OCCUPATIONAL THERAPY FOR MANAGEMENT OF ATAXIA

Bridgett Piernik-Yoder, PhD, OTRUT Health Science Center at San AntonioDepartment of Occupational Therapy

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The information provided by speakers in any presentation made as part of the 2012 NAF Annual Membership Meeting is for informational use only.

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OVERVIEW

Current evidence for rehabilitation intervention in the management of ataxia

Role of OT Intervention approaches

Can rehabilitation intervention help ataxia?

CHALLENGES IN RESEARCH

Ataxia results from a range of conditions

Rehabilitation interventions for neuromuscular conditions often address motor learning

Therapeutic gains may be mitigated by changes in a person’s condition

Variability in ataxia may make it difficult to control for differences

EVIDENCE TO SUPPORT REHABILITATION 16 patients with degenerative cerebellar ataxia Participated in a 4-week therapy program,

followed by 8-week home program Experienced improvements in motor control and

reduction of ataxia symptoms Found those who maintained home program

were more likely to retain gains Therapy may result in gains but continuous

therapy may be most beneficial

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

EVIDENCE TO SUPPORT REHABILITATION 3 individuals with ataxia from stroke Completed a modified constraint-induced

movement therapy protocol (CIMT) Participants improved on several outcome

measures Specific measures of reach Reported increased use of upper extremity

Intense motor therapy may be beneficial for some

Richards, L., Senesac, C., McGuirk, T., Woodbury, M., Howland, D., Davis, S., Patterson, T. (2008). Response to intensive upper extremity therapy by individuals with ataxia from stroke. Topics in stroke rehabilitation, 15(3), 262 – 271.

EVIDENCE TO SUPPORT REHABILITATION Examined outcome of postural training with

an individual with ataxia due to stroke Received four weeks of neuromuscular

postural control intervention by an OT Participant improved function of ataxic

upper extremity yet still required assistance for all ADLs

Addressing postural control may be beneficial for some

Stoykov, M. Stojakovich, M., Stevens, J. (2005). Beneficial effects of postural intervention on prehensile action for an individual with ataxia resulting from brainstem stroke. Neurorehabilitation, 20(2), 85 – 89.

WHAT DOES IT MEAN? Intensive therapy has potential to

improve motor function in some with ataxia

Mechanism for improvements is not clear Create alternative neural pathways to better

control movement Rely on residual function Non-specific therapeutic gains

Does clinical function translate to functional gains?

OCCUPATIONAL THERAPY INTERVENTION Focus is dependent on goals of the client Typical physical challenges

Decreased strength and endurance Decreased proximal strength Difficulty with multi-joint movements

Typical functional challenges Home management tasks Driving Work and leisure occupations

OCCUPATIONAL THERAPY INTERVENTION

Address skills to support function

Daily “occupatio

ns”

Adapt the task to support function

Adapt the environme

nt to support function

Systems model of motor control

OCCUPATIONAL THERAPY INTERVENTION

Skills

• Strength• Activity tolerance or endurance

Task

• Change the requirements of the task

• Adaptive equipment

Environmen

t

• Adaptations• Social supports

OCCUPATIONAL THERAPY INTERVENTION Addressing physical

aspects Addressing task

performance Utilizing adaptive

equipment Modifying the

environment

OT - CASE EXAMPLE

42 year-old female with ataxia resulting from MS Pharmacological tx dampened magnitude of tremors Identified self-care skills as greatest area of concern

Feeding – max assistance - UE, head and neck tremors worsen when bringing food or utensil to mouth

Grooming – max assistance Bathing – max assist Home management – difficulty with meal prep, dialing

home phone Dressing – satisfied with performance, had adapted style

of clothing over time

OT - CASE EXAMPLE

More difficulty with tasks that required multi-joint control

Strategies Sliding hand across a surface to reach an

object rather than reaching in space Using a high-backed, firm chair during self-

care activities Resting elbow on table or counter for support Stabilizing upper extremities against trunk or

chin for activities that required hand function

OT - CASE EXAMPLE

Strategies Use of orthotics or wrist supports during self-care Use of a tub bench with back support improved

stability and conserved energy Use of a bathing mitt and sliding mitt over body

parts Use of electric toothbrush reduced motor

requirements Use of an adaptive cutting board to assist with

meal preparation Started exclusively using a mobile phone with

voice-dial

OT - CASE EXAMPLE

Symptoms related to ataxia did not change

Focus of OT was environmental and adaptive strategies Positioning Movement patterns Maximizing limb stability Adaptive equipment

SUMMARY

Research shows that therapy can be beneficial in addressing some aspects of motor control

Focus of OT intervention is function OT will address skills, task

requirements, environment Strategies will be aimed at supporting

function, or daily “occupations”

Questions, Comments, or Suggestions

Contact:piernikyoder@uthscsa.edu210-567-8889