Intensive coordinative training improves motor performance in degenerative cerebellar disease
Intensive coordinative training improves motor performance in degenerative cerebellar disease
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DOI：
10.1212/wnl.0b013e3181c33adf
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发表时间：
2009-12-01
期刊：
影响因子：
9.9
通讯作者：
Schoels, L.
中科院分区：
文献类型：
--
作者：
Ilg, W.;Synofzik, M.;Schoels, L.
目的：小脑在运动控制和运动学习中起着重要的功能作用。因此，物理治疗训练对小脑变性患者的益处仍然存在争议。在这项研究中，我们对16例因小脑变性（n = 10）或传入通路变性（n = 6）导致的进行性共济失调患者进行了为期4周的强化协调训练。方法：采用临床共济失调评定量表、个体目标实现评分和定量运动分析来评估效果。进行4项评估：训练前8周、训练前8周、训练后8周、训练后8周。为了控制疾病进展的可变性，我们采用了个体内部控制设计，比较训练前后的表现变化。结果：在训练后的临床评分中观察到运动表现的显著改善和共济失调症状的减轻，并在随访评估中持续。以小脑性共济失调为主的患者比传入性共济失调的患者在步态速度、侧摆和肢体内协调等几个方面有更明显的改善。与此一致的是，在没有传入共济失调的小脑患者中，静态和动态平衡任务的平衡调节显著改善。结论：在小脑性共济失调患者中，协调训练可以改善运动表现，减轻共济失调症状，使他们能够在日常生活中实现个人有意义的目标。传入通路未受影响的患者的训练效果更为明显。对于这两组人来说，持续的训练似乎对稳定的改善至关重要，应该成为标准的护理。证据水平：本研究提供了III级证据，表明协调训练可以改善进行性小脑性共济失调患者的运动表现并减轻共济失调症状。神经病学(R) 2009；73: 1823 - 1830
Objectives: The cerebellum is known to play a strong functional role in both motor control and motor learning. Hence, the benefit of physiotherapeutic training remains controversial for patients with cerebellar degeneration. In this study, we examined the effectiveness of a 4-week intensive coordinative training for 16 patients with progressive ataxia due to cerebellar degeneration (n = 10) or degeneration of afferent pathways (n = 6).Methods: Effects were assessed by clinical ataxia rating scales, individual goal attainment scores, and quantitative movement analysis. Four assessments were performed: 8 weeks before, immediately before, directly after, and 8 weeks after training. To control for variability in disease progression, we used an intraindividual control design, where performance changes with and without training were compared.Results: Significant improvements in motor performance and reduction of ataxia symptoms were observed in clinical scores after training and were sustained at follow-up assessment. Patients with predominant cerebellar ataxia revealed more distinct improvement than patients with afferent ataxia in several aspects of gait like velocity, lateral sway, and intralimb coordination. Consistently, in patients with cerebellar but without afferent ataxia, the regulation of balance in static and dynamic balance tasks improved significantly.Conclusion: In patients with cerebellar ataxia, coordinative training improves motor performance and reduces ataxia symptoms, enabling them to achieve personally meaningful goals in everyday life. Training effects were more distinct for patients whose afferent pathways were not affected. For both groups, continuous training seems crucial for stabilizing improvements and should become standard of care.Level of evidence: This study provides Class III evidence that coordinative training improves motor performance and reduces ataxia symptoms in patients with progressive cerebellar ataxia. Neurology (R) 2009; 73: 1823-1830