Transcript OCCUPATIONAL Therapy for Management of Ataxia

Bridgett Piernik-Yoder, PhD, OTR
UT Health Science Center at San Antonio
Department of Occupational Therapy
OCCUPATIONAL THERAPY FOR
MANAGEMENT OF ATAXIA
DISCLAIMER
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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
OVERVIEW
Current evidence for rehabilitation intervention
in the management of ataxia
 Role of OT
 Intervention approaches
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Can rehabilitation intervention
help ataxia?
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
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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
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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
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
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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
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
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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.
WHAT DOES IT MEAN?
Intensive therapy has potential to improve
motor function in some with ataxia
 Mechanism for improvements is not clear
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 Create
alternative neural pathways to better control
movement
 Rely on residual function
 Non-specific therapeutic gains
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Does clinical function translate to functional
gains?
OCCUPATIONAL THERAPY INTERVENTION
Focus is dependent on goals of the client
 Typical physical challenges
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 Decreased
strength and endurance
 Decreased proximal strength
 Difficulty with multi-joint movements
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Typical functional challenges
 Home
management tasks
 Driving
 Work and leisure occupations
OCCUPATIONAL THERAPY INTERVENTION
Systems model of motor control
Adapt the
environment
to support
function
Address skills
to support
function
Daily
“occupations”
Adapt the task
to support
function
OCCUPATIONAL THERAPY INTERVENTION
Skills
•Strength
•Activity tolerance or endurance
Task
•Change the requirements of the task
•Adaptive equipment
Environment
•Adaptations
•Social supports
OCCUPATIONAL THERAPY INTERVENTION
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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
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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
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OT - CASE EXAMPLE
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More difficulty with tasks that required multi-joint
control
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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
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Strategies
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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 voicedial
OT - CASE EXAMPLE
Symptoms related to ataxia did not change
 Focus of OT was environmental and adaptive
strategies
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 Positioning
 Movement
patterns
 Maximizing limb stability
 Adaptive equipment
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”
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Questions, Comments, or Suggestions
Contact:
[email protected]
210-567-8889