Orr HT, Zoghbi HY (2011) Exercise and genetic rescue of SCA1 via the transcriptional repressor Capicua. Science 334:690–693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Galea JM, Jayaram G, Ajagbe L, Celnik P (2009) Modulation of cerebellar excitability by polarity-specific noninvasive direct current stimulation. J Neurosci 29:9115–9122

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gill-Body KM, Popat RA, Parker SW, Krebs DE (1997) Rehabilitation of balance in two patients with cerebellar dysfunction. Phys Ther 77:534–552

    Article  CAS  PubMed  Google Scholar 

  • Ilg W, Timmann D (2013) Gait ataxia-specific cerebellar influences and their rehabilitation. Mov Disord 28:1566–1575

    Article  PubMed  Google Scholar 

  • Ilg W, Synofzik M, Brötz D, Burkard S, Giese MA, Schöls L (2009) Intensive coordinative training improves motor performance in degenerative cerebellar disease. Neurology 73:1823–1830

    Article  CAS  PubMed  Google Scholar 

  • Ilg W, Brötz D, Burkard S, Giese MA, Schöls L, Synofzik M (2010) Long-term effects of coordinative training in degenerative cerebellar disease. Mov Disord 25:2239–2246

    Article  PubMed  Google Scholar 

  • Ilg W, Schatton C, Schicks J, Giese MA, Schols L, Synofzik M (2012) Video game-based coordinative training improves ataxia in children with degenerative ataxia. Neurology 79:2056–2060

    Article  PubMed  Google Scholar 

  • Ilg W, Bastian AJ, Boesch S, Burciu RG, Celnik P, Claassen J, Feil K, Kalla R, Miyai I, Nachbauer W, Schols L, Strupp M, Synofzik M, Teufel J, Timmann D (2014) Consensus paper: management of degenerative cerebellar disorders. Cerebellum 13:248–268

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ilg W, Fleszar Z, Schatton C, Hengel H, Harmuth F, Bauer P, Timmann D, Giese M, Schols L, Synofzik M (2016) Individual changes in preclinical spinocerebellar ataxia identified via increased motor complexity. Mov Disord 31:1891–1900

    Article  PubMed  Google Scholar 

  • Jacobi H et al (2011) The natural history of spinocerebellar ataxia type 1, 2, 3, and 6: a 2-year follow-up study. Neurology 77:1035–1041

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kaut O, Jacobi H, Coch C, Prochnicki A, Minnerop M, Klockgether T, Wullner U (2014) A randomized pilot study of stochastic vibration therapy in spinocerebellar ataxia. Cerebellum 13:237–242

    Article  CAS  PubMed  Google Scholar 

  • Keller JL, Bastian AJ (2014) A home balance exercise program improves walking in people with cerebellar ataxia. Neurorehabil Neural Repair 28:770

    Article  PubMed  PubMed Central  Google Scholar 

  • Konczak J, Schoch B, Dimitrova A, Gizewski E, Timmann D (2005) Functional recovery of children and adolescents after cerebellar tumour resection. Brain 128:1428–1441

    Article  PubMed  Google Scholar 

  • Marsden J, Harris C (2011) Cerebellar ataxia: pathophysiology and rehabilitation. Clin Rehabil 25:195–216

    Article  PubMed  Google Scholar 

  • Milne SC, Corben LA, Georgiou-Karistianis N, Delatycki MB, Yiu EM (2017) Rehabilitation for individuals with genetic degenerative ataxia: a systematic review. Neurorehabil Neural Repair 31:609–622

    Article  PubMed  Google Scholar 

  • Milne SC, Corben LA, Roberts M, Murphy A, Tai G, Georgiou-Karistianis N, Yiu EM, Delatycki MB (2018) Can rehabilitation improve the health and well-being in Friedreich’s ataxia: a randomized controlled trial? Clin Rehabil 32:630–643

    Article  PubMed  Google Scholar 

  • Milne SC, Corben LA, Roberts M, Szmulewicz D, Burns J, Grobler AC, Williams S, Chua J, Liang C, Lamont PJ, Grootendorst AC, Massey L, Sue C, Dalziel K, LaGrappe D, Willis L, Freijah A, Gerken P, Delatycki MB (2020) Rehabilitation for ataxia study: protocol for a randomised controlled trial of an outpatient and supported home-based physiotherapy programme for people with hereditary cerebellar ataxia. BMJ Open 10:e040230

    Article  PubMed  PubMed Central  Google Scholar 

  • Miterko LN et al (2019) Consensus paper: experimental neurostimulation of the cerebellum. Cerebellum 18:1064–1097

    Article  PubMed  PubMed Central  Google Scholar 

  • Miyai I, Ito M, Hattori N, Mihara M, Hatakenaka M, Yagura H, Sobue G, Nishizawa M (2012) Cerebellar ataxia rehabilitation trial in degenerative cerebellar diseases. Neurorehabil Neural Repair 26:515–522

    Article  PubMed  Google Scholar 

  • Morton SM, Bastian AJ (2004) Cerebellar control of balance and locomotion. Neuroscientist 10:247–259

    Article  PubMed  Google Scholar 

  • Platz T, Winter T, Muller N, Pinkowski C, Eickhof C, Mauritz KH (2001) Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: a single-blind, randomized, controlled trial. Arch Phys Med Rehabil 82:961–968

    Article  CAS  PubMed  Google Scholar 

  • Schatton C, Synofzik M, Fleszar Z, Giese MA, Schols L, Ilg W (2017) Individualized exergame training improves postural control in advanced degenerative spinocerebellar ataxia: a rater-blinded, intra-individually controlled trial. Parkinsonism Relat Disord 39:80–84

    Article  PubMed  Google Scholar 

  • Schöls L, Bauer P, Schmidt T, Schulte T, Riess O (2004) Autosomal dominant cerebellar ataxias: clinical features, genetics, and pathogenesis. Lancet Neurol 3:291–304

    Article  PubMed  Google Scholar 

  • Sonoda Y, Yoshida N, Kawami K, Kitamura A, Ogawa N, Yamakawa I, Kim H, Sanada M, Imai S, Urushitani M (2021) Short-term effect of intensive speech therapy on dysarthria in patients with sporadic spinocerebellar degeneration. J Speech Lang Hear Res 64:725–733

    Article  PubMed  Google Scholar 

  • Synofzik M, Ilg W (2014) Motor training in degenerative spinocerebellar disease: ataxia-specific improvements by intensive physiotherapy and exergames. Biomed Res Int 2014:583507

    Article  PubMed  PubMed Central  Google Scholar 

  • Taub E, Uswatte G, Pidikiti R (1999) Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation—a clinical review. J Rehabil Res Dev 36:237–251

    CAS  PubMed  Google Scholar 

  • Therrien AS, Bastian AJ (2015) Cerebellar damage impairs internal predictions for sensory and motor function. Curr Opin Neurobiol 33:127–133

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Therrien AS, Wolpert DM, Bastian AJ (2016) Effective reinforcement learning following cerebellar damage requires a balance between exploration and motor noise. Brain 139:101–114

    Article  PubMed  Google Scholar 

  • Therrien AS, Statton MA, Bastian AJ (2021) Reinforcement signaling can be used to reduce elements of cerebellar reaching ataxia. Cerebellum 20:62–73

    Article  PubMed  PubMed Central  Google Scholar 

  • Vogel AP, Stoll LH, Oettinger A, Rommel N, Kraus EM, Timmann D, Scott D, Atay C, Storey E, Schols L, Synofzik M (2019) Speech treatment improves dysarthria in multisystemic ataxia: a rater-blinded, controlled pilot-study in ARSACS. J Neurol 266:1260–1266

    Article  PubMed  Google Scholar 

  • Wang RY, Huang FY, Soong BW, Huang SF, Yang YR (2018) A randomized controlled pilot trial of game-based training in individuals with spinocerebellar ataxia type 3. Sci Rep 8:7816

    Article  PubMed  PubMed Central  Google Scholar 

  • Zimmet AM, Cao D, Bastian AJ, Cowan NJ (2020) Cerebellar patients have intact feedback control that can be leveraged to improve reaching. Elife 9:e53246

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Winfried Ilg .

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Ilg, W., Timmann, D. (2023). Motor Rehabilitation of Cerebellar Disorders. In: Gruol, D.L., Koibuchi, N., Manto, M., Molinari, M., Schmahmann, J.D., Shen, Y. (eds) Essentials of Cerebellum and Cerebellar Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-15070-8_107

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