Effectiveness of physiotherapy for adults with cerebellar dysfunction: a systematic review

Abstract

Objective: To systematically review the literature investigating the effectiveness of physiotherapy in adults with cerebellar dysfunction and to document treatment strategies currently employed in the physiotherapy management of this patient population.

Data sources: Eight electronic databases were searched to source English-language studies published up to December 2007. Secondary searching of reference lists was also undertaken.

Review methods: Studies were included if they used a quantitative research design to investigate the effect of physiotherapy on adults with diagnosed cerebellar dysfunction. Three reviewers were involved in study selection. Eligible studies were assessed for methodological quality. Data pertaining to the participants, interventions received, outcomes measured, and the effectiveness of the intervention were systematically extracted and synthesised in a narrative format.

Results: Nine studies were included in the review. The majority of the studies (n = 7) were case studies or case series. The median quality score was 8/16 (range 4—10). The studies were heterogeneous in terms of patient characteristics, interventions received and outcomes measured. All studies reported positive effects of physiotherapy over a range of outcomes measured, in particular balance, gait and function.

Conclusion: There is some evidence that supports the effectiveness of physiotherapy in adults with cerebellar dysfunction. However, these results need to be interpreted with caution due to the low volume, quality and clinical applicability of this evidence. There is a need for further high-quality research in this area.

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References

Bakker M. , Allum JHJ , Visser JE et al. Postural responses to multidirectional stance perturbations in cerebellar ataxia. Exp Neurol 2006; 202: 21-35.

Bastian AJ , Martin TA , Keating JG , Thach WT Cerebellar ataxia: Abnormal control of interaction torques across multiple joints. J Neurophysiol 1996; 76: 492-509.

Ghez C. , Thach WT The cerebellum. In Kandel ER , Schwartz JH , Jessell TM. eds. Principles of neural science, fourth edition. McGraw-Hill, 2000, 832-52.

Ilg W. , Golla H. , Thier P. , Giese MA Specific influences of cerebellar dysfunctions on gait. Brain 2007; 130: 786-98.

Ausim Azizi S. And the olive said to the cerebellum: organization and functional significance of the olivo-cerebellar system. The Neuroscientist 2007; 13: 616-26.

Boyd LA , Winstein CJ Cerebellar stroke impairs temporal but not spatial accuracy during implicit motor learning. Neurorehabil Neural Repair 2004; 18: 134-43.

Doyon J. , Penhune V. , Ungerleider LG Distinct contribution of the cortico-striatal and cortico-cerebellar systems to motor skill learning. Neuropsychologia 2003; 41: 252-62.

Molinari M. , Leggio MG , Solida A. et al. Cerebellum and procedural learning: Evidence from focal cerebellar lesions. Brain 1997; 120: 1753-62.

Kabat H. Analysis and therapy of cerebellar ataxia and asynergia. Arch Neurol Psychiatry 1955; 74: 375-82.

10.

Barclay HV Medical gymnastics in locomotor ataxia: The frenkel and other exercises . Am J Nurs 1913; 13: 428-36.

11.

Bastian AJ Mechanisms of ataxia. Phys Ther 1997 ; 77: 672-75.

12.

Morgan MH Ataxia and weights. Physiotherapy 1975; 61: 332-34.

13.

Lucy SD , Hayes KC Postural sway profiles: Normal subjects and subjects with cerebellar ataxia . Physiother Can 1985; 37: 140-48.

14.

Crowdy KA , Kaur-Mann D. , Cooper HL , Mansfield AG , Offord JL , Marple-Horvat DE Rehearsal by eye movement improves visuomotor performance in cerebellar patients . Exp Brain Res 2002; 146: 244-47.

15.

Ioffe MF , Ustinova KI , Chernikova LA , Kulikov MA Supervised learning of postural tasks in patients with poststroke hemiparesis, parkinson's disease or cerebellar ataxia. Exp Brain Res 2006; 168: 384-94.

16.

Lacourse MG , Turner JA , Randolph-Orr E. , Schandler SL , Cohen MJ Cerebral and cerebellar sensorimotor plasticity following motor imagery-based mental practice of a sequential movement. J Rehabil Res Dev 2004 ; 41: 505-23.

17.

Matsumura M. , Sadato N. , Kochiyama T. et al. Role of the cerebellum in implicit motor skill learning: A pet study. Brain Res Bull 2004; 63: 471-83.

18.

Carr JH , Shepherd RB Training motor control, increasing strength and fitness and promoting skill acquisition. In Neurological rehabilitation: Optimizing motor performance. Butterworth Heinemann, 1998: 23-46.

19.

Law M. , Stewart M. , Pollock N. , Letts L. , Bosch J. , Westmorland M. Guidelines for critical review form - quantitative studies. 1998. Accessed 5 August 2007, from: http://www._fhs.mcmaster.ca/rehab/ebp/pdf/quanguidelines.pdf

20.

Nhmrc. How to use the evidence: Assessment and application of scientific evidence. Biotext (Australia Govt), 2000.

21.

Bialocerkowski A. , Kurlowicz K. , Vladusic S. , Grimmer K. Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. Int J Evid Based Healthcare 2005; 3: 27-44.

22.

Mills R. , Yap L. , Young CA Treatment for ataxia in multiple sclerosis. Cochrane Database Syst Rev Issue 1. Art. No. CD005029. DOI: 101002/ 14651858. pub2, 2007.

23.

Armutlu K. , Karabudak R. , Nurlu G. Physiotherapy approaches in the treatment of ataxic multiple sclerosis: a pilot study. Neurorehabil Neural Repair 2001 ; 15: 203-11.

24.

Jones L. , Lewis Y. , Harrison J. , Wiles CM The effectiveness of occupational therapy and physiotherapy in multiple sclerosis patients with ataxia of the upper limb and trunk. Clin Rehabil 1996; 10: 277-82.

25.

Balliet R. , Harbst KM , Kim D. , Stewart RV Retraining of functional gait through reduction of upper extremity weight-bearing in chronic cerebellar ataxia. Int Rehabil Med 1987; 8: 148-53.

26.

Brown KE , Whitney SL , Marchetti GF , Wrisley DM , Furman JM Physical therapy for central vestibular dysfunction. Arch Phys Med Rehabil 2006; 87: 76-81.

27.

Folz TJ , Sinaki M. A nouveau aid for posture training in degenerative disorders of the central nervous system. J Musculoskel Pain 1995; 3: 59-69.

28.

Gialanella B. , Bertolinelli V. , Monguzzi R. , Santoro R. Walking and disability after rehabilitation in patients with cerebellar stroke. Minerva Med 2005; 96: 373-78.

29.

Gill-body KM , Popat RA , Parker SW , Krebs DE Rehabilitation of balance in two patients with cerebellar dysfunction. Phys Ther 1997 ; 77: 534-52.

30.

Karakaya M. , Kose N. , Otman S. , Ozgen T. Investigation and comparison of the effects of rehabilitation on balance and coordination problems in patients with posterior fossa and cerebellopontine angle tumours. J Neurosurg Sci 2000; 44: 220-25.

31.

Perlmutter E. , Gregory PC Rehabilitation treatment options for a patient with paraneoplastic cerebellar degeneration. Am J Phys Med Rehabil 2003; 82: 158-62.

32.

Crombie IK The pocket guide to critical appraisal: a handbook for health care professionals, fourth edition. BMJ Books, 1996.

33.

Bailar JC III , Mosteller F. Guidelines for statistical reporting in articles for medical journals. Amplifications and explanations. Ann Intern Med 1988; 108: 266-73.

34.

Polgar S. , Thomas SA Introduction to reseach in the health sciences, fifth edition. Churchill Livingstone, 2008.