S11-4. Efficacy and its neural mechanisms of neurorehabilitation for ataxic gait

Abstract

In degenerative cerebellar diseases, it is unclear whether patients can relearn motor sequences required for activities of daily living (ADLs) after neurorehabilitation since the cerebellum plays a crucial role in motor learning. It is also unknown whether functional gain can be sustained for a long period because of the progressive nature of the diseases. Thus Cerebellar Ataxia Rehabilitation (CAR) trial tested if intensive rehabilitation improved ataxia, gait and ADLs in 42 patients with degenerative cerebellar diseases. Intensive rehabilitation comprising 1-h physical and 1-h occupational therapy for 4 weeks significantly improved ataxia, gait speed and ADLs than control. The improvements in ataxia and gait speed were sustained at 12 weeks and 24 weeks after the intervention, respectively (Miyai I et al. Neurorehabil Neural Repair 2012;26:515–22). Neural mechanisms underlying functional improvement remain to be elucidated. Functional near-infrared spectroscopy studies have implied that recruitment of the prefrontal cortex and supplementary motor area are involved in improvement of gait and balance function as well as motor learning in patients with cerebellar damage (Mihara M et al. NeuroImage 2007;37:1338–45, Mihara M et al. NeuroImage 2008:43:329–33, Mihara M et al. NeuroReport 2012;23:314–19, Hatakenaka H et al. Neurorehabil Neural Repair 2012;26:293–300).