Objective: To evaluate the effectiveness of an intensive multidisciplinary rehabilitation program in patients with spinocerebellar ataxia.

Background: Spinocerebellar ataxias (SCAs) cause significant motor impairment, affecting independence and quality of life (1). No pharmacological treatment has proven effective in improving clinical outcomes or modifying disease progression. Evidence suggests that motor training and exergames may slow disease progression (2-4), with a correlation between exercise intensity and SARA score reduction (5).

Method: A blinded, randomized clinical trial was conducted, including individuals over the age of 18 with a confirmed SCA diagnosis and a SARA gait score <7. Exclusion criteria included clinical contraindications, unavailability for rehabilitation, MMSE <24/30, and attendance <80%. Participants were divided into an immediate intervention group and a delayed intervention control group. The rehabilitation program consisted of two-hour sessions three times per week for four weeks, including balance and coordination training, exergames, and strength training exercises. A home exercise manual was provided for continued training. Participants were assessed at baseline and after four weeks using the Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale, Falls Efficacy Scale (FES-I), Timed Up and Go test, 36-Item Short-Form Health Survey (SF-36), static balance assessment, gait parameters, and isometric strength testing.

Results: Of the forty-six individuals initially recruited, ten were excluded, resulting in a final sample of 36 patients. SCA3 was the most common type (91%), with a mean symptom duration of 10.6 years and a mean SARA score of 10.6. No significant differences were found between groups at baseline. In the immediate intervention group, comparisons between baseline and week five showed a 0.8-point reduction in SARA, a 1.4-point increase in the Berg Balance Scale, and a 2.2-point reduction in FES-I. Significant improvements were observed in knee extension, elbow flexion strength, and the six-minute walk test. Between-group comparisons showed significant improvements in lower limb strength and gait parameters at weeks one and four.

Conclusion: Intensive rehabilitation may improve clinical and functional parameters in patients with SCA. Long-term follow-up is needed to assess sustained benefits.

References: 1. Oliveira LAS, Rodrigues EDC, Sancho AG, Mainenti MRM, Vigário PDS, Lopes AJ, et al. Functional capacity, cardiorespiratory fitness and quality of life in spinocerebellar ataxia: Implications for rehabilitation. European Journal of Physiotherapy. 2015;17(4):176-82.
2. Lanza G, Casabona JA, Bellomo M, Cantone M, Fisicaro F, Bella R, et al. Update on intensive motor training in spinocerebellar ataxia: time to move a step forward? J Int Med Res. 2020;48(2):300060519854626.
3. Synofzik M, Ilg W. Motor training in degenerative spinocerebellar disease: ataxia-specific improvements by intensive physiotherapy and exergames. Biomed Res Int. 2014;2014:583507.
4. Milne SC, Corben LA, Georgiou-Karistianis N, Delatycki MB, Yiu EM. Rehabilitation for Individuals With Genetic Degenerative Ataxia: A Systematic Review. Neurorehabil Neural Repair. 2017;31(7):609-22.
5. Ilg W, Brotz D, Burkard S, Giese MA, Schols L, Synofzik M. Long-term effects of coordinative training in degenerative cerebellar disease. Mov Disord. 2010;25(13):2239-46.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-an-intensive-multidisciplinary-rehabilitation-program-on-patients-with-spinocerebellar-ataxia/