Topic: Management of Ataxia Ideal for: BPT students Level: Beginner

1. ATAXIA
GENERAL PT MANAGMENT

2. GENERAL MANAGMENT
• AIMS OF GENERAL PT
• Aims are as follows
• 1 To reduce hypotonicity.
• 2 Provide relaxation in muscles.
• 3 To reduce fatigue.

3. GOALS OF GENERAL PT
• 1- Prevent secondary complications or impairments.
• 2- Treat hypotonicity, dysmetria and dysdidokinesia.
• 3- Improve muscle strength.
• 4-Increase ROM of entire trunk and extremities.
• 5- Provide understanding of disease, its symptoms,
and management.
• 6- Teach problem solving skill.

4. GENERAL MANAGEMENT INCLUDE
• RELAXATION TECHNIQUES.
• STRENGTHENING EXERCISES.
• FATIGUE REDUCTION MEASURES.

5. RELAXATION TECHNIQUE
• RELAXATION
• Relaxation is defined as a state in which muscle of the body is free
from any tension.
• INDICATIONS OF RELAXATION
• a) Reduction of anxiety and stress.
• b) Improve muscle control.
• c) Reduce fatigue and relieve pain.
• d) enhance sleep.

6. PRINCIPLES OF RELAXATION
• SUPPORT.
• COMFORT.
• RESTFUL ENVIROMENT.

7. SUPPORT
• Various of forms and modifications of the lying
positions are used, to achieve full support of the
body.
• Prerequisite is firm surface and comfortable
posture such as lying supine, half lying, prone lying,
side lying.

8. COMFORT
• The ingredients of comfort include
• 1> Freedom to breath deeply.
• 2> Warmth.
• 3> Abdominal quiescence.
• 4> Removal of constrictive clothing.
• 5> Light well balanced meal.

9. RESTFUL ATMOSPHEHRE
• 1 - Quiet room.
• 2 - Light music.
• 3 - Well diffuse light.
• 4- Warm room.

10. GENERAL RELAXATION TECHNIQUE
1. Breathing exercises.
2. Progressive muscle relaxation.
3. Yoga
4. Contrast method.
5. Guided imagery.
6. Hydrotherapy.

11. LOCAL RELAXATION TECHNIQUE
1. Heat.
2. Joint traction.
3. Passive movement.
3a) Hold relax
3b) Contract relax
4. Massage
5. Suspension
6. Biofeedback.

12. MANAGEMENT OF FATIGUE
• FATIGUE
• Fatigue is one of the most debilitating symptoms of
the ataxia and is characterized by overwhelming
sleepiness , excessive tiredness, and sense of
weakness that comes on severely and suddenly.
• The resultant lowered activity levels have important
implications for diminished health status and
deconditioning.

13. Conti....• Aerobic exercises training and energy effectiveness strategies
are central to any to any intervention plan to lessen fatigue.
• Keep an activity diary in which they record how they slept the
night before, daily activities by hour, and how costly those
activities were.
• ENERGY CONSERVATION- Refers to the adoption strategies that
reduce overall energy requirements of the task and overall
level of fatigue.
• For example, a motorized scooter or powered wheelchair can
be consider for community or home mobility to help conserve
energy and maintain independence
• ACTIVITY PACING – Refers to the balancing of activity with rest
periods interspersed throughout the day
• For the patient with chronic fatigue, rest fatigue,rest activity
ratios are developed with periodic rest periods planned in
advance.
• Time-outs with complete rest should be instituted if an activity
become exhaustive .

14. STRENGTH AND CONDITIONING
• Determining an appropriate exercise prescription to improve strength
and endurance is challenging and needs to be carefully individualized
for each patient.
• Prescription is based on four interrelated elements: frequency of
exercise, intensity of exercise, type of exercise, and duration..

15. The following guidelines can be used
• Exercise session can be scheduled on alternate days and during optimal times,
such as in morning, when body core temperature tends to be lowest and before
sets in.
• Circuit training, in which improved work capacity is developed through the use of
various different stations that alternate work between upper and lower
extremities, distributes the load among muscles and may prove best for reducing
the fatigue.
• Resistance training include weight machines, free or pulley weights elastics
resistance bands or isokinetic machines.
• Functional training activities ( e.g closed chain exercises ) can be used to promote
strength and functional endurance.
• Individual with balance problems require the use of more stable postures(e.g
plantigrade, quadruped,or supported sitting .)
• Group exercises classes can provide valuable motivation and social support.

16. CARDIOVASCULAR CONDITIONING
• Individual with ataxia demonstrate expected physiological responses
to submaximal aerobic exercise, that is heart rate, blood pressure
,and oxygen uptake all increase in linear fashion in response to
increasing workloads.
• Patients with ataxia can also demonstrate respiratory muscle
dysfunction, contributing to reduced exercise tolerance.

17. The following guidelines for clinical exercise
testing can be used
• The preferred mode is either an upright on recumbent leg cycle
ergometer. A recumbent device is indicated if sitting balance is
impaired . Combination leg and arm ergometery or UE ergometery
may be necessary with increased LE involvement.
• Toe clips and heel straps are recommended to control foot
placement especially in patients with spasticity, tremor, or
weakness.

18. • Performance measures include : HR, RPE ( rate of perceived exertion) ,BP
and expired gas analysis (vo2 ). Using the RPE scale, peripheral exertion is
consistently rated as more stressful( higher) than central exertion.
Precaution should be taken to monitor the effects of fatigue.
• Precaution should be taken to prevent the deleterious effects of over work
• Recommended training frequency is 3 sessions per week an alternate days.
• Training intensity should be limited to 60-75% peak heart rate.
• Type of exercise can include cycling, walking , swimming and water
aerobics.

19. MANAGEMENT OF PAIN
• The management of pain depends on an accurate determination of its cause.
• Musculoskeletal strain or joint malalignment from chronically weakened muscle are
important consideration and are responsive to physical therapy to intervention.
• Patients may experience of pain with regular stretching or exercise, massage and
ultrasound.
• Postural retraining and correction of faulty movement patterns along with orthotic and /
or adaptive sitting devices can reduce malalignment and pain.
• Stabbing pain from Lhermitte’s sign may be relieved with a soft collar to limit neck
flexion.
• Hydrotherapy using luke warm water may have a beneficial effect on painful
dysesthesias.
• Pressure stoking and gloves can also be used to relieve pain , converting the sensation of
pain to one of pressure.

20. • Stress management techniques , relaxation training , biofeedback ,
meditation , and so forth are often helpful in reducing both anxiety
and pain.
• TENS .

21. FUNCTIONAL TRAINING
• Functional training should focus on problem solving and the development
of appropriate decision making skill required to meet the challenges of
being disabled.
• Skills should be adapted and practised to ensure safe performances in
both the home and community environment.
• Full participation of the patient in all phases of planning and training will
increase personal involvement , while decreasing dependency and
passivity.
• This requires careful attention to appropriate prescription of devices and
environmental modification to function.
• Adaptive equipment can include bed bathroom grab bars , overhead
trapeze , raised seas transfer board or hydraulic lift.

22. PATIENT AND FAMILY/CAREGIVER EDUCATION
• The development of a strong collaborative relationship with the
patient and family/caregivers in which there is respect , compassion
and effective communication is key to successful rehabilitation
outcomes.
• As an educator , the therapist has an important role in assisting the
patient and family/caregivers in providing information on:

23. 1. The disease process, clinical manifestation , and there significance in
terms of management.
2. Prevention of secondary complication , indirect impairments , and
functional limitations.
3. The rehabilitation process , the plan of care and its specific interventions.
4. The home exercise programme interventions that can be carried out
independently.
5. Monitoring the effects and possible adverse reactions of medications
6. Use of assistive device and adaptive equipments.
7. General health and management techniques.
8. Community resources.

24. FLEXIBILITY EXERCISES
1. Flexibility exercises and ROM exercises are necessary to ensure
adequate joint ROM and to prevent tightness and contractures.
2. Sedentary or inactive persons often develop tightness in hip flexors
,adductors, hamstring or heel cord.
3. Limited overhead ROM is seen with tightness in pectoralis
major/minor , latissimus dorsi and is associated with slumped ,
forward posture .
4. Supported position should be used to decrease the impact of
balance problems.
5. Goniometry is an appropriate outcome measures.

25. To PREVENT CHEST COMPLICATION
• Relaxed diaphragmatic breathing exercises should be done .
• Segmental exercises.
• Huffing and coughing to clear secretion .