Editing Ataxia (section)

== Treatment ==
The treatment of ataxia and its effectiveness depend on the underlying cause. Treatment may limit or reduce the effects of ataxia, but it is unlikely to eliminate them entirely. Recovery tends to be better in individuals with a single focal injury (such as [[stroke]] or a [[benign tumour]]), compared to those who have a neurological degenerative condition.<ref name="can rehabilitation help">{{cite journal | vauthors = Morton SM, Bastian AJ | title = Can rehabilitation help ataxia? | journal = Neurology | volume = 73 | issue = 22 | pages = 1818–1819 | date = December 2009 | pmid = 19864635 | doi = 10.1212/WNL.0b013e3181c33b21 | s2cid = 5481310 }}</ref> A review of the management of degenerative ataxia was published in 2009.<ref name="systematic review">{{cite journal | vauthors = Trujillo-Martín MM, Serrano-Aguilar P, Monton-Alvarez F, Carrillo-Fumero R | title = Effectiveness and safety of treatments for degenerative ataxias: a systematic review | journal = Movement Disorders | volume = 24 | issue = 8 | pages = 1111–1124 | date = June 2009 | pmid = 19412936 | doi = 10.1002/mds.22564 | s2cid = 11008654 }}</ref> A small number of rare conditions presenting with prominent cerebellar ataxia are amenable to specific treatment and recognition of these disorders is critical. Diseases include vitamin E deficiency, abetalipoproteinemia, cerebrotendinous xanthomatosis, Niemann–Pick type C disease, Refsum's disease, glucose transporter type 1 deficiency, episodic ataxia type 2, gluten ataxia, glutamic acid decarboxylase ataxia.<ref>{{cite journal | vauthors = Ramirez-Zamora A, Zeigler W, Desai N, Biller J | title = Treatable causes of cerebellar ataxia | journal = Movement Disorders | volume = 30 | issue = 5 | pages = 614–623 | date = April 2015 | pmid = 25757427 | doi = 10.1002/mds.26158 | s2cid = 9560460 }}</ref> Novel therapies target the RNA defects associated with cerebellar disorders, using in particular anti-sense oligonucleotides.<ref>{{cite journal | vauthors = Manto M, Gandini J, Feil K, Strupp M | title = Cerebellar ataxias: an update | journal = Current Opinion in Neurology | volume = 33 | issue = 1 | pages = 150–160 | date = February 2020 | pmid = 31789706 | doi = 10.1097/WCO.0000000000000774 | s2cid = 208538266 }}</ref>

The movement disorders associated with ataxia can be managed by pharmacological treatments and through [[physical therapy]] and [[occupational therapy]] to reduce [[disability]].<ref name="pmid17000340">{{cite journal | vauthors = Perlman SL | title = Ataxias | journal = Clinics in Geriatric Medicine | volume = 22 | issue = 4 | pages = 859–77, vii | date = November 2006 | pmid = 17000340 | doi = 10.1016/j.cger.2006.06.011 }}</ref> Some drug treatments that have been used to control ataxia include: [[5-hydroxytryptophan]] (5-HTP), [[idebenone]], [[amantadine]], [[physostigmine]], [[L-carnitine]] or derivatives, [[trimethoprim/sulfamethoxazole]], [[vigabatrin]], [[phosphatidylcholine]], [[acetazolamide]], [[4-aminopyridine]], [[buspirone]], and a combination of [[coenzyme Q10|coenzyme Q<sub>10</sub>]] and [[vitamin E]].<ref name="systematic review"/>

[[Physical therapy]] requires a focus on adapting activity and facilitating [[motor learning]] for retraining specific functional motor patterns.<ref name="Intensive coordinative training improves motor performance in degenerative cerebellar disease">{{cite journal | vauthors = Ilg W, Synofzik M, Brötz D, Burkard S, Giese MA, Schöls L | title = Intensive coordinative training improves motor performance in degenerative cerebellar disease | journal = Neurology | volume = 73 | issue = 22 | pages = 1823–1830 | date = December 2009 | pmid = 19864636 | doi = 10.1212/WNL.0b013e3181c33adf | s2cid = 2087750 }}</ref> A recent systematic review suggested that physical therapy is effective, but there is only moderate evidence to support this conclusion.<ref name="pmid19114434">{{cite journal | vauthors = Martin CL, Tan D, Bragge P, Bialocerkowski A | title = Effectiveness of physiotherapy for adults with cerebellar dysfunction: a systematic review | journal = Clinical Rehabilitation | volume = 23 | issue = 1 | pages = 15–26 | date = January 2009 | pmid = 19114434 | doi = 10.1177/0269215508097853 | s2cid = 25458915 }}</ref> The most commonly used physical therapy interventions for cerebellar ataxia are vestibular habituation, [[Frenkel exercises]], [[proprioceptive neuromuscular facilitation]] (PNF), and balance training; however, therapy is often highly individualized and gait and coordination training are large components of therapy.<ref>{{cite journal | vauthors = Schatton C, Synofzik M, Fleszar Z, Giese MA, Schöls L, Ilg W | title = Individualized exergame training improves postural control in advanced degenerative spinocerebellar ataxia: A rater-blinded, intra-individually controlled trial | language = English | journal = Parkinsonism & Related Disorders | volume = 39 | pages = 80–84 | date = June 2017 | pmid = 28365204 | doi = 10.1016/j.parkreldis.2017.03.016 }}</ref>

Current research suggests that, if a person is able to walk with or without a [[mobility aid]], physical therapy should include an exercise program addressing five components: static balance, dynamic balance, trunk-limb coordination, stairs, and [[contracture]] prevention. Once the physical therapist determines that the individual is able to safely perform parts of the program independently, it is important that the individual be prescribed and regularly engage in a supplementary home exercise program that incorporates these components to further improve long term outcomes. These outcomes include balance tasks, gait, and individual activities of daily living. While the improvements are attributed primarily to changes in the brain and not just the hip or ankle joints, it is still unknown whether the improvements are due to adaptations in the cerebellum or compensation by other areas of the brain.<ref name="Intensive coordinative training improves motor performance in degenerative cerebellar disease"/>

Decomposition, simplification, or slowing of multijoint movement may also be an effective strategy that therapists may use to improve function in patients with ataxia.<ref name="pmid9184691">{{cite journal | vauthors = Bastian AJ | title = Mechanisms of ataxia | journal = Physical Therapy | volume = 77 | issue = 6 | pages = 672–675 | date = June 1997 | pmid = 9184691 | doi = 10.1093/ptj/77.6.672 | doi-access = free }}</ref> Training likely needs to be intense and focused—as indicated by one study performed with stroke patients experiencing limb ataxia who underwent intensive upper limb retraining.<ref name="stroke ataxia">{{cite journal | vauthors = Richards L, Senesac C, McGuirk T, Woodbury M, Howland D, Davis S, Patterson T | title = Response to intensive upper extremity therapy by individuals with ataxia from stroke | journal = Topics in Stroke Rehabilitation | volume = 15 | issue = 3 | pages = 262–271 | year = 2008 | pmid = 18647730 | doi = 10.1310/tsr1503-262 | s2cid = 207260777 }}</ref> Their therapy consisted of [[constraint-induced movement therapy]] which resulted in improvements of their arm function.<ref name="stroke ataxia" /> Treatment should likely include strategies to manage difficulties with everyday activities such as walking. Gait aids (such as a cane or walker) can be provided to decrease the risk of falls associated with impairment of [[Balance (ability)|balance]] or poor [[Motor coordination|coordination]]. Severe ataxia may eventually lead to the need for a [[wheelchair]]. To obtain better results, possible coexisting motor deficits need to be addressed in addition to those induced by ataxia. For example, muscle weakness and decreased endurance could lead to increasing fatigue and poorer movement patterns.{{citation needed|date=August 2021}}

There are several assessment tools available to therapists and health care professionals working with patients with ataxia. The [[International Cooperative Ataxia Rating Scale]] (ICARS) is one of the most widely used and has been proven to have very high reliability and validity.<ref>{{cite journal | vauthors = Schmitz-Hübsch T, Tezenas du Montcel S, Baliko L, Boesch S, Bonato S, Fancellu R, Giunti P, Globas C, Kang JS, Kremer B, Mariotti C, Melegh B, Rakowicz M, Rola R, Romano S, Schöls L, Szymanski S, van de Warrenburg BP, Zdzienicka E, Dürr A, Klockgether T | title = Reliability and validity of the International Cooperative Ataxia Rating Scale: a study in 156 spinocerebellar ataxia patients | journal = Movement Disorders | volume = 21 | issue = 5 | pages = 699–704 | date = May 2006 | pmid = 16450347 | doi = 10.1002/mds.20781 | s2cid = 28633679 }}</ref> Other tools that assess motor function, balance and coordination are also highly valuable to help the therapist track the progress of their patient, as well as to quantify the patient's functionality. These tests include, but are not limited to:
* The [[Berg Balance Scale]]
* Tandem Walking (to test for [[Tandem gait]]ability)
* Scale for the Assessment and Rating of Ataxia (SARA)<ref name="pmid16769946">{{cite journal | vauthors = Schmitz-Hübsch T, du Montcel ST, Baliko L, Berciano J, Boesch S, Depondt C, Giunti P, Globas C, Infante J, Kang JS, Kremer B, Mariotti C, Melegh B, Pandolfo M, Rakowicz M, Ribai P, Rola R, Schöls L, Szymanski S, van de Warrenburg BP, Dürr A, Klockgether T, Fancellu R | title = Scale for the assessment and rating of ataxia: development of a new clinical scale | journal = Neurology | volume = 66 | issue = 11 | pages = 1717–1720 | date = June 2006 | pmid = 16769946 | doi = 10.1212/01.wnl.0000219042.60538.92 | s2cid = 24069559 }}</ref>
* tapping tests – The person must quickly and repeatedly tap their arm or leg while the therapist monitors the amount of [[dysdiadochokinesia]].<ref name="Notermans_1994">{{cite journal | vauthors = Notermans NC, van Dijk GW, van der Graaf Y, van Gijn J, Wokke JH | title = Measuring ataxia: quantification based on the standard neurological examination | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 57 | issue = 1 | pages = 22–26 | date = January 1994 | pmid = 8301300 | pmc = 485035 | doi = 10.1136/jnnp.57.1.22 }}</ref>
* [[finger-nose testing]]<ref name="Notermans_1994"/> – This test has several variations including finger-to-therapist's finger, finger-to-finger, and alternate nose-to-finger.<ref name="urlOPETA: Neurologic Examination">{{cite web|url=http://medinfo.ufl.edu/other/opeta/neuro/NE_ch3.html |title=OPETA: Neurologic Examination |work=Online physical exam teaching assistant |publisher=The UF College of Medicine Harrell Center |access-date=7 May 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120318005424/http://medinfo.ufl.edu/other/opeta/neuro/NE_ch3.html |archive-date=18 March 2012}}</ref>