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Challenge-Oriented Gait and Balance Training in Sporadic Olivopontocerebellar Atrophy: A Case Study

Landers, Merrill DPT, OCS; Adams, Melissa DPT, ATC, CSCS; Acosta, Keri DPT; Fox, Andrew DPT

Journal of Neurologic Physical Therapy: September 2009 - Volume 33 - Issue 3 - pp 160-168
doi: 10.1097/NPT.0b013e3181b511f4
Case Reports

Background and Purpose: Sporadic olivopontocerebellar atrophy (OPCA) is a rare and debilitating neurologic disease of insidious onset. It is characterized by atrophy of the cerebellum, pons, and inferior olivary nuclei with concomitant ambulation deficits and dyscoordination. To our knowledge, there has been no published study investigating any aspect of rehabilitation in OPCA. Therefore, the purpose of this study was to investigate the use of challenge-oriented gait and balance training to improve gait and balance in OPCA.

Case Description: An otherwise healthy 19-year-old woman with moderate to severe upper and lower extremity ataxia, secondary to sporadic OPCA, participated in this prospective case study. She also had a vestibulotoxic treatment procedure to decrease the severity of her vertigo.

Intervention: This individual participated in a 12-week gait and balance training program (five times per week), which consisted of one to two hours of various challenging static and dynamic balance tasks. To measure her progress, the following scales and tests were used: Berg Balance Scale, Dynamic Gait Index, Activities-Specific Balance Confidence Scale, computerized dynamic posturography (sensory organization test and limits of stability), and self-selected gait velocity.

Outcomes: Improvements were noted in all the dependent measures (pre to post): Berg Balance Scale (34/56 to 39/56), Dynamic Gait Index (1/24 to 7/24), Activities-Specific Balance Confidence Scale (50.6%-85.1%), sensory organization test (composite score, 31/100 to 47/100), limits of stability (maximum excursion, 89-105; endpoint excursion, 57-93; directional control, 60-78), and SSGV (0.375-0.526 m/sec).

Discussion: Results from this case study suggest that a gait and balance training program may be beneficial to individuals with ataxia from OPCA. This early evidence warrants further investigation using more rigorous methods.

Department of Physical Therapy (M.L.), University of Nevada, Las Vegas, Las Vegas, Nevada; Muir Orthopaedic Specialists Physical Therapy (M.A.), 350 John Muir Parkway, Brentwood, California; Sharp Memorial Hospital (K.A.), San Diego, California; Kelly Hawkins PT Works (A.F.), 921 S. Highway 160 Suite 409, Pahrump, Nevada.

Address correspondence to: M. Landers, E-mail:

© 2009 Academy of Neurologic Physical Therapy, APTA