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Bridgett Piernik-Yoder, PhD, OTR UT Health Science Center at San Antonio Department of Occupational Therapy. OCCUPATIONAL Therapy for Management of Ataxia.

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Presentation Transcript
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Bridgett Piernik-Yoder, PhD, OTR

UT Health Science Center at San Antonio

Department of Occupational Therapy

OCCUPATIONAL Therapy for Management of Ataxia

disclaimer

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

  • NAF encourages all attendees to consult with their primary care provider, neurologist, or other health care provider about any advice, exercise, therapies, medication, treatment, nutritional supplement, or regimen that may have been mentioned as part of any presentation.
  • Products or services mentioned during these presentations does not imply endorsement by NAF.
  • I have no personal financial relationships with commercial interests relevant to this presentation to disclose
Disclaimer
overview

Current evidence for rehabilitation intervention in the management of ataxia

Role of OT

Intervention approaches

Overview
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

Challenges In RESEARCH
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
evidence to support rehabilitation1

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
evidence to support rehabilitation2

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.

Evidence TO SUPPORT rehabilitation
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?
What Does it mean?
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
occupational therapy intervention1
Occupational Therapy intervention

Systems model of motor control

occupational therapy intervention3
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
ot case example1

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
ot case example2

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
ot case example3

Symptoms related to ataxia did not change

  • Focus of OT was environmental and adaptive strategies
    • Positioning
    • Movement patterns
    • Maximizing limb stability
    • Adaptive equipment
OT - CASE EXAMPLE
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”

Summary
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Questions, Comments, or Suggestions

Contact:

piernikyoder@uthscsa.edu

210-567-8889