The assessment and treatment of postural disorders in cerebellar ataxia: A systematic review
The assessment and treatment of postural disorders in cerebellar ataxia: A systematic review
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DOI：
10.1016/j.rehab.2014.01.002
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发表时间：
2014-03-01
影响因子：
4.6
通讯作者：
Perennou, D.
中科院分区：
文献类型：
--
作者：
Marquer, A.;Barbieri, G.;Perennou, D.
步态和平衡障碍通常是小脑性共济失调患者残疾的主要原因。虽然人们认为小脑共济失调的姿势和平衡障碍是不可治疗的，但最近的研究表明康复计划的有益效果。本文是对小脑性共济失调中体位障碍治疗的首次系统综述。我们选择了19篇文章，其中3篇是随机对照试验。研究了小脑性共济失调的各种病因：5项研究评估多发性硬化症患者，4项研究评估退行性共济失调患者，2项研究评估脑卒中患者，8项研究评估各种病因的患者。准确评估小脑性共济失调的体位障碍在临床试验和临床实践中都具有重要意义。共济失调评定评定量表（SARA）是一种简单、有效的测量工具，40分中有18分与体位障碍有关。该量表可用于监测伴有体位障碍的共济失调患者。现在有中等水平的证据表明，康复治疗对改善小脑性共济失调患者的姿势能力是有效的，特别是对退行性共济失调或多发性硬化症患者。有平衡和协调练习的强化康复计划是必要的。尽管虚拟现实、生物反馈、支撑体重和躯干重量的跑步机锻炼等技术似乎很有价值，但它们的具体功效还有待进一步研究。药物只研究了退行性共济失调，证据水平很低。现在需要进行大规模的、随机的、对照试验来测试适合小脑性共济失调患者姿势和步态障碍的康复方案。(C) 2014 Elsevier Masson SAS。版权所有。
Gait and balance disorders are often major causes of handicap in patients with cerebellar ataxia. Although it was thought that postural and balance disorders in cerebellar ataxia were not treatable, recent studies have demonstrated the beneficial effects of rehabilitation programs. This article is the first systematic review on the treatment of postural disorders in cerebellar ataxia. Nineteen articles were selected, of which three were randomized, controlled trials. Various aetiologies of cerebellar ataxia were studied: five studies assessed patients with multiple sclerosis, four assessed patients with degenerative ataxia, two assessed stroke patients and eight assessed patients with various aetiologies. Accurate assessment of postural disorders in cerebellar ataxia is very important in both clinical trials and clinical practice. The Scale for the Assessment and Rating of Ataxia (SARA) is a simple, validated measurement tool, for which 18 of the 40 points are related to postural disorders. This scale is useful for monitoring ataxic patients with postural disorders. There is now moderate level evidence that rehabilitation is efficient to improve postural capacities of patients with cerebellar ataxia - particularly in patients with degenerative ataxia or multiple sclerosis. Intensive rehabilitation programs with balance and coordination exercises are necessary. Although techniques such as virtual reality, biofeedback, treadmill exercises with supported bodyweight and torso weighting appear to be of value, their specific efficacy has to be further investigated. Drugs have only been studied in degenerative ataxia, and the level of evidence is low. There is now a need for large, randomized, controlled trials testing rehabilitation programs suited to postural and gait disorders of patients with cerebellar ataxia. (C) 2014 Elsevier Masson SAS. All rights reserved.